Switching from Traditional Reporting to Bedside Reporting - Essay Example

Change Practice: Traditional Hand-over to Bedside Reporting Change in Practice From the literature review, it is evident that bed side reportinghas more advantages than traditional office hand-off in terms of increased patient satisfaction, increased involvement of the patient and the family members in the care of the patient, decreased time consumption, decreased time lag between coming to duty and seeing the patient first, proper transfer of complete information pertaining to the patient, decreased chances of error in medication and increased patient safety. Thus, change from traditional hand-off to bedside reporting is beneficial to both patients and nurses and this change can be implemented using Rosswurm and Larrabees model for evidence based change (Rosswurm and Larrabee, 1999). Implementation of change based on Rosswurm and Larrabees model: Step 1: Assess Need for Change in Practice The problems arising due to traditional hand-off method must be discussed with the nurse managers and other nurses involved in the team. Traditional hand-off consumes lot of time and the transfer of information is partial. It is often repetitive. The nurses may discuss unnecessary things irrelevant to the care of the patient, thus contributing to waste of time. A time lag develops between meeting the patient first time after coming to duty. Wrong dose medications and medications for which orders have been given to discontinue can continue to be given. The patient will also be apprehensive as to whether professional transfer of appropriate information has occurred between the out-going nurses and the incoming one. Many researchers (Laws and Amato, 2010) have opined that traditional hand off methods are subjective as far as their content is concerned and on several occasions labeling of patients and value-based judgments occur. These disadvantages with traditional hand-off methods can be overrided by introduction of bed-side reporting. Step 2: Link Problem with interventions and Outcomes The hand-off problems include "failed communication, omissions, distractions, lack of or illegible documentation, lack of utilization of transfer forms, incomplete medical records, lack of medication reconciliation,and lack of easy accessibility to information" (Friesen et al, 2008). The JCAHO (cited in Caruso, 2007) has set several goals of nursing care like improvement in the accuracy of identification of the patient, improvement in the effectiveness of communication between various care giving staff and family members and encouragement of active involvement of the members of the family and the patient in the patient safety strategy. All these goals can be met by introducing bedside reporting. The main outcomes of such an intervention is enhanced patient satisfaction and patient safety which are very essential in any clinical practice. Bed side reporting has some disadvantages too, like length of report, confidentiality, inability to discuss new diagnosis and new test results in front of the patient and also inability to discuss sensitive items pertaining to the patient and the disease of the patient (laws and Amato, 2010). However, these disadvantages are not of much importance when compared to the the positive outcomes. Step 3: Synthesize best evidence According to Greaves (1999), bedside hand overs are better than traditional hand-off methods because they offer immediate solution to many of the problems of the patient. The researcher opined that in bedside reporting, individualized care is emphasized when compared to traditional method. Mckenna (1997) reviewed literature pertaining to bedside reporting and opined that "patients involved in handovers gain access to information that is thought to provide them with comfort and speed recovery." Caruso (2007) demonstrated that the goals of nursing could be met with bedside reporting. Thus there is enough evidence in literature implying the need to change from traditional hand-off to bedside reporting. Step 4: Design a change in practice To design change in practice, excellent communication skills and leadership qualities are very essential (Hussay, 1997). The change must be announced to the nurses of the team in advance and the nurses must be encouraged to participate in the change. The reactions of the colleagues must be shared and their valuable proposals be discussed and taken into account. During these interactions issues like dealing with confidential information, non-overlapping of shifts and lateness to work must be discussed. Several meetings between various groups of nurses must be organized with intentions to clarify any short comings and to reach upon a consensus idea. Once consensus on the idea of change is achieved, a pilot bedside handover session in which a senior staff members is participating must be arranged. Following, this the change must be implemented based on this pilot session. Step 5: Implement and evaluate the practice change The implementation involves asking the nurses to strictly follow bedside reporting in all shifts. Opposing forces occur due to differences in the opinion about the particular change amongst health professionals. For example, some nurses may perceive the change as unnecessary un-timely and pointless and feel threatened by the change and provide resistance. Some others may embrace the change and the challenges it possess (Bozac 2003). As such, nursing is a field that requires a good deal of adaptation by an individual due to its many changes and fundamental processes. People involved in change can only feel empowered by a vision if they are able to understand and participate in the change. Therefore it is essential that communication is a two way process in order to make the change management process successful. Without proper communication in this field of work, there are going to be roadblocks preventing a smooth transition from one way of doing things to a transformation into an improved interpretation of how the work is and should be carried out. Patton (2006) suggested that those involved in change should be well informed and made to understand why the change is proposed and what may happen so that the chances of the change being successfully implicated will rise. Any resistance to change has to be identified and managed appropriately for successful change. Those health professionals who are resistant to change need to be involved to develop a sense of involvement through participation and to feel part of the team Huttinson (2000) suggested that such people need to be guided by evidence based research, valid data and facts. It is important to know that not all resistance is negative. Constructive criticism, structured debates and disagreement are a part of development process and give all team members involved a chance to voice concerns and worries (Bolognese, 2002). The evaluation of can be done based on evaluation of change criteria used in the study by Kassean and Jagoo (2005) (Refer table-1). Table-1: Evaluation of bedside handover from patients perspectives (adopted from Kassean and Jagoo, 2005) 1. Do the outgoing and incoming nurse come to your bedside to handover in the morning and in the evening during the change of shifts? 2. How do you feel about their presence at your bedside to discuss your care? 3. Do the nurses involve you in your care planning? 4. Are you satisfied with the way information about your care is passed on and followed by the incoming nurses? 5. How do you feel issues of confidentiality are handled? 6. Any other comments you would like to make to improve on shift handovers? Step 6: Integrate and maintain the practice change Following implementation and evaluation of the change practice, a meeting must be held where the incharge discusses about the benefits or disadvantages of the implemented change with evidence. The difficulties of the nurses with the new change must be addressed and nurses must be asked to give proper and accurate feedback and issues pertaining to this feedback must be handled. Such discussion sessions must be carried out until all the nurses of the team become fully conversant with the change. References Bolognese, A. F., 2004. Employee resistance to organisational change. Retrieved on 29th May, 2010 from http://www.newfoundation.com/orgtheory/Bolognese721.html accessed 011206 Bozac, M. G., 2003. Using Lewin’s Force Field Analysis in Implementing a Nursing Information System, CIN:computers,informatics, Nursing, 21 (2), 80-87. Friesen, M.A., White, S.V., and Byers, J.F. (2008). Patient Safety and Quality, Retrieved on 29th May, 2010 from http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=nursehb&part=ch34 Greaves, C. (1999). Patients perceptions of bedside handover. Nurs Stand., 14, 32–5. Hussay D. Creativity, innovation and strategy. In: Hussay D, editor. The innovative challenge. Chiclester: Wiley. Hutchinson, C., 2000. Making Change Happen: models for change. Retrieved on 29th May, 2010 from http://www.biothinking.com/applysd/making-change-happen.httm Kassean, H.K., and Jagoo, Z.B. (2005). Managing change in the nursing handover from traditional to bedside handover – a case study from Mauritius. BMC Nurs., 4, 1. McKenna, L.G. (1997). Improving the nursing handover report. Prof Nurse., 12, 637–9. Patton, R. A. & Mccalman, J., 2006. Change Management: A guide to effective implementation, London: Sage Publications Ltd Rosswurm, M.A., and Larrabee, J.H. (1999). A Model for Change to Evidence-Based Practice. Journal of Nursing Scholarship, 31, 4, 317- 322. Read More