Blending Caring and Excellence: Translating Culture of Caring and Safety in Bedside Handoff

Purpose for the program:

To determine whether the blending of culture of caring and bedside handoff and safety checks will improve patient satisfaction, increase collaboration among team members and improve patient safety in Labor and Delivery.

Proposed change:

A Labor and Delivery unit in a community hospital developed a new process for shift to shift reporting blending the culture of caring concept with bedside handoff and safety checks.

Implementation, outcomes and evaluation:

 Change of shift report is the time when critical information relevant to patient care is communicated and exchanged between staff members. With the initiation of culture of caring concept and the analysis of the last two quarters’ housewide Press Ganey Patient Satisfaction Scores, results revealed that improving patient satisfaction and safety must be the primary goals of the unit. A voluntary Labor and Delivery core team of nurses and physicians named “Innovative Practice Team” (INPT) was created. Expectations, goals and evaluations were developed and probable challenges and barriers were recognized and identified. Information regarding the new initiative was communicated through emails prior to implementation. Physician and nurses’ champions piloted the initiative. This was followed by the “go live” phase. Structured bedside handoffs were implemented. Critical and private information were discussed in a “brief” report outside the patients’ rooms. Bedside handoffs took place in the patients’ rooms utilizing the care board with patient friendly language. Key information such as plan of care were discussed with the patients,including significant events that occurred during the previous shift. Teach back method was utilized including pain medication and plan of care. Safety checks were performed on high alert medications and equipments.

Staff evaluations provided strong positive feedback in the areas of value of communication methods, increase in collaborative efforts among team members, and efficacy of safety checks. Leadership will continue to play an important role in sustainability through daily shift to shift rounding. Additional outcomes will continue to be assessed through housewide quarterly Press Ganey Patient Satisfaction Scores.

Implications for nursing practice:

The methods utilized enhanced majority of staff acceptance and participation necessary to improve patient satisfaction, and maintain culture of safety and caring while including patients in the plan of care. Patients witness collaborative effort among team members. Staff participation has been strong and continuous efforts to bring staff to compliance through unit leadership daily rounding has played a considerable role.

Keywords:  bedside handoffs, safety checks, champions and culture of safety