6 Main

Nurse to Nurse Handoff Report

Patient Safety

Exceeding Expectations

Why are we here today?

• Patient Safety is at risk.– 3 hour time gap of patients not being seen during report time.

– The most dangerous time for a patient is between care givers.

• What we are doing today is not working for staff, patients or MD’s Patient Safety

Introduction• Communication is a two way process of reaching mutual understanding, in 

which participants not only exchange information but also create and share meaning (Business Dictionary, 2010).

Nurse Communication• A highly complex skill that is rarely taught in nursing school.  • Often decisions are made and a plan of care is developed based on 

communication given and received.  • Much of our nursing practice is dependent on the communication 

between two nurses, nurse and the patient, or physicians and other members of the multidisciplinary team.

• Our nursing assessment is based on the previous nurses’ communication of a patients’ baseline

• many decisions are made based on the communication between two caregivers

Face to FacePRO

allows for questions and answers to occurnurses reflect on their past shift, and demonstrates thoughtfulness toward oncoming staffcreates a smoothing transition between caregiversDecreases errors of omission; increases congruency in the exchange of information.Increases nurse accountability and teamwork between shifts.  Allows for clarifying questions to be asked, and eliminates incongruence in patient assessment.  

CONInterruptions, distractions, noisy environmentThere is incongruence between the reported information and the actual condition of the patient. Unless all staff participate and are good citizens for the unit, this will not be successful, causing more errors and confusion among caregivers.

What has happened for others (Mercy) who have tried this….

• In an effort to improve outcomes, increase patient satisfaction and display best practice; we will be instituting bedside report. – Hospitals that have utilized this process have found many benefits to bedside 

communication including:• Reassuring the patient that the staffs work as a team.• Patients are encouraged to ask questions and add information• Better informed patients are less anxious and more likely to be compliant with medical care.

• Patients who are involved in their healthcare are more satisfied.• The oncoming nurse visualizes the patient immediately and prioritizes care for the shift.

• Nurses are more prepared to answer MD questions and prioritize care with PCT’s & NA’s.

• Experiential learning occurs.• Bedside report decreases the potential for near misses through a transfer of responsibility and trust using standard communication.

• There is increased accountability throughout the shifts and levels of care.

Bedside ReportPro:

Decreases errors of omission; increases congruency in the exchange of information.Increases nurse accountability and teamwork between shifts.  Allows for clarifying questions to be asked, and eliminates incongruence in patient assessment.  

Con:

Unless all staff participate and are good citizens for the unit, this will not be successful, causing more errors and 

confusion among caregivers.

Plan for Bedside Reporting Process

Who:• Training for bedside report will occur from Dec 1‐Dec 5. 

– All staff including RN’s, PCT’s, NA’s & HUC’s will attend a mandatory 60 minute in‐service. 

– The go live date for bedside report is December 13, 2011. All in‐services will be held on the eleventh floor in the staff lounge; room 11049.

Patient Safety

HUC’s role

• Field phone calls from family members, physicians, radiology, etc.

• Transfer urgent calls to Free Charge phone

Today’s Education Goals• Staff will verbalize the rationale for initiating the Bedside 

Report Process

• Staff will understand and embrace the individual roles and responsibilities of all levels of care that impact the process.

• Education sessions will allow staff to visualize the process, ask questions and integrate the process in to their work process.

• Utilization of Bedside Report will improve communication between healthcare providers, increase accountability and ensure safe patient care

Patient Safety

STEPS FOR BEDSIDE REPORT PROCESSEveryone plays a part!

PCT’s/ NA’sPREP TIME• These tasks are to be completed 30‐60 minutes before shift change (6am‐

7am, 2pm‐3pm, 6pm‐7pm & 10pm‐11pm).

• Pass ice & water.• Stock rooms with patient care items.

• Offer assistance with toileting; change incontinent patients.• Safety checks: call bells in reach, bed alarms on, beds locked & in low 

position.• Tidy tray tables, rooms, place personal items within reach.

• Offer assistance with positioning.• Prepare patients for OR, appointments, hydro, dialysis, etc.

• Complete task lists.

NA/PCT Flow• Receive & review written NA/PCT report tool from previous shift. 

• Work with previous shift PCT/NA to prep patients for appointments, meals, get patients out of bed.

• Check utility rooms for tidiness.

• Obtain BGM’s.

• Within the first 45 minutes of the shift meet with other team members and receive RN hand‐off and plan for the day.

RN’s• Discuss all sensitive information prior to entering patient’s room 

– (family dynamics, full block patient issues, new diagnosis that has not been told to the patient). 

• Attention should be given not to label the patient which can make impartial care difficult for subsequent shifts.

• Off‐going RN introduces on‐coming RN to the patient and explains how bedside report will work.

• Ask the patient if it is ok to give report in front of visitors; if not ask visitors to leave until report is over.

• Check name and allergy band.Patient Safety

RN’s• Using SBAR method give verbal hand‐off:

– SITUATION: Briefly explain why the patient is here and the diagnosis– BACKGROUND: Significant past medical history, surgeries, and 

procedures.– ASSESSMENT: Current condition of the patient.  

• LOOK at: IV Sites, PCA/CADD settings, IVF, drains, nerve blocks, chest tubes, Foleys, wounds, etc.….look under the covers. Discuss pain medication regime. 

– RECCOMMENDATION: What needs to be done to progress patient along toward achieving their goals for the day?  What is needed for discharge? What tests are planned for the day?

Patient Safety

RN’s • White board is updated by the off‐going RN. 

– Avoid using medical jargon.  • Allow for questions/concerns from patient. 

– “Is there anything that we discussed that you did not understand?”• Ask the patient if there is anything they need before you leave the room.

– Assure the patient you will be back to check on them within the hour.• Your first set of patient rounds is now completed for the day ☺

• Thank the patient. “Mr. S. thanks you for allowing us to care for you today. I hope that you are feeling better soon.” Patient Safety

Time Line

12/1/11EducationSessions

12/02/11Education Sessions

12/05/11Education Sessions

Patient Safety

Dec 13-17“Go LIVE”

Questions?

• Who wants to be a part of the pilot the first week as a “Report Champion”?

• Questions about the pilot?Patient Safety

1. Prepare: Discuss all sensitive information prior to entering patient’s room (family dynamics, full block pa-

tient issues, new diagnosis that has not been told to the patient). Attention should be given not to label

the patient which can make impartial care difficult for subsequent shifts.

2. Introductions: Off-going RN introduces on-coming RN to the patient and explains how bedside report

will work.

3. Patient involvement: Ask the patient if it is ok to give report in front of visitors; if not ask visitors to leave

until report is over.

4. Safety Check: Check name and allergy band.

5. Verbal Report: Using SBAR method give verbal hand-off:

SITUATION: Briefly explain why the patient is here and the diagnosis

BACKGROUND: Significant past medical history, surgeries, and procedures.

ASSESSMENT: Current condition of the patient.

LOOK at: IV Sites, PCA/CADD settings, IVF, drains, nerve blocks, chest tubes, Foleys,

wounds, etc.….look under the covers. Discuss pain medication regime.

RECCOMMENDATION: What needs to be done to progress patient along toward achieving their

goals for the day? What is needed for discharge? What tests are planned for the day?

6. Update: White board is updated by the off-going RN. Avoid using medical jargon.

7. Q & A: Allow for questions/concerns from patient. “Is there anything that we discussed that you did not

understand?”

8. Conclude Report: Ask the patient if there is anything they need before you leave the room. Assure the

patient you will be back to check on them within the hour.

9. Close: Thank the patient. “Mr. S. thanks you for allowing us to care for you today. I hope that you are feel-

ing better soon.”

6 Main RN Nurse to Nurse Report Steps

“6M Exceeding Expectations and Keeping Patients Safe”

1. Prepare: Discuss all sensitive information prior to entering patient’s room (family dynamics, full block pa-

tient issues, new diagnosis that has not been told to the patient). Attention should be given not to label

the patient which can make impartial care difficult for subsequent shifts.

2. Introductions: Off-going RN introduces on-coming RN to the patient and explains how bedside report

will work.

3. Patient involvement: Ask the patient if it is ok to give report in front of visitors; if not ask visitors to leave

until report is over.

4. Safety Check: Check name and allergy band.

5. Verbal Report: Using SBAR method give verbal hand-off:

SITUATION: Briefly explain why the patient is here and the diagnosis

BACKGROUND: Significant past medical history, surgeries, and procedures.

ASSESSMENT: Current condition of the patient.

LOOK at: IV Sites, PCA/CADD settings, IVF, drains, nerve blocks, chest tubes, Foleys,

wounds, etc.….look under the covers. Discuss pain medication regime.

RECCOMMENDATION: What needs to be done to progress patient along toward achieving their

goals for the day? What is needed for discharge? What tests are planned for the day?

6. Update: White board is updated by the off-going RN. Avoid using medical jargon.

7. Q & A: Allow for questions/concerns from patient. “Is there anything that we discussed that you did not

understand?”

8. Conclude Report: Ask the patient if there is anything they need before you leave the room. Assure the

patient you will be back to check on them within the hour.

9. Close: Thank the patient. “Mr. S. thanks you for allowing us to care for you today. I hope that you are feel-

ing better soon.”

6 Main RN Nurse to Nurse Report Steps

“6M Exceeding Expectations and Keeping Patients Safe”

OFFGOING

RN

Assess for pain; medicate accordingly.

Ensure IVF, tube feeds are adequate.

Assist with positioning, bathroom needs, check for incontinent patients.

Neaten room, place items within patients reach.

Complete nursing task lists and ensure orders are signed off.

Prepare written PCT/NA Report tool.

Have dry erase materials available to update whiteboards.

Inform the patient that you will be in shortly to give bedside report.

11-7 RN’s will print and separate Nurse Hand-Off reports by patient assignment.

ONCOMING RN

Gather Nurse Hand-Off reports and flo cart or med cart.

Be prepared, punched in and ready to receive report at 0700, 1500, 1900 & 2300.

Bedside report should take 3-5 minutes per patient.

PREP TIME

These tasks are to be completed 30-60 minutes before shift change

(6am-7am, 2pm-3pm, 6pm-7pm & 10pm-11pm).

“6M Exceeding Expectations and Keeping Patients Safe”

OFFGOING

RN

Assess for pain; medicate accordingly.

Ensure IVF, tube feeds are adequate.

Assist with positioning, bathroom needs, check for incontinent patients.

Neaten room, place items within patients reach.

Complete nursing task lists and ensure orders are signed off.

Prepare written PCT/NA Report tool.

Have dry erase materials available to update whiteboards.

Inform the patient that you will be in shortly to give bedside report.

11-7 RN’s will print and separate Nurse Hand-Off reports by patient assignment.

ONCOMING RN

Gather Nurse Hand-Off reports and flo cart or med cart.

Be prepared, punched in and ready to receive report at 0700, 1500, 1900 & 2300.

Bedside report should take 3-5 minutes per patient.

PREP TIME

These tasks are to be completed 30-60 minutes before shift change

(6am-7am, 2pm-3pm, 6pm-7pm & 10pm-11pm).

“6M Exceeding Expectations and Keeping Patients Safe”