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Running Head: BEDSIDE SHIFT REPORT 1

Bedside Shift Report

Danielle McWilliams

Delaware Technical Community College

NUR 410 Nursing Informatics

Dr. Wheeler

April 19, 2019


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In the healthcare profession, current practices are strongly influenced by evidenced-based

practice. Bedside shift report is a process that has been implemented in many healthcare facilities

across the United States. The idea behind bedside shift reporting (BSR) includes increasing

patient safety as well as nurse and patient satisfaction (McAllen et al, 2019). Performing bedside

shift report “allows the nurse to visualize and assess the patient and environment, as well as

communicate with the patient essentially including the patient in the plan of care” (McAllen et

al, 2019).

The Agency for Healthcare Research and Quality believes that report should include

introduction of the nursing staff to the patient and any visitors, invite the patient and family to

participate in the report, use of the electronic medical record to provide pertinent patient health

information whilst using wording that the patient and family will understand, conduct a focused

patient assessment and room safety assessment, and lastly to address any patient and/or family

questions and concerns (Lippincott Solutions, 2017). By utilization of this process and including

all steps of report can increase time of end-of-shift report.

With every process, there is room for improvement. Potential challenges of bedside shift

report includes “possibility of HIPPA violations related to lack of privacy in semi-private

rooms, unknown visitors, discovery of new diagnoses or lab results, patient’s inability to

participate in report due to sensory or cognitive impairments, and/or questions that require

lengthy clarification or explanation” (Lippincott Solutions, 2017).

“Bedside shift report is a clinical expression of engaging patients and families as essential

partners in the health care team” (Agency for Healthcare Research and Quality (AHRQ), pg.3).

A study showed that more than 70 percent of adverse events are caused by ineffective

communication between caregivers and patients, whereas another study showed that bedside
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shift report improves patient safety and service delivery” (AHRQ, pg.3). After implementation of

bedside shift reporting, “a decrease in patient falls during change of shift, dropping from one to

two patient falls per month to one patient fall in six months was recognized” (AHRQ, p.3).

Hospitals have reported an increase in patient and nursing staff satisfaction scores and

improvements in the nurse-patient relationship have been reported since implementation of

bedside shift report” (AHRQ, pg. 3).

Conducting report at the bedside with the patient encourages effective communication

between not only nurses to nurses but patients to nurses as well. Reports at the bedside allow the

patient to clarify any incorrect health information provided and allows the patient to feel heard

when their concerns and questions are addressed. “Bedside shift report is the perfect time to

develop the nurse-patient relationship, building trust and confidence in care; the relationship is

strengthened when patients have the ability to ask questions, share information, and the ability to

take an active role in the planning and decision making process.” (Lippincott Solutions, 2018).

Research has shown that “sentinel events are more likely to occur during change-of-shift

and often occur due to handoff errors” and “miscommunication between healthcare providers

during shift change contributes to at least 35% of all sentinel events” (Lippincott Solutions, 2018).

However, “research also shows that bedside shift report helps decrease frequency of sentinel

events and medication errors because both nurses have the opportunity to review medications,

allergies, and pump rates” (Lippincott Solutions, 2018)

The health care profession focuses on customer service and strives to achieve optimal care,

it has been said that “effective communication is a key driver to improvements in the delivery of

high-quality patient care and safety” (Lippincott Solutions, 2018). End of shift report at the bedside
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provides the opportunity for nurses to “better understand patient expectations and goals, which

helps increase compliance and the likelihood of positive outcomes” (Lippincott Solutions, 2018).

Nursing practice is guided by many regulations however, the American Nurses Association

Code of Ethics provides fundamental guidance to nurses to provide dignified care. Provisions 2

through 4 and provision 6 support the practice of bedside shift report to improve quality of patient

care as well patient safety.

The American Nurses Association Code of Ethics, provision 2 states “the nurse’s primary

commitment is to the patient, whether as an individual, family, group, community, or population”

(American Nurses Association (ANA), 2015). Provision 3 describes the nurse’s responsibility to

“promote, advocate, and protect the rights, health, and safety of the patient” whereas provision 4

describes the “nurse’s authority and obligation to provide optimal patient care” (ANA, 2015).

Each hospital faces their own challenges in the use of the bedside shift report process. The

navigation between multiple screens is time consuming and is frustrating for many of us. The issue

that is faced in bedside shift reporting is that important information is still being missed in report

and interrupts continuity of care. I compare the change of shift report to the game, “telephone”.

Patient information is reported off initially and may include all important points of the patient’s

care, treatments and/or orders, with each handoff report some information is omitted or lost and

the reports continue to lose vital information. With modification of the current report processes

and creation of a standardized handoff report tool, the time spent reporting off could decrease as

well as reduce the amount of information that is lost throughout the patient’s hospitalization; the

utilization of a handoff report template could improve the bedside shift reporting process.
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The creation of an in-depth electronic template that pulls information from the patient’s

electronic medical record would make change of shift report more efficient, purposeful, and user-

friendly. This template should include a variety of patient information including: name, reason for

hospitalization, past medical history, allergies, code status, diet and restrictions, abnormal vital

signs or trends, wounds, range of blood sugars, important medications (blood thinners, anti-

seizure), as needed medications and last time administered, full list of most recent labs in

comparison to previous, weight (critical for CHF patients), test results, fall risk level and the most

recent therapy updates about patient’s mobility. The template should also pull critical information

from previous shifts that indicate change in patient condition or medical concerns.

A workflow map demonstrates the flow of the process from start to finish which can allow

businesses to identify weaknesses within the processes. I believe the use of this diagram would

allow our bosses as well as electronic health record developers to visualize how report is

given/received by the nurses and the difficulty they face when trying to report every critical piece

of patient information while trying to address patient concerns, questions, etc. Finances, patient

satisfaction and nursing staff satisfaction are strongly affected by bedside reporting.

Organizations or facilities would reap the benefits of this process because it would cut

down time of bedside shift report as well as improve the effectiveness of bedside shift report.

Frequently nurses stay later during shifts to have ample time to perform bedside shift report

accurately and effectively; in return, nurses are not leaving work when they are scheduled too. By

shortening report time, nurses will be able to clock out by scheduled ending time which would

decrease costs of overtime payout as well as increase nurse satisfaction. After working twelve plus

hours, nurses look forward to clocking out and going home on time with staff who consistently

leave past the end of their shift, are more easily burnt out. Patient satisfaction would also improve
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by use of the template; it would allow nurses to have time to purposefully and effectively address

patient concerns and questions during report.

“Very few hospitals use an electronically-driven hand-off tool through existing electronic

health records systems and according to research, electronic health records benefit the

communication by allowing fewer errors and increasing satisfaction by increasing the quality of

report” (Carpenter, K., & Tebrinke, L., 2019).

Two nurses that graduated from UW-Madison School of Nursing conducted research from

their “informatics colleagues, they were able to create a patient report to streamline shift-to-shift

report that printed a standardized, one-page report per patient” (Carpenter, K., & Tebrinke, L.,

2019). Carpenter and Tebrinke stated, “optimizing the power and potential of technology and

informatics to support innovative patient care and enhancing the effectiveness of professional

practice; meanwhile utilizing data to its fullest potential” (Carpenter, K., & Tebrinke, L., 2019).

Creation and utilization of a standardized, comprehensive handoff reporting tool has the

potential to increase nurse’s satisfaction, increase patient satisfaction, reduce medical errors, and

greatly improve the quality of the current bedside shift report in facilities nationwide. Many

benefits have been demonstrated through use of research trials of bedside report as it relates to

patient’ss quality of care, satisfaction, and safety.


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References

Agency for Healthcare Research and Quality (AHRQ). (n.d.). Nurse Bedside Shift Report

Implementation Handbook. Retrieved from

https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagin

gfamilies/strategy3/Strat3_Implement_Hndbook_508.pdf

American Nurses Association (ANA). (2015). Code of ethics with interpretative statements.

Retrieved from

http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNur

ses/Code-ofEthics-For-Nurses.html

Carpenter, K., & Tebrinke, L. (2019). Improving shift handoff reports. Retrieved from

https://www.uwhealth.org/nursing-uw-hospital-uw-medical-foundation/improving-shift-

handoff-reports/46299

Lippincott Solutions. (2017). Bedside shift report can save lives. Retrieved from

Lippincottsolutions.lww.com/blog.entry.html/2017/11/17/bedside_shift_report-

dMev.html

Lippincott Solutions. (2018). Bedside shift report: Positive implications on patient care.

Retrieved from

lippincottsolutions.lww.com/blog.entry.html/2018/08/14/bedside_shift_report-5Pwz.html

McAllen, E., Stephens, K., Swanson-Biearman, B., Kerr, K, & Whiteman, K. (2018). Moving

shift report to the bedside: An evidence-based quality improvement project. Retrieved

from

http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJ
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IN/TableofContents/Vol-23-2018/No2-May-2018/Articles-Previous-Topics/Moving-

Shift-Report-to-the-Bedside.html