Evidence-Based Information about the Benefits of Bedside Handoff - Essay Example

Evidence-Based Information about the Benefits of Bedside Hand-off The need for safe hand-offs about patients is a much discussed topic among nurses and other health care professionals and also the consumers and government agencies (Trossman, 2009). The methodology of shift handover is different from institution to institution and unit to unit. According to an observational study conducted at Riley hospital in Indianapolis, it was found that there was a wide variability in the process of nursing hand-over, while in some units the oncoming nurses gathered in a room to hear the hand-off, in other units one-to-one hand-off was given (Trossman, 2009). The time spent in the hand-off lasted from 30 minutes to one hour. While some nurses reported lack of real-time information pertaining to the patient during hand-offs, others reported unnecessary lag time between coming to duty and seeing the patients. This lag time was a hindrance for proper functioning of the nurses because of inability to answer call lights and delayed response to to the complaints of the patients. Another major hurdle in the variability of hand-off system was increased number of errors (Trossman, 2009). According to the Joint Commission (2000), one of the leading causes of sentinel events in a hospital setting is failure in proper communication during shift hand-off (Laws and Amato, 2010). Traditional shift reporting is often repetitive, unstructured and inconsistent as far as information is concerned. According to Johnson and Web (1995; cited in Laws and Amato, 2010), traditional hand-offs "are frequently subjective in their content and accompanied by value judgments and labeling of patients." Mosher and Bontomasi (1996; Laws and Amato, 2010) opined that traditional shift hand-off also lacked in planning of care. This is evident from the study by Jordan et al (1991; cited in Laws and Amato, 2010) in which "only 12% of change-of-shift reports included care planning and 2% included evaluation of nursing care." Traditional hand-off methods also deliver poor information (OConnell et al, 2008). From this it is evident that traditional hand-off methods have several disadvantages and research has shown that these disadvantages can be tackled by implementing bedside reporting. Cline (cited in Trossman, 2009) reported that bedside reporting has many benefits like review of the patient together, review of physician and medication orders, participation from the patients and their families and establishing of patient goals. Also, since the documentation is review together by the out-going and incoming nurse together, making phone calls for doubts is limited. Real-time information is good, especially in patients in whom the clinical features change rapidly. A number of potential errors like delivery of wrong medications and continuing of stopped orders can be averted. Another major advantage with bedside reporting is the improvement in patient safety like noting of allergy alerts and positioning suctioning machine besides the patient (Truran; cited in Trossman, 2009). By the time hand-off ends, the nurses would have seen all their patients and the time lag due to office hand-off is not there. In some situations, patients get used to a particular nurse and they may feel uncomfortable when another nurse takes over. The uneasiness can be minimised when the patient sees that the outgoing nurse hand over everything about the patient to the incoming nurse. The time spent in bedside reporting is minimal. According to Timonen and Sihvonen (2009), the average time per patient in bedside reporting is 3 minutes. Bedside reporting is a collaborative approach and helps new nurses and nurse trainees to get accustomed to the process of hand-over and be familiarized with the operation systems of the unit and various unit protocols. According to Cline, "as a profession, we should be promoting the use (cited in Trossman, 2009) of bedside shift reports at hospitals everywhere." Bourne (2000; cited in Caruso, 2007) opined that bedside reporting enhances patient empowerment, causes involvement of the patient and their family members in the treatment of the patient and provides inputs from the patient for diagnosis and management. Cahill (1998; cited in Caruso, 2007) reported that in his study, patients expressed that their involvement in bedside reporting improved their physical condition. The patients opined that bedside reporting ensured "a safe and professional transition of patient care from one nurse to the next" and ruled out any chances of misconception. According to Kelly (2005; cited in Caruso, 2007), bedside reporting enhances a rapport between patients and nurses. Similar reports were demonstrated by Minick (1995; cited in Caruso, 2007) in a study on critical care nurses wherein the researcher examined that bedside reporting helped "connecting with the patient." Such an approach helped in early detection of patient problems. According to JCAHO, (2005, cited in Caruso, 2007), the goals of nursing are to "improve the accuracy of patient identification", to “improve the effectiveness of communication among caregivers” and to “encourage the active involvement of patients and their families in the patient’s own care as a patient safety strategy.” Similar goals were set by the Joint Commission (2007). All these 3 goals are achievable through bedside reporting (Caruso, 2007). Laws and Amato (2010) opined that bedside reporting brings in new issues when compared to traditional shift hand-off like "confidentiality; length of report; and discussion of sensitive items such as a new diagnosis, test results, and issues surrounding difficult or non-compliant patients." Similar opinion was demonstrated by Caruso (2007) also. According to Richard (1989; cited in Laws and Amato, 2010), "one of the benefits of bedside report for the staff nurse is the oncoming nurse’s ability to immediately confirm the previous shift’s report by visualizing the patient and getting a baseline assessment to compare against changes during the shift." Such a method also allows panning by the nurse, prioritize patient care and manage the work load in a efficient and effective manner. Bedside reporting allows team work by all nursing staff anf the patient will be able to witness safe transfer of information. Anderson and Mangino (2006; cited in Laws and Amaro, 2010) concluded that, "patients involved in their care are less anxious and more likely to follow medical advice, start treatments earlier, and, therefore, are able to select lower-risk interventions and litigate less." The researchers opined that such a strategy leads to individualized care and plan of action and causes active planning and participation. Thus bedside reporting or hand-off allows collaborative team work between nursing staff and nurse and patient, ensures safe and professional delivery of information between care-taking nurses, decreases patient anxiety, enhances patient satisfaction and allows nurses to manage work load efficiently and give priority to the more sick patients. References Caruso, E.M. (2007). The Evolution of Nurse-to-Nurse Bedside Report on a Medical- Surgical Cardiology Unit. MEDSURG Nursing, 16(1), 17- 22. Connell, B., Macdonald, K., and Kelly, C. (2008). Nursing handover: It’s time for a change. Contemporary Nurse, 30, 2-11. Laws, D., and Amato, S. (2010). Incorporating Bedside Reporting into Change-of-Shift Report. Rehabilitation Nursing, 35(2), 70- 74. Trossman, S. (2009). Shifting to the bedside for report. The American Nurse, 7. Timonene, L., and Sihvonen, M. (1999). Patient participation in beside reporting on surgical wards. Journal of Clinical Nursing, 9, 542- 548. The Joint Commission. (2009). National Patient Safety Goals. Accreditation Program: Hospital Read More