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The Essentials of Bedside Shift Report

in Acute CareAdapted from AHRQ and the Studer Group

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Overview & Objectives

• It’s critical that you understand the concepts behind Bedside Shift Report and how you are expected to incorporate them into your practice here at GHS

• This learning event is one part of the training plan you will participate in to ensure your knowledge and success

• At the conclusion of this presentation you should be able to do the following:

– Define patient and family centered care and engagement and identified benefits

– Define Bedside Shift Report and purpose– List the critical elements of bedside shift report– Discuss the benefits and challenges of bedside shift report– Identify what HIPAA says about bedside shift report

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Patient- and Family-Centered Care

At GHS we are committed to providing patient and family centered care

What are the Core Concepts of patient- and family-centered care?

Dignity and Respect - listening to and honoring patient and family ideas/choices and using patient and family knowledge/values/beliefs and cultural backgrounds to improve care planning and delivery

Information Sharing – communicating and sharing complete, unbiased information with patients and families in useful ways. Patients and families receive timely and accurate details so they can take part in care and decision making

Involvement – encouraging and supporting patients and families in care and decision making at the level they choose

Collaboration – inviting patients and family members to work together with health care staff to develop and evaluate policies/programs and care processes

Patient and family engagement is an important part of providing patient- and family-centered

care

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What is Patient and Family Engagement?

Actively and Purposefully involving patients and family members as:

• members of the health care team• advisors working with clinicians and leaders to improve

policies and procedures

Our goal at GHS is to create a set of conditions where patients, family members, clinicians and

hospital staff are all working together as partners to improve the quality and safety of care

Bedside Shift Report supports this goal!

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What is Bedside Shift Report?

• Nursing staff conducts change of shift/hand-off of care reports at the patient’s bedside

• Patients can identify a family member or close friend to participate

• Patients and family actively participate in report• Report should take about 3-5 minutes per

patient• Purpose:

– To engage the patient and family in hospital care – To share accurate and useful information between

nurses, patients, and families– To ensure safe hand-offs – To improve quality care and optimal patient

outcomes

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Why Focus on Bedside Shift Report?• Transitions in care have potential for medical errors • More than 70 percent of adverse events are caused by

breakdowns in communication among caregivers and between caregivers and patients1

• Research shows bedside shift report can improve:– Patient safety and quality

• Improved communication• Decrease in hospital-acquired complications

– Patient experiences of care– Time management and accountability between nurses

• Decrease in time needed for shift report• Decrease in overshift time

Ask your manager about your unit’s patient satisfaction scores and the goals for

implementation of Bedside Shift Report

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What are the Critical Elements of Bedside Shift Report?

On Admission:• All patients/families must receive BSSR brochure and

education on what to expect (These will be available from print-shop for inclusion in admission

packets by May 1, 2014. In the interim, your Manager will share copies with you and direct you on where to get them for patient education)

• Ask patients/families if they want to be awakened to participate should they be sleeping

• Ask patients if they want family to participate in BSSR or if they want them to be asked to step outside of the room for privacy

Prior to end of Each Shift:• Notify pt/family during last round that bedside report will

occur soon • Verify pt permission for family to be present during report

(HIPAA)• Check Pain Score/Adm. meds if needed

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Critical Elements of Bedside Shift Report continued…

For EVERY Change of Shift/Caregiver:

• Bedside Shift Report is required as part of handoff communication

• Bedside Shift Report must be done inside room (exceptions: sharing of sensitive information such as psychosocial family dynamics, new diagnosis or lab results that the patient is not aware of yet. Your Manager/CNS/CNE will discuss unit specific examples with you during your

unit specific training)

• Bedside Shift Report should focus on sharing priority clinical and care information with collaborative, focused assessments of high-risk findings and equipment

• Bedside Shift Report should only take about 5 minutes per patient

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Critical Elements of Bedside Shift Report continued… What information must be shared?

Minimum Information Required to be Shared During BSSR:

• Patient name, diagnosis and procedures since admission

• Changes in patient’s condition or episodic events

• Current condition

• Current orders and goals reviewed, anything requiring follow-up

• IV site check, verification of fluids and rates

• Visual check and tracing of all lines, tubes, drains to patient

• Visual check of all dressings

• Equipment check

• Scan of environment for safety/hazards

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Critical Elements of Bedside Shift Report continued… What are the KEY Components?

• Active Patient ID (Wrist Band/DOB)

• Manage up oncoming RN

• Use of AIDET *may do abbreviated with full AIDET done during second encounter

• Use of SBAR to organize report

• Include Patient and Family

• Use whiteboard

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Critical Elements of Bedside Shift Report continued…

Setup for Success

Your Unit:• off-going Charge RN makes patient assignments to support BSSR• shift change huddles occur where off-going charge RN gives overview to all on-coming nurses

before dismissing for BSSR• use of standardized report form customized for your specific unit/patient population

Off-going RN :• during rounds toward end of shift tell patient/family when BSSR (Bedside Shift Report) will take

place• remind patient/family that BSSR is to ensure a safe hand-off of care• ask patient/family if they need anything prior to BSSR so focus can be on hand-off of information• prepare for BSSR by having essential information/labs/etc. ready• take WOW in room during BSSR to check meds and pertinent information with on-coming RN• do a brief teach back with patient on a medication or other patient education you’ve covered

during your shift

On-coming RN :• carry report form for documenting information shared during report• use whiteboard• ask patient their goal for the shift• ask patient if they have questions• discuss plan of care for shift and anticipated discharge date• inform patient/family when you will be back and what they can expect next

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Video of Bedside Shift Report –

What does RIGHT look like?

•  Acute Care  BSSR- Right Way 

https://www.youtube.com/watch?v=H8eEo1Kfzfo&feature=youtu.be • ER BSSR  -   Right wayhttps://www.youtube.com/watch?v=q1OJ61jHnsc

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Video of Bedside Shift Report – What does RIGHT look like?

• Use the Bedside Shift Report Video Form you printed at the beginning of this training to answer questions about the video you just watched

• Remember to turn in the completed form to your Manager/Supervisor or CNS/CNE

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Critical Elements of Bedside Shift Report – SPECIAL SITUATIONS

• Sometimes there will be special situations where accommodations to Bedside Shift Report (BSSR) must be made

• Your Manager will define how these situations are to be handled on your unit

• BSSR must still occur but accommodations will be made

– Unstable Suicidal/Homicidal/Violent patients

– Patient Unresponsive and no family present

– Patient Confused and Disoriented

– Patient is non-compliant

– Sensitive information that should not be included in BSSR

– Family member always tries to take over BSSR and prevents you from having effective communication

– Oncoming RN will be late

– Code or other emergency is occurring on unit during shift change

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Critical Elements of Bedside Shift Report - What does Non-Compliance look like?

• Giving report at the nurse’s station, in the break room, or away from the patient’s room

• Talking about personal or unit issues when you’re in the patient’s room (i.e. staffing is short today)

• Using the excuse that the patient was “sleeping”

• Not educating patient/family on BSSR

• Not following BSSR expectations and outlined process

• Not involving the patient and family

• Not using whiteboard

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Video of Bedside Shift Report –

What does WRONG look like?

•   Acute Care  BSSR-Wrong Way  https://www.youtube.com/watch?v=xj0rK0u-SbA&feature=youtu.be • ER BSSR - Wrong Way https://www.youtube.com/watch?v=45PAIffJf3o

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Video of Bedside Shift Report – What does WRONG look like?

• Use the Bedside Shift Report Video Form you printed at the beginning of this training to answer questions about the video you just watched

• Remember to turn in the completed form to your Manager/Supervisor or CNS/CNE

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What About Support Staff…What are they doing during Bedside Shift Report?

• Depending on the structure of your unit, on-coming support staff will round on their assigned patients with the off-going support staff

• Their Bedside Shift Report looks like this:– Off going introduces on-coming and manages them up– Patient ID is verified– Environment is scanned for safety – Ensure patient is clean and comfortable– Ask patient if they need anything “We have time now…)– Write name on whiteboard– Inform patient when they will be back

• When you have completed BSSR on all of your patients, you must meet with any support staff assigned to your patient group and conduct report and delegation of assigned tasks and patient needs for the shift

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Benefits of Bedside Shift Report – WINS for the Patient

• Our patients will feel involved in their care

• Our patients will feel informed which increases trust and compliance with their plan of care

• Our patients will be more satisfied because they know what things will be done and monitored during the next shift

• Our patients will not feel “alone” during change of shift. Many patients perceive the 2 – 3 hours around the change of shift to be a time when no one is around. Sentinel events also occur more often during this time

• Our patients will know who their nurse and other caregivers are at the beginning of the shift

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Benefits of Bedside Shift Report – WINS for the YOU!

• More time! Bedside shift report is proven to reduce time in report as you have to keep report focused on the patient and what is reported follows a standard approach

• Real-time shared assessments with another RN for critical patient care elements such as wounds, drains, central lines

• Accountability! Bedside shift report means you don’t walk into a patient room after report and find an infiltrated IV site or a urine soaked bed

• Your patients are safer!

• If you have questions the off-going care provider is right there with you

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Bedside Shift Report & HIPAA

• As healthcare providers, you may be concerned about violating HIPAA, especially when family members are present at shift report

• It is important to know that because bedside shift report is part of treatment and normal operations, it does not violate HIPAA

• Health information can be disclosed for:– Treatment– Health care operations– Payment

• HIPAA acknowledges incidental disclosures may occur

• It’s not a HIPAA violation as long as:– reasonable safeguards are done to protect privacy– you only disclose or use the minimum necessary

information

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Bedside Shift Report & HIPAA

FAQs:• Is a covered entity (in this case an RN or support tech)

required to prevent any incidental use or disclosure of protected health information?Answer: No. Your responsibility is to ensure that you are making reasonable efforts to safeguard patient privacy

• Can physicians and nurses engage in confidential conversations with other providers or with patients,even if there is a possibility that they could be overheard?Answer: Yes. HIPAA does not prohibit providers from talking to each other and to their patients. Providers’ primary consideration is the appropriate treatment oftheir patients. Reasonable precautions could include using lowered voices or talking apart from others when sharing protected health information

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Bedside Shift Report & HIPAA

FAQs:

• How does all of this relate to doing Bedside Shift Report?

Answer: The HIPAA Privacy Rule recognizes that oral communications often must occur freely and quickly in treatment settings. Thus, covered entities are free to engage in communications as required for quick, effective, and high-quality health care

Examples – • Health care staff may orally coordinate services at hospital

nursing stations• A physician may discuss a patient’s condition or treatment

regimen in the patient’s semiprivate room• Health care professionals may discuss a patient’s condition during

training rounds in an academic or training institution

Your main responsibility with Bedside Shift Report is to take reasonable precautions such as using lowered voices or talking apart from others when sharing protected health information

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Putting It All Together…

• Our Hospital is committed to patient and family engagement and YOU play a critical part

• Patients and families won’t engage if they believe that you don’t want them to so you have to show them through things like Bedside Shift Report and Rounding

• Your job is to make it safe for them to be involved in their care, not just as patients but as partners

Bedside Shift Report is an evidence-based method of improving patient satisfaction,

safety and outcomes when used along with other tools and initiatives on your unit!

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• For more information or questions, please see your Manager, Supervisor or CNS/CNE

• Don’t forget to complete the Bedside Shift Report Video Form and turn it in as directed for credit

• So what’s next? You will be receiving, or already have received, information from your unit leadership about next steps. These include additional training using simulated bedside shift report , competency validations and on-going monitoring and support to make sure we keep Bedside Shift Report going and working for you and our patients

Thank You!

Putting It All Together…