Bedside Safety Handoffs: Transitioning Trust for Patients and Staff

Purpose:
Park Nicollet Methodist Hospital has had inconsistent bedside report and safety checks compromising patient safety and the patient experience. A team of staff RNs worked to develop and implement bedside safety handoffs and engage over 800 registered nurses in this practice change.

Significance:
The Joint Commission Safety Goals include improving effectiveness among caregivers and encouraging patients' involvement in their own care. A communication process at the bedside meets the needs of the patient, family, and staff and mitigates the risk of errors reaching the patient.

Strategy and Implementation:
A shared governance was developed, including a staff RN from each unit and 2 nursing leaders to support the team and remove barriers. The workgroup kicked off with a call to action by our CNO. The RNs supported the practice but were apprehensive due to failed attempts to implement bedside report in the past. The team used the ADKAR change adaptation model as they developed a plan for implementation. The project included reviewing current shift report, identifying barriers to success, collaborating with Patient Safety to develop a process, creating awareness and desire for nurses prior to go-live, leveraging our EHR to create a SBAR tool for report, and training for RNs and NAs. Each unit scheduled a leader to be present during change of shift to support staff, reinforce the practice, and troubleshoot any barriers. A tracking tool was developed for leaders to document any barriers to completing the bedside safety handoff so we could understand trends and implement countermeasures.

Evaluation:
Go-live is scheduled to occur on 6/6/12. We will continue to monitor the HCAHPS question, "During the hospital stay, how often did you have confidence and trust in the nurses treating you?" Nurses will also initial a tracking sheet in the patient room to ensure the process is being completed.

Implications for Practice:
The bedside safety handoff process includes updating the whiteboard, validating the fall risk and assistance level, checking alarms, checking medications/infusions, assessing any patient abnormals, and is an opportunity for the patient to witness the transfer of knowledge from one RN to the next.