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Project Title:  Transferring Accountability at the Bedside: An Evidence-Based Practice Project

Introduction:  In our commitment to improve patient safety and nurse-to-nurse communication, we used an evidence-based practice (EBP) model to implement a practice change.

Triggers to Improve Practice: The current method of shift-to-shift report was not standardized or consistent. It did not follow SBAR format and had the potential to omit essential patient care information. The nursing unit EBP team designed “Transferring Accountability at the Bedside” to create a safe and effective method of communication, utilizing the principles generated by national safety organizations.

A Priority Topic for the Organization: This initiative impacts all four quadrants of the hospital’s balanced scorecard. Staff nurses on a Medical-Surgical Gyn/Oncology unit implementing a verbal bedside shift report process in place of taped report will improve customer service, quality of care & safety, nurse satisfaction, and financial performance.

Implementation:  A team was assembled of members including staff nurses, unit managers, department CNS, EBP specialist, physician and administrative assistant.  A literature review and appraisal of 23 research and non-research articles occurred. A pilot was designed and included measurable outcomes, staff and patient surveys, a staff education plan and creation of a bedside report in SBAR format.

Results:  Baseline data was acquired prior to implementation. This EBP project had immediate positive results.  Patients were engaged and involved in their plan of care, from the first day of implementation.  This process enhances numerous bedside safety checks. Identification and allergy bands are confirmed. Skin assessments, pain management, and daily plan of care is occurring directly with patient input. Nurses state that less time is spent giving report, averaging three to four minutes per patient. The new SBAR report form supports a relevant and efficient transfer of information at shift change from RN to RN. Data will be tracked that reflect PressGaney scores for customer satisfaction i.e.: involvement in decisions about treatment; patient care safety outcomes i.e.: decreased rate of outdated IV’s and dressings, and patient identification issues; RN satisfaction indicators, i.e. NDNQI scores, post-implementation nurse and patient surveys; and financial benefits, i.e.: decreased overtime at shift change. Conclusion:  The 2009 National Patient Safety Goals direct health care systems to provide evidence-based patient care. A culture of safety includes the development and implementation of a process of effective handoffs, patients’ active involvement in their care, accurate patient identification, improving the effectiveness of communication among caregivers, improving recognition and response to changes in a patient’s condition, and standardization of processes. The EPB Transferring Accountability at the Bedside shift handoff process improves bedside patient safety.  Several nursing units have adopted our process that includes: staff education, patient communications, and assorted forms.