Getting Emergency Department Nurses to do Bedside Handoff
Janet Heath and Jennifer Rambo
Purpose of Project
The purpose of this Quality Improvement Project is to increase awareness and
educate Emergency Department nurses about the importance of bedside
handoffs. Since it is not being practiced in the department, emphasis was
placed on how evidence validates improved patient safety resulting in better
patient outcomes when bedside reporting is put into effect. The goal is to
improve compliance and to increase awareness regarding the advantages of
engaging in bedside reporting. It has been proven to decrease adverse events,
as well as, encouraging communication between staff members. Studies have
shown that .good communication also increases satisfaction of patients and
their family members and decreases error, ensuring safe passage for patients
(Rogers, Li, Clements, Casperson, & Sifri, 2017, p. 105).
Aim of Study
The Aim of this study is to improve the compliance of bedside shift exchange
between incoming and outgoing nurses in the Emergency Department to >90%
by July 14, 2017. Transforming Care at the Bedside (TCAB) was a national
initiative developed by the Robert Wood Johnson Foundation in collaboration
with the Institute of Healthcare Improvement (IHI) that ran from 2003 through
2008 ("TCAB," 2011, p. 328). This initiative alone, along with additional
research has proven that successful implementation of bedside handoff
contributes to the global aim of patient safety and satisfaction.
Method
Data analysis was obtained by observation of nurses in the emergency department
giving bedside report prior to the initiation of the Quality Improvement Project. Two days
after the project was implemented, measurements were obtained once more by the same
method. Results were compared using percentages with pie charts.
Education and emphasis on the importance of bedside reporting was communicated to
the staff nurses during Huddles, providing information regarding the correlation
between evidence based practice and positive outcomes related to bedside handoffs.
Initially, the staff was introduced to the concept during Huddle. Awareness of the
expectation was discussed and the initiative was accepted. Additionally, the Project and
Unit Coordinators reinforced implementation of bedside reporting during Huddle for the
duration of the project.
Laminated, bright, yellow signs were placed near and around the nurses station as a
reminder to do bedside reporting with the catchy phrase to pass it on, shift to shift,
ensure a safe handoff, take it to the bedside (Rambo, 2017).
Pass if on,
shift to shift,
ensure a safe
hand-off, take
it to the
bedside
Bon Secours Memorial College of Nursing
Synthesis in Nursing Practice
NUR 4242
W. Liverman
PDSA Before & After
Plan
The long term plan is to transition to bedside
hand-off for 100% of all nurse to nurse hand-offs.
The plan for the first cycle of this PSDA cycle is to
give an in-service during our daily huddles. This
will introduce the staff to the concept and make
them aware of what is expected of them. The
importance of bedside hand-off will be discussed.
Evidence based practice research will be
available for staff to read .
Study
Some nurses will resist changing to bedside hand-
off. Do
Due to limited time and resources, it would be We will plan to observe nurse hand-off for 4 days
difficult to obtain adequate results. throughout the weeks of June 30th through July
Overlap of assignments will result in prolonged 14th.
length of time to start report to oncoming nurses.
Some nurses adapt well to bedside reporting.
Act
The next PSDA cycle will involve a larger section
of the emergency room. It will include feedback
from the nurses on what works best for them, what
are the obstacles they face that prevents them
from participating in bedside handoff, and receive
feedback about what the unit could do to help Baseline data was observed prior to the start of the project. It was determined
improve compliance.
that 85% of the time nurses did not engage in bedside hand-off. On day 2, after
the implementation of the Bedside Handoff Quality Improvement Project, we
observed a significant increase in bedside hand off. Bedside hand-off
increased to 75% during a 24 hour observation window. We can predict, that
with further education and reinforcement we can get that number to improve to
greater than 95% nurse to nurse hand-off at the bedside.
Conclusions
Improved patient outcomes were not seen in the short period of time during this
project. However, research shows that when patients are engaged in their
health care, it can lead to measurable improvements in safety and the quality of
care received. The agency of healthcare research and quality (AHRQ) stated
that research shows that when patients are engaged in their health care, it References:
can lead to measurable improvements in safety and quality ("AHRQ," 2013, Agency for healthcare research & quality. 2013, June). Strategy 3: nurse bedside shift
para. 7). report agency for healthcare research & quality. Retrieved July17,
2017fromhttp://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/stratgy
3/index.html
Rambo, J. (2017). Pass It On Star. Richmond, VA.
Rogers, J., Li, R., Clements, R., Casperson, S., & Sifri, C. (2017, April). Can
We Talk? The bedside report project. Critical Care Nurse, 37(2), 104-107.
http://dx.doi.org/10.4037/ccn2017369
Strategy 3: Nurse Bedside Shift Report. (2013). Retrieved from
https://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/strategy3/index.
html
Transforming Care at the Bedside. (2011). Retrieved from
http://www.ihi.org/Engage/Initiatives/Completed/TCAB