Patient hand-off has been identified as a time when the risk for ineffective communication contributes to errors and miscommunication. Accrediting organizations in the U.S. and Canada have identified the importance of an effective transfer of accountability process.  Legislation and professional standards address privacy and the need to identify, assess, plan, implement and evaluate care on an ongoing basis.  Transfer of accountability episodes throughout the continuum of a woman's in-patient experience provide opportunities for providers to exchange important and relevant information about the woman and include her in the interaction. Bedside report in the perinatal setting places the woman and her family in the centre of the process and has been demonstrated to improve provider to provider and patient to provider communication, improve nurse efficiency at shift change, improve patient satisfaction with their care, and improve nurses satisfaction. On our unit, chart audits uncovered concerns and when seeking the root cause of the issues identified, the shift handover report was identified as one system issue contributing to near misses and adverse events.

Proposed change:

Shift report traditionally took place in the nurses station.  There was no standard format for report and the quality and value of information exchanged varied widely.  The proposed change moved shift report and all transfers of accountability to the bedside.  

Implementation, outcomes and evaluation:

Utilizing recommendations from evidence-based literature, and the shared experiences of a peer hospital, our unit implemented the bedside transfer of accountability initiative using role play, a report prompt tool and addressing questions and concerns. When the off-going and on-coming nurses exchange information about the woman at the bedside it provides an opportunity to use visual cues, including verification of the patient's identification, intake and output, the status of dressings and drainage devices and pain management. It also enables the oncoming nurse to "pull" information from the off-going nurse.  Women and their families are provided with the opportunity to be partners in their care and contribute information or clarification.  Patient rounds data, risk audits and nurse feedback have revealed positive outcomes, including improved quality of communication, documentation, and both patient and staff satisfaction.

Implications for nursing practice:

Implementing change can be challenging in any unit culture.  This presentation, related to putting patient's first whenever there is a transfer of accountability, will share our strategies and experiences as a learning opportunity for others considering implementation of bedside report.

Keywords:

transfer of accountability, bedside report, patient-centered care, patient safety