in Acute Care Adapted from AHRQ and the Studer Group 1 Overview amp Objectives Its critical that you understand the concepts behind Bedside Shift Report and how you are expected to incorporate them into your practice here at GHS ID: 527812
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The Essentials of Bedside Shift Report in Acute CareAdapted from AHRQ and the Studer Group
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Overview & ObjectivesIt’s critical that you understand the concepts behind Bedside Shift Report and how you are expected to incorporate them into your practice here at GHSThis learning event is one part of the training plan you will participate in to ensure your knowledge and successAt the conclusion of this presentation you should be able to do the following:Define patient and family centered care and engagement and identified benefitsDefine 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 CareAt GHS we are committed to providing patient and family centered careWhat 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 processesPatient 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:
m
embers of the health care team
a
dvisors 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!4Slide5
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 participatePatients and family actively participate in reportReport should take about 3-5 minutes per patientPurpose: To engage the patient and family in hospital care To share accurate and useful information between nurses, patients, and familiesTo 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 qualityImproved communicationDecrease in hospital-acquired complications
Patient experiences of care
Time management and accountability between nurses
Decrease in time needed for shift report
Decrease in
overshift
timeAsk your manager about your unit’s patient satisfaction scores and the goals for implementation of Bedside Shift Report6Slide7
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 sleepingAsk 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 communicationBedside 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 admissionChanges in patient’s condition or episodic eventsCurrent conditionCurrent 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 RNUse of AIDET *may do abbreviated with full AIDET done during second encounterUse of SBAR to organize report
Include Patient and FamilyUse whiteboard
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Critical Elements of Bedside Shift Report continued… Setup for SuccessYour Unit:off-going Charge RN makes patient assignments to support BSSRshift change huddles occur where off-going charge RN gives overview to all on-coming nurses before dismissing for BSSRuse of standardized report form customized for your specific unit/patient populationOff-going RN :
during rounds toward end of shift tell patient/family when BSSR (Bedside Shift Report) will take placeremind 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 reportuse whiteboardask patient their goal for the shiftask patient if they have questionsdiscuss plan of care for shift and anticipated discharge dateinform patient/family when you will be back and what they can expect next11Slide12
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 watchedRemember to turn in the completed form to your Manager/Supervisor or CNS/CNE13Slide14
Critical Elements of Bedside Shift Report – SPECIAL SITUATIONSSometimes there will be special situations where accommodations to Bedside Shift Report (BSSR) must be madeYour Manager will define how these situations are to be handled on your unitBSSR must still occur but accommodations will be madeUnstable 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 change14Slide15
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 roomTalking 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 watchedRemember to turn in the completed form to your Manager/Supervisor or CNS/CNE17Slide18
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 upPatient ID is verifiedEnvironment 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 careOur 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 approachReal-time shared assessments with another RN for critical patient care elements such as wounds, drains, central linesAccountability! 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 & HIPAAAs healthcare providers, you may be concerned about violating HIPAA, especially when family members are present at shift reportIt is important to know that because bedside shift report is part of treatment and normal operations, it does not violate HIPAAHealth information can be disclosed for:TreatmentHealth 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 & HIPAAFAQs: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 privacyCan 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 & HIPAAFAQs: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 partPatients 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 RoundingYour 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/CNEDon’t forget to complete the Bedside Shift Report Video Form and turn it in as directed for creditSo 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!
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Putting It All Together…