Bedside Handoff at change-of-shift: A strategy to improve patient outcomes

Purpose:
Transfer of patient information and responsibility is a high risk process that exposes patients to adverse outcomes. Implementing a process that minimizes delay in assessing patients and setting priorities in care will be beneficial in providing patients opportunities for positive outcomes.

Significance:
Handoff at change-of-shift is a standard nursing practice that occurs at least twice to three times a day that has a potential to cause gaps in communication. Breakdown in communication was the leading root cause of sentinel events reported to the Joint Commission between 1995 and 2006.

Strategy and Implementation:
Bedside handoff at change-of-shift provides an interactive process of sharing patient information among caregivers and the patient. This process ensures continuity of care from shift to shift that allows caregivers to confirm information provided with the current status of the patient. The implementation was guided by Lewin's change model. Informational meeting about handoff and its relationship to patient outcomes was conducted. Nurses were surveyed on the barriers to bedside handoff. The current process of handoff at change-of-shift was reviewed and the need to change process was identified. Literature review was conducted to find best practices on bedside handoff at change-of-shift. Protocol for bedside handoff was developed. Nurses were educated on the protocol for bedside handoff using PowerPoint presentation and case scenarios. Learning of the protocol was evaluated by post test.

Evaluation:
The 2010 NDNQI 1st quarter report on patient falls per 1000 days shows a downward trend on the number of falls with injuries. Patient satisfaction scores on how well they were informed and how well staff worked together to care for them showed significant increase as measured by Press Ganey.

Implications for Practice:
Bedside handoff at change-of-shift focuses on patient-centered care. Nurses are able to see patients right away, prioritize patient care, and manage load effectively. Nurses can perform safety checks while doing partnership rounding.