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Bedside Report: Nursing Handoffs Impact Outcomes for Caregivers, Healthcare Providers, and Organizations Margaret A. Gettis, DNP, CPNP-PC ! Betsy Dye, MSN, RN, CPN ! Calvin Williams, MSN, RN ! Brenna Frankish, MSN, RN, CPN ! Beverly Alvarez, BSN, RN, CPN

This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning and implementation of EBP principles and processes by clini- cians as well as nursing and interprofessional students. Guidelines for submission are available at http://onlin elibr ary.wiley.com/journ al/10.1111/(ISSN)1741-6787.

BACKGROUND A large pediatric healthca re org anization is undergo ing transformation to align nur sing c are with scientific evi- dence supporting its functi on (Ch ildren’s Healthcar e of Atlanta, 2017). Nurses are gi ven opportunities to attend evidence-based practice (EBP) academy to enculturate this change. Recent participating nurses recognized the critical importance of standardized transfer of care to impact pa- tient safety. The management of the three hospital system agreed no consensus existed about best practice for nurs- ing report when transferring care to the next shift. Also noted was a lack of family participation with the hea lth- care team’s process.

Broad variation existed with transfer of care execu- tion and reporting locations. Incoming nurses would gather with outgoing nurses for change in shift report at the nurses’ station, available computers, or open spaces. Complicating things further, the sanctioned Situation, Background, Assessment, Recommendation (SBAR) re- porting tool was used inconsistently. Some reported using the format, while others recalled the day’s events from memory, the electronic medical record, or the personalized sheets. Nursing leadership verbalized concern that critical patient information could be missed, and private protected health information could be overheard inappropriately. For example, three general care units all employed different methodologies. Average patient satisfaction scores in the Hospital Consumer Assessment of Healthcare Providers and Systems survey question, “How often did your child’s nurse explain things in a way that was easy to understand,” were 82.7%, 85.7%, and 87.3%, respectively. Scores to the question, “the nurse listened carefully to the parent,” var- ied from 84.6%, 89.1%, and 76.4%. Given the lack of stan- dardized approach and potential relationship with nursing

satisfaction scores, alignment of bedside report was identi- fied as a critical initiative across the system.

POPULATION INTERVENTION COMPARISION OUTCOME Academy nurses posed the question: “For pediatric pa- tients and families, how does transfer of nursing care at the bedside compared to current practices impact safety and satisfaction?”

SEARCH STRATEGY The nurses worked collaboratively, completing a literature review. Databases searched are as follows: PubMed, CINAHL, and OVID for the years 2010-2017 yielded 221 articles. Key search terms were as follows: nursing report/handoff, care transfer, multidisciplinary rounds, and bedside handover. Refined searching used the following: nursing AND bed- side AND report. Twenty-five articles selected represented the current state of science. Nurses appraised each article, synthesizing the evidence into a literature summary table. The literature summary table and accompanying recommen- dations for a new bedside shift report were communicated to nursing leadership at a culminating event for academy graduates.

CRITICAL APPRAISAL OF THE EVIDENCE Identified by the Institute of Medicine, Joint Commission, and the Agency for Healthcare Research and Quality (2013), the evidence-based findings are clear: bedside shift report is best practice using standardized reporting tools and for- matting (Vines, Dupler, Vanson, & Guido, 2014). Uniform

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transfer of care at the bedside can decrease medication er- rors, limit interruptions, and provide opportunity for the pa- tient or family to correct misconceptions or misinformation promoting patient safety (Mardis et al., 2015). According to several studies, implementation of consistent care handoff procedures can reduce overtime as nurses remain focused solely on patients while giving the report (Carnes, Dudjak, Hoffman, & Lorenz, 2013; Tidwell et al., 2011).

INTEGRATION OF EVIDENCE WITH CLINICAL EXPERTISE AND PATIENT PREFERENCES; CLINICAL DECISION AND IMPLEMENTATION OF PRACTICE CHANGE Academy nurses formulated the following recommenda- tions to improve bedside shift report:

1. Perform bedside report between incoming and outgoing nurses at each shift, executing transfer of care utilizing SBAR reporting exclusively.

2. Modify SBAR reporting with “S” (sensitive-situa- tion-social) and “B” (background) information given outside the patient’s room in a private area. Completion of “A” (assessment) and “R” (recom- mendations) occurring inside the patient’s room with patient or family present to share informa- tion and answer questions.

3. Engage stakeholders and pilot the process on three general care units at two hospitals.

IMPLEMENTATION Prior to piloting, a survey was given on the units to assess perceptions of current shift change reporting. Perceptions were examined and discussed by unit leaders. Core teams formed to role-play the new format allowing these mem- bers to serve as role models to staff. Nurse forums allowed staff to learn specifics about rollout, ask questions, and practice the new reporting structure. The “Go Live” for unit implementation started in May 2017. All nurses in the pilot units began assimilating and executing the new process at the bedside with EBP Academy nurses’ support and encour- agement. These nurses were able to offer feedback about successes and challenges to their colleagues in real time. Based on feedback, the pilot was successful and rollout to other units progressed smoothly.

OUTCOMES Nursing leadership expected some resistance by clini- cal staff to changes in transfer of care but was confident families would be pleased with inclusion and participa- tion in bedside report. Outcomes evaluation and postdata collection began in September 2017. For the nurse “ex- plaining” question, two units reported a 4.2% increase

and a 10.15% increase, while one unit reported a 3.09% decrease. Concurrently, the nurse “listening” question on one unit showed a slight 0.22% decrease, but two units showed 3.07% and 20.8% increases. These improvements validated to staff EBP initiatives can impact nursing trans- fer of care and patient and family satisfaction. Ongoing data monitoring by clinical leaders remains a priority to address percentage decreases and minimize the likeli- hood of practice drift, further hardwiring the practice change (Harvey & Sotardi, 2017). Informal rounding at change of shift reveals nurses engaging in care transfer outside patient rooms and inside with families actively participating.

DISSEMINATION Besides publication, plans include poster entry in the or- ganization’s EBP awards program highlighting nursing projects. Winners are featured at an annual breakfast, and posters are displayed within the hospitals showcasing to patients, families, and community scientific methodologies being employed by nurses to improve patient care. National dissemination plans include poster and podium presenta- tions at professional organization events. WVN

LINKING EVIDENCE TO ACTION

• Evidence demonstrates bedside shift report is consid- ered best practice when using standardized reporting tools/formatting.

• Patient safety can be improved by implementing evi- dence-based transfer of care at the bedside. Engaging nurses in EBP Academy and mentoring relationships can bring importance of EBP to life.

Author information Margaret A. Gettis, Nurse Scientist/Pediatric Nurse Practitioner, Children’s Healthcare of Atlanta at Scottish Rite, Atlanta, GA, USA; Betsy Dye, Clinical Educator, Children’s Healthcare of Atlanta at Scottish Rite, Atlanta, GA, USA; Calvin Williams, Assistant Nurse Manager, Children’s Healthcare of Atlanta at Egleston, Atlanta, GA, USA; Brenna Frankish, Clinical Educator, Children’s Healthcare of Atlanta at Scottish Rite, Atlanta, GA, USA; Beverly Alvarez, Assistant Nurse Manager, Children’s Healthcare of Atlanta at Scottish Rite, Atlanta, GA, USA.

Address correspondence to Margaret A. Gettis, Children’s Healthcare of Atlanta, 1649 Tullie Circle, Atlanta, GA 30329, USA; margaret.gettis@choa.org

Accepted 20 July 2019 © 2019 Sigma Theta Tau International

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References Agency for Healthcare Research and Quality. (2013). Strategy 3: Nurse bedside

shift report. Retrieved from http://www.ahrq.gov/profe ssion als/syste ms/ hospi tal/engag ingfa milie s/strat egy3/index.htm

Carnes, L., Dudjak, L., Hoffman, R., & Lorenz, H. (2013). Utilizing bedside shift report to improve the effectiveness of shift handoff. Journal of Nursing Administration, 43, 160–165. https ://doi.org/10.1097/NNA.0b013 e3182 83dc02

Children’s Healthcare of Atlanta. (2017). Nurses station, children’s profes- sional practice model. Retrieved from https ://choa.caref orcec onnec tion. org/commu nity/clini cal-care/nurses-stati on/nursi ng-practice

Harvey, H. B., & Sotardi, S. T. (2017). Normalization of deviance and practical drift. Journal of the American College of Radiology, 14(12), 1572–1573. https ://doi. org/10.1016/j.jacr.2017.08.003

Mardis, T., Mardis, M., Davis, J., Justice, E. M., Holdinsky, R., Donnelly, J., … Riesenberg, L. A. (2015). Bedside shift-to-shift handoffs: A systematic review of the literature. Journal of Nursing Care Quality, 31(1), 54–60.

Tidwell, T., Edwards, J., Snider, E., Lindsey, C., Reed, A., Scroggins, I., … Brigance, J. (2011). A nursing pilot study on bedside reporting to promote best practice and patient/family centered care. Journal of Neuroscience Nursing, 43, E1–E5. https ://doi.org/10.1097/JNN.ObO13 e3182 21a1d

Vines, M. M., Dupler, A. E., Vanson, C. R., & Guido, G. W. (2014). Improving client and nurse satisfaction through the utilization of bedside re- port. Journal for Nurses in Professional Development, 30(4), 166–173. https ://doi. org/10.1097/NND.00000 00000 000057

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