Program Evaluation of a Bundled Educational Intervention to Enhance Implementation of Professional Exchange Report

Communication handover is a source of potential error and risk to patient safety. Electronic-based tools may reduce errors and mitigate risks to patient safety. Electronic tools have been successfully implemented using multiple methods of education and training. Electronic tools vary in functionality and integration with the electronic health record (EHR). A large West Michigan Regional Health System (RHS) implemented a new EHR containing an embedded tool for communication handover called Professional Exchange Report (PER). There was inconsistency in the practice of bedside report by nurses. The RHS planned to use a bundled approach of educational interventions to implement the new tool and report structure including communications, video demonstration, in-seat training and at the elbow support during the go-live. This project systematically evaluated the interventions to implement PER using evidence based methodology. Evaluation was based on collection of data and evidence through interviews, pre- and post-implementation surveys, observations of the report process, and review of documents related to planning, implementing and evaluating the program. Organizational leaders engaged in robust planning. Educational interventions were evidence-based. Implementation was carried out effectively. The organization did not have a detailed, specific plan for evaluation of educational interventions or PER outcomes. Change in length of report could not be attributed to the process change, and nurse perceptions of the process and consistency of practice at bedside did not change. Observed opening of the EHR during report increased by 68%. There were statistically significant increases in yes responses to awareness of, understanding why, knowledge of specific, and ability to make practice changes

Evidence-Based Protocol: Standardizing Handoffs to Improve Outcomes

Nurse to nurse handoffs were identified as an area for improvement in an acuity-adaptable, progressive care (AAPC) unit in a Midwestern hospital. By using the Plan, Do, Study, and Act (PDSA) quality improvement framework, the content of handoffs was standardized by the creation and use of a handoff tool, organized in a Situation, Background, Assessment, Recommendation (SBAR) manner. Outcomes of nursing satisfaction and incidental overtime were improved after the implementation of the handoff tool. This cost neutral project has a cost savings potential of $2000/year with the reduction of incidental overtime

A Standardized Electronic Handover Report for Anesthesia Providers

Background: Despite numerous studies and agencies recommending the standardization of handovers to improve the quality and safety of patient care, intraoperative anesthesia handovers have remained unstandardized at many institutions. Objectives: The purposes of this study were to 1) develop the preliminary Anesthesia Handover Report (AHR) and evaluate its accessibility, layout, and content using feedback from an Expert Sampling Group; 2) create the finalized AHR and evaluate the impact it had on the perceived quality of handover among anesthesia providers; and 3) to assess the uptake of the finalized AHR. Methods: This study was implemented at NorthShore University Health System (NSUHS), Evanston, Highland Park and Glenbrook locations. In Phase 1, an Expert Sampling Group of ten experienced anesthesia providers evaluated the preliminary AHR for its accessibility, layout and content using the Expert Sampling Group Questionnaire. In Phase 2, using feedback from this questionnaire, the finalized AHR was created and all 140 anesthesia providers at the three study locations were invited to utilize and evaluate the AHR during intraoperative anesthesia handover, additionally, during Phase 3 the use of the AHR was queried every two weeks for the duration of Phase 2 to assess uptake. Results: Five anesthesia providers completed the Expert Sampling Group Questionnaire in Phase 1. Changes made to the preliminary AHR in response to feedback from the Expert Sampling Group Questionnaire included the removal of redundant information, more appropriate layout of information in the sidebar, the addition of total drug dose given in the medications panel, an additional hyperlink to anesthesia nerve block reports, and corrections to wrong information being pulled into the AHR. During Phase 2, 21 anesthesia providers completed the Anesthesia Handover Survey. The overall mean Likert score for handover conduct was 3.72 with a SD of .475 (minimum 2, maximum 4), this indicated that overall the majority of the respondents perceived that the AHR improved the conduct component of handover. The overall mean Likert score for teamwork was 3.76, with a SD of .432 (minimum 3, maximum 4), which indicated that respondents felt the AHR improved teamwork during handover. Lastly, the mean Likert score for the handover quality was 3.64 with a SD of .611 (minimum 1, maximum 4), this indicated respondents felt the AHR improved overall handover quality. Results of Phase 3 indicated the uptake did not increase as expected over the six-week monitoring window, but rather peaked during week four and quickly dropped off thereafter. The mean number of times the “Anesthesia Handoff” event button was clicked each week was 3.17. Conclusions: Use of the AHR improved the perceived conduct, teamwork, and quality of intraoperative anesthesia handovers. The use of the AHR did not improve over time. Overall, use of the AHR improved the perceived quality of anesthesia handovers. Future studies should be done to determine if use of the AHR would result in the standardization of anesthesia handovers

Standardizing the Bedside Shift Report: Improving Communications and Promoting Patient Safety

PROBLEM: Nursing shift reports are integral to nursing as they allow for the transfer of critical information and responsibility of patient care from one nurse to another. Ineffective communication during shift-to-shift reports can contribute to gaps in patient care and breaches in patient safety, including medication errors, falls, and sentinel events. The greatest risk of communication breakdown is during transitions in care. CONTEXT: St. Louise Regional Hospital, a small community hospital, consisting of an eight-bed medical-surgical intensive care unit lacked structure in how handoff should occur and had variances in shift handoffs. Observation of the shift handoff at the nurses’ station revealed many communication gaps that have shown negative impacts on patient safety and outcomes. The improvement project described in this paper focused on evidence-based practices that support the benefits of bedside shift and implementations of standardized handoff tools. INTERVENTION: Intervention included an education in-service for unit managers, educational coordinators, and staff nurses to emphasize the important benefits of bedside shift report. MEASURES: The three components for evaluating improvement include outcome, process, and balancing measures to determine whether the improvement project has had the desired impact. The outcome measure expected to yield the following: direct observation of nurses during bedside report to calculate how often is being done, monitor for decrease in overtime due to more efficient shift-to-shift bedside reports, and a review of risk management reports observing for effect on the number and severity of medication errors. RESULTS: The outcome measure is to increase the nurses’ compliance with bedside shift report in the intensive care unit to at least 80% within six months of implementation. CONCLUSION: With the proposed change, bedside shift report will addresses all the safety hazards by reducing adverse events, such as medical errors, patient falls at shift change, and sentinel events. Bedside shift report improves patient safety, enhances the quality of care, improves patient and nurse satisfaction, decrease unnecessary healthcare expenditure, and saves time

Bedside Shift Report: A Way to Improve Patient and Family Satisfaction with Nursing Care

Poor communication during the handoff process contributes to approximately 30% of malpractice claims costing up to $1.3 billion annually (Fenner, 2017), which demonstrates the importance of evaluating the quality of information exchange between nurses, patients, and families when associating quality of care to patient satisfaction (Kullberg et al.,2017). The following question guided this Evidence-Based Project (EBP) project. In adult, progressive care unit patients (P), does the implementation of a nursing bedside handoff (I) compared to current handoff practices (C) improve patient/family satisfaction with nursing care (O) over eight weeks (T)? The literature revealed evidence from 10 studies answering the practice problem and supported implementing a Bedside Handoff (BSH) bundle. Themes from the evidence included patient and family participation in care, bedside handoff and impact on patient and family satisfaction, nursing perceptions associated with bedside handoff process, and measuring patient and family satisfaction with nursing care. The BSH bundle included staff education, utilization of a standardized handoff communication tool, safety checks, and use of patient whiteboards. Direct observation occurred to understand staff compliance using the Handoff Observation Feedback Audit Tool. The project demonstrated that bundling evidence-based practices improved specific nursing care aspects that influence the patient and staff experiences and satisfaction survey results

The Design, implementation and Evaluation of a Technology Solution to Improve Discharge Planning Communication in a Complex Patient Population

Unnecessary delays in discharge planning can extend the length of stay (LOS) and add non-reimbursable days for socially and medically complex patients thereby increasing the financial burden to healthcare organizations. The literature supports enhanced discharge communication strategies and the use of checklists to facilitate safe and timely discharges. Following root cause analyses of significant discharge delays, one hospital identified gaps in communication as key precursors associated with discharge planning breakdown when discharging patients to skilled nursing facilities. Review of these events demonstrated the need for concurrent communication strategies between multidisciplinary care team members in planning for complex discharges. Following a complete assessment of the current discharge planning process, a web-based interactive discharge checklist was designed, implemented and evaluated in the attempt to provide guided communications to the essential partners of the patient’s team in an effort to reduce LOS and readmissions. After a six-month rollout of the new technology and concomitant procedures, the analyses revealed improvement in both the patient’s perception of discharge planning and the ability to discharge patients by noon. Results for LOS and readmission demonstrated inconsistent improvement. The use of an electronic checklist as a communication tool did reduce variability in discharge procedures and provided for continuity in handoff communication between team members. Staff agreed it promoted continuity and improved efficiency

Implementation of a Situation, Background, Assessment, Recommendation (SBAR) Patient Handoff Tool in the Electronic Medical Record (EMR)

Abstract Purpose and Problem: Handoffs that are poorly conducted are implicated in 80% of preventable adverse events in healthcare facilities. Within a Pediatric Rehabilitation Facility in Maryland Heights, Missouri it was observed that nurse handoffs were not conducted and lacked the use of a standardized evidence-based tool, resulting in nurse dissatisfaction with the handoff process and miscommunication. Recognized by the World Health Organization, The Joint Commission, and Agency for Healthcare Research and Quality, the Situation, Background, Assessment, Recommendation (SBAR) evidence-based tool is effective in improving handoff communication, improving nurse satisfaction, reducing adverse events, and promoting patient safety. The purpose of this Quality Improvement (QI) project was to implement a patient handoff tool into the electronic medical record (EMR) based on the SBAR method to help improve handoff communication and documentation. Methods: Nurses were educated on the SBAR method and tool prior to implementation of the tool. A survey was distributed pre-implementation and again at the end of the 12-week implementation period. Observation audits were conducted weekly to determine nurse compliance with the use/documentation of the SBAR handoff tool. Results: Findings indicated nurse compliance with the use of the SBAR handoff tool for day shift was 99.35% and for night shift was 99.37%. Meaning there was only a 1.43 standard deviation for day shift and a 1.29 standard deviation for night shift. Demonstrating the stated goal of increasing the minimum staff compliance to 80% with the use of a standardized shift report tool in the EMR was met. Comparison of pre and post survey mean responses showed modest improvements in items related to the use of an SBAR tool during handoff and there was an increased dissatisfaction with the amount of time it took to give handoff using an SBAR tool. Nurses stated that handoff took longer due to the cosigning requirement of the handoff. Conclusion: Use of the SBAR tool improves nurse-to-nurse communication when used during handoffs. Future Plan-Do-Study-Act (PDSA) cycles and data collection should take place for ongoing quality improvement and analysis

Examining Nurse Satisfaction with a Bedside Handover Report Process

Nurses\u27 job satisfaction affects work performance at the point of care in hospitals. The incoming nurses who are able to receive a comprehensive patient report at shift change are more prepared in comparison to incoming nurses who are not able to receive a comprehensive patient report to provide care that is safe. The purpose of this project, guided by the theory of organization change, was to explore whether the use of a bedside handover process impacts nurses\u27 satisfaction in an adult postoperative orthopedic and spine unit. A post-implementation survey of the bedside handover process was conducted after one month and two months to examine registered nurses\u27 (RN) (n = 50) satisfaction using a 7-question self-designed instrument with a reliability coefficient of 0.80. The Bedside Handover Report Staff Nurses\u27 Satisfaction Survey consisted of 5-item Likert scale with scores ranging from 1 (strongly disagree) to 5 (strongly agree). The survey results found that RNs were satisfied with the bedside handover report process. Matched-pair t tests revealed significant differences between the first and second months after the handover report process was implemented. Specifically, \u27Bedside handover report provides time for the incoming RN to verify patient\u27s health issues\u27 (p = .05),\u27 I am satisfied with the handover report process conducted at the patient\u27s bedside\u27 (p = .01), and total score (p = .03) improved from the first to second month. A longitudinal study spanning 6 months to a year is recommended when the project will be implemented in the entire facility. A bedside handover report increases nurse satisfaction because the process allows the nurses to verify and address patient health issues that are essential for positive social change

An Exploratory Study on how to Improve Bedside Change-of-Shift Process: Evidence from One Hospital Using Technology to Support Verbal Reporting

Change-of-shift report, often referred to as patient handoff in the inpatient setting involves exchange of accurate and critical information between providers to ensure continuity of patient care. Inefficient communication significantly contributes to medical errors, affecting patient safety, and care quality. The current exploratory study was conducted to understand the issues associated with change-of-shift reporting that occurs throughout one hospital in its various nursing units. Nurses participating in the study were assigned a simulated patient case to develop a shift report to transfer to the incoming nurse. After completing the report, each nurse was interviewed using open-ended questions. Based on qualitative analysis of data obtained from sixteen one-on-one nurse interviews, ten themes were identified. The themes highlighted issues that posed coordination challenges for nurses, impeded nurse workflow, and underscored deficiencies in the bedside reporting process followed at the hospital. Recommendations are discussed on how to overcome these challenges

Creating a Culture of Learning: Improving Patient Mobility in a Medical-Surgical Unit

Abstract PROBLEM: Hospitalization, especially among older adults aged 65 or over, can result in decreased mobility and functional decline. This decreased mobility can lead to accelerated bone loss, falls, increased length of stay, and delirium. In this medical-surgical unit, a pattern reflecting lack of adequate patient mobility has persisted over one year. CONTEXT: Northwest (NW), a 42-bed community hospital medical-surgical unit- part of an integrated regional health care delivery system, has not been maximizing the mobilization of their patients for the past year based on internal data.The improvement project described in this paper focused on creating a culture of continuous learning to identify evidence-based practices and to implement the use of a standardized progressive mobility protocol. INTERVENTIONS: The project intervention consisted of a targeted educational series for nurse leaders and frontline staff that emphasized the need for early patient mobilization. MEASURES: A set of metrics was developed to address outcome, process, and balancing measures. The outcome measure was defined as the calculated average daily mobility score. The regional organizational mobility score goal is 4.8 and the specific project aim for the medical-surgical microsystem was to meet or exceed that metric. RESULTS: Over nine months, the practice change project resulted in improved patient and organizational outcomes as reflected in clinical, financial, and operational metrics. The unit mobility score increased from 4.3 in January 2018 to 5.1 in October 2018. CONCLUSION: Mobilization contributes to improved outcomes of hospitalized patients. The intervention of early and progressive mobilization is the most significant and specific nursing measure to optimize quality outcomes and prevent costly complications related to immobility. Keywords: early mobilization, progressive mobility protocol, immobility, hospitalizatio