Evidence-Based Quality Improvement Project

Evidence-Based Quality Improvement Project

Background

Nursing shift change requires the transfer of a large amount of information from the outgoing nurse to the oncoming one. Handover is a valuable and essential process of nursing care. Incorrect or incomplete handover can significantly impact the on-coming nurse’s administration of care (Ernst, Mccomb, and Ley, 2019). Due to a lack of communication among healthcare providers, safety errors occur daily across the United States. The Joint Commission estimates that “80% of serious medical errors involve miscommunication between caregivers during the transfer of patients”. According to Becker’s Hospital Review, one-third of malpractice suits involving nursing cite a breakdown in communication. Nurses often state that bedside reporting is time-consuming due to patient interruptions and other issues. Despite this issue, research consistently shows an increase in patient safety and satisfaction when bedside reporting is implemented (Mitchell, Gudeczauskas, Therrien, and Zauher, 2018)Evidence-Based Quality Improvement Project.

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At Rasmussen Hospital, end of shift report is done at the nurse’s station, where everyone struggles to hear each other. Information is often missed, and nurses are spending extra time perusing patient charts to find answers. Rasmussen Hospital has a high rate of falls compared to the national average. Medication errors have increased significantly over the past six months and patient satisfaction scores have decreased. One particular incident has sparked the need for further intervention. A sentinel event occurred where a patient fell and struck their head on the corner of the sink and was rendered unconscious. The off-going nurse failed to conduct end of shift rounds, bedside report was not conducted, and the oncoming nurse, after receiving report that the patient was stable, chose to see this patient last on her list. Upon arrival to the patient’s room nearly an hour after the shift started, the patient was found deceased.

Formulation of PICOT Question

P- Patients on the medical/surgical unit

I – Shift report performed at the bedside, including the patient

C – Comparing shift report given at the nurses’ station

O – Reduction of falls and medication errors

On the Medical/Surgical unit, does the change of shift report given at the patient’s bedside decrease the risk of falls and medication errors compared to the current method of reporting at the nurse’s station? The PICO method requires that the solution be timely. This problem and the suggested solution will be evaluated over a period of 6 months and compared to the previous 6 months. Evidence-Based Quality Improvement Project

Article Reviews

Nurses’ perceptions of mandatory bedside clinical handovers

Background: Accurate information transfer information during shift handover is vital for practice to ensure reduction in medical errors, falls, and pressure ulcers. There are limited studies that present quantitative evidence in bedside nursing handover reports. Slade et al. (2018) conducted a study using a unique quantitative tool to determine the acceptability and nurses’ view on the bedside handing over compared to handing over at the nurses’ desk. Before implementing the mandatory bedside handing over, 66 nurses were recruited to fill out the Bedside Handover Attitudes and Behaviors (BHAB) questionnaire. The study showed that many nurses value bedside shirt reports and verbalize readiness and ability to manage this new practice.

Method:  In the absence of a tool to assess nurses’ views and perceptions, Slade et al. (2018) developed a tool (BHAB questionnaire) that assessed the nurses’ opinions. The tool was derived from an extensive literature review on clinical handovers, emphasizing their safety, comprehensiveness, and effectiveness. The BHAB questionnaire focused on nurses’ attitudes and self-perceived capabilities in bedside nursing handovers. It consisted of two sections, 18 items on attitude and 14 on roles in handing over. Evidence-Based Quality Improvement Project

Measures: Slade et al. (2018) analyzed data from the questionnaires using SPSS and MedCal. They calculated the mean and standard deviation of every item in both sections.

Analysis:  Slade et al. (2018) used the McNemar test to analyze the alignment of the nurses’ perception of and confidence in bedside handing-over reports.

Results: Most of the nurses provided a high-level agreement from the results of section one and moderate to high agreement from the results of section two with mean scores of 5.37 (SD=0.32) and 5.06 (SD=0.60)Evidence-Based Quality Improvement Project. These results showed that 1. Nurses endorse and have good attitudes towards bedside handing over concepts and 2. Nurses had confidence and believed they could enact these principles despite having no prior training.

Strengths:

1. The study provided first-hand information from the nurses hence increasing the reliability of the data
2. The study utilized a unique tool, the HBAB questionnaire, that contained core elements of bedside handing over, increasing data validity.
3. The research utilized reversed scales for half of the questions in data collection. This intervention helped reduce category bias hence increasing the effectiveness of the study tool and its reliability Evidence-Based Quality Improvement Project

Limitations:

1. Selection bias where the nurses involved were those willing to participate, which could have also been the nurses supporting the mandatory intervention.
2. The study used a small sample size (n=66), significantly affecting the generalizability of the results.
3. The study was a single-site study; done in one hospital, thus affecting the generalizability of the results.

Implications:

Nurses have good attitudes towards bedside handing over and report self-confidence in implementing the principles of bedside handing over. Healthcare institutions should leverage bedside handing over to improve communication and reduce medication errors, patient falls, and pressure sores.

• Article Title

Bedside shift report: Nurses’ opinions based on their experiences.

Background: Jimmerson et al. (2020) conducted a qualitative phenomenology study to describe and identify the opinions and experiences of nursing supervisors and acute care clinical nurses regarding appropriate content for bedside shift report (BSR), the process of BSR, and the facilitators and barriers to the implementation of this intervention. The researchers recruited 22 clinical nurses and 12 nursing supervisors. The findings of this study indicated that interruptions during BSR can hinder nurses from transferring important information from one shift to the next, which is one of the causes of medical errors.

Method: Jimmerson et al. (2020) recruited 12 nursing supervisors and 22 clinical nurses from all the inpatient divisions of a not-for-profit academic medical center. They examined the differences, similarities, and relationships between the participants’ responses and identified five themes. The major theme revealed that interruptions during BSR hindered the effectiveness of transferring information from one shift to the other Evidence-Based Quality Improvement Project.

Measures: Jimmerson et al. (2020) transcribed interviews, sorted, and coded the data. They identified the main themes and analyzed the differences and similarities between the themes.

Analysis: Jimmerson et al. (2020) used the themes identified from the transcribed interviews to determine the ones in line with the study’s objectives.

Results: The findings of the study indicated five major themes. These are the need to consider time constraints and nurses’ workflow, integrate bedside shift reports with out-of-patients room hand-off, and individualize BSR. Other themes are the need to discuss patients’ critical information at the bedside and the need to identify specific information that should be discussed outside the patients’ room.

Limitations:

1. The research occurred in a single site thus limiting generalizability.
2. The results of the study were not generalizable. The researchers recruited a few participants from a single setting.
3. The results of the study could not be transferred to other settings. The experiences and opinions of nurses from the study setting could differ significantly from those of other settings.
4. The study results could be affected by recall bias. The researchers depended on the nurses’ ability to recall information

Strengths:

1. The researchers obtained a complete description of the nurses’ opinions and experiences. This is a strength because it provides reliable first-hand information.
2. The researchers could identify new ideas and issues as they emerged during the interview. Researchers could determine how to adjust their measures as new issues emerged.
3. The data gathered was natural, not artificial. The researchers obtained information from the nurses who were directly involved in BSR Evidence-Based Quality Improvement Project.

Implications:

Addressing the interruptions that occur during BSR can help reduce or prevent medication errors. Nurses need to prioritize information that they should share in the patient’s room and outside the patient’s room.

 

 

Appraisal of research findings

Through research and analysis of the findings, it is evident that an effective hand-off report increases patient safety and satisfaction, and decreases fall rates and medication errors. A good practice environment includes a quiet area that is free from distraction. It is also helpful to have a template for nurses to follow when giving report. This ensures that information is not missed. There is growing support for the use of bedside reporting that includes the patient. This practice ensures that patients feel in control of their own health and allows them to add information and ask questions.

Evidence-Based Practice Solution

Current handoff practice is done at the nurses’ station with multiple nurses present. This is noisy and information is easily missed. Evidence-based research shows that the implementation of bedside handoff increases patient safety and nurse satisfaction (McAllen, 2018). The practice council, after seeking input from the nurses on the medical/surgical unit, have created a short bedside report template that includes generic patient information, health problem, current intravenous medications and treatments, allergies, and level of fall risk. Research shows that the use of a template such as the ISBAR form increases nursing satisfaction by improving communication and increasing efficiency Labriole, et al., 2018)Evidence-Based Quality Improvement Project. As communication and accountability improve, patient safety will also improve.

Education will be provided in the form of emails, one-to-one sessions that include hand-outs and the new template for the hand-off report (Labriole, et al., 2018). After each staff member has been educated in a projected two-week period, the practice of bedside reporting will begin. Nurses will report any confidential information including test results that have not been given to the patient yet prior to entering the patient’s room.

Evaluation of the practice solution will involve conducting surveys to evaluate the satisfaction of the nurses after 60 days post-implementation. Falls and medication administration error data will be compared using a period of 3 months pre-and post-implementation. Barriers to successful hand-off report include nurses arriving late for their shift, codes or other events happening during shift change, and resistance to change Evidence-Based Quality Improvement Project.

References

Jimmerson, J., Wright, P., Cowan, P. A., King‐Jones, T., Beverly, C. J., & Curran, G. (2020). Bedside shift report: Nurses’ opinions based on their experiences. Nursing Open, 8(3), 1393-1405. https://doi.org/10.1002/nop2.755

Labriole, J., MacAulay, C., Williams, K., Bunting, D. R., & Pettorini-D’Amico, S. (2018). Implementing bedside shift report. Nursing, 48(3), 1–4. https://doi.org/10.1097/01.nurse.0000529809.90912.30

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McAllen, E., Stephens, K., Swanson-Biearman, B., Kerr, K., & Whiteman, K. (2018). Moving shift report to the bedside: An evidence-based Quality Improvement Project. OJIN: The Online Journal of Issues in Nursing, 23(2). https://doi.org/10.3912/ojin.vol23no02ppt22

Slade, D., Murray, K. A., Pun, J. K., & Eggins, S. (2019). Nurses’ perceptions of mandatory bedside clinical handovers: An Australian hospital study. Journal of nursing management, 27(1), 161-171.https://doi.org/10.1111/jonm.12661 Evidence-Based Quality Improvement Project