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Smoothing the Change of Shift

Bedside handoffs improve care outcomes and patient satisfaction at Fawcett Memorial Hospital

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Mention "shift change" on any given med/surg unit and two pictures come to mind: a nurses station buzzing with activity as oncoming and offgoing shifts exchange information and virtually empty hallways.

A half-hour can easily pass before the oncoming nurse sees her first patient, compromising quality of care and hindering patient satisfaction, noted Lisa Orlick, RN-BC, nursing director at Fawcett Memorial Hospital, Port Charlotte. Hospital leaders and staff, also wanting to increase patient education and participation in care, recently launched bedside rounding at shift change. Staff nurses and CNAs now complete patient handoffs at the foot of the bed.

"When staff nurses made rounds after getting reports, they noticed the information often did not match bedside assessments," Orlick said. "Actually, the issues started with the change of shift report not informing the oncoming shift on IV sites and start dates or tubing labels; not knowing when they were to be changed."

MAKING THE ROUNDS: Nursing director Lisa Orlick, RN-BC, and charge nurse Carol Nies, RN, review medication information on the third floor at Fawcett Memorial Hospital. photo by John Ciuppa
Orlick illustrated a recent case: One patient's chart indicated he was stable, the rounding team saw he was dusky and short of breath. By summoning the rapid response team, the patient received faster care and recovered more quickly. Even CNAs have found patients with low blood pressure or other issues during their own rounds.

"The nurses are picking up changes in patient conditions earlier and they're able to conduct a more accurate assessment based on information given and assessment findings," said chief nursing officer Sandy Morgan, MSN, RN. "The picture is more vivid."

"Patients like the practice too," Added night shift charge nurse Millie Campione, RN. "They're contributing to their care, and they develop more trust with the charge nurse and primary nurses."

'Head-To-Toe'

In report, nurses cover a head-to-toe assessment and report any abnormal findings, review recent labs and scheduled tests, and cover any type of skin, wound or fall prevention needs. "The oncoming nurse ensures the patient is aware of the 'day's events' and course of medical treatment," Orlick said.

They speak to patients in regards to any tests or procedures scheduled for that day, and ensure the call light is within reach.

Nurses also visually inspect IV sites for time, date, patency and appearance and IV tubing is labeled with the correct date. In addition, they check anchoring of Foley caths with Foley straps (to decrease UTIs); turn and position of patient (skin and wound care), and oxygen use and saturation (fifth vital sign).

Reporting Tools

Orlick created a reporting script designed to assist novice nurses as well as experienced RNs and LPNs. Staff "tweaked" the scripting form and developed their own style for shift handoff at the bedside.

"The tool was developed to help nurses adapt easier. They were then given free reign as to how the information was given, making sure that pertinent details were included," Orlick said.

Staff - held accountable for giving pertinent information - first used the tool to give report "as usual" and progressed to walking rounds and giving information in the room, usually at the door within the room, Orlick said. Finally, it became mandatory all reports would be given at the bedside with the patient present, Orlick noted.

"We monitored staff and if they were seen not doing report correctly, they were educated to follow protocol," she said.

The new reporting protocol also means charge nurses are more involved with patients and families, being the first line for patient complaints or issues and "managing up" when necessary, Orlick noted.

"The practice helps the charge nurse to place a face to the name and diagnoses," she said.


Smoothing the Change of Shift

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Excellent article. As others, we have tried, failed and are again retrying a hand-off process in our Critical Care Units. Would love to look at your scripting and report tool. Have you been able to "sustatin the gain" post implementation?

Jennifer Ringle,  Asst. Director,  NCHFebruary 21, 2012
Naples, FL



Would love to have a copy of your scripting and shift report. 586-307-9005

Cindi Nader,  DQM,  Select Specialty HospitalSeptember 17, 2011
Macomb, MI



Great article! Content kept me reading. We have tried and failed in the past using a handoff tool. Wondering if you would be interested in sharing your scripting and handoff tool with us?
Thanks,
Anna

Anna Stuart Everett,  charge nurse,  Natividad Medical CenterOctober 14, 2010
Salinas,, CA



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