Provide 2 reasons why nursing report is important to quality patient care.

1. In Charge and On Time Impacting patient care through improving time management DeAnna Middleton, RN; Janet Michaels, RN; Jody Wasielewski, BSN, RN; Lisa Chismar, RN; Mary Jo Kocan, MSN, RN, CNRN University of Michigan Hospital Neurosurgical Intensive Care Unit • ABSTRACT • Communication failure has been cited as the most frequent cause of medical errors.7 The Joint Commission recommends standardizing handoff to ensure patient safety and improve outcomes.3 • Our handoff process includes a group charge report to give information necessary for making assignments, consisting of a brief overview of current patients, admissions and discharges. This is followed by a more in depth report from the bedside nurse and validation of the neurological assessment by the oncoming and off-going nurses. We created a computerized spreadsheet for group charge report detailing pertinent patient information on a standardized template in an effort to improve time management. • We believe that by streamlining group charge report we have improved the quality of our handoff process. The majority of time is now spent getting bedside report versus group charge report. Staff surveys show improved compliance with jointly performing the bedside neurological exams. Incidental overtime related to late report has also been reduced, which has increased staff satisfaction by allowing staff to leave on time. • STAFF FEEDBACK • "LOVE IT!!!" • "Rarely was ever out on time and also rarely • documented my OT(with old system)“ • "Always felt rushed(with old system)" • "Definitely NOT able to perform neuro exam • (with old system)“ • "With the old system the majority of staff did not • leave on time, but most didn't document 5-10-15 • minutes of OT. 12 hours is long enough and report • shouldn’t take 45minutes.“ • "With the old system, I'd run into people waiting to • leave after report and they were skipping neuroexams. • “I have more time to spend at the bedside giving report and checking the neuro exam then wasting time in charge report getting info I didn’t need. CONCLUSION • Encouraged review of patient care orders and vital signs for patient safety during bedside report. • Allowed for introduction and goal setting with patient’s and family to promote family centered care. • Provided time for bedside neuro exams to be done more frequently and consistently. • Decreased risk of information being missed due to staff member rushing through report. Improved staff preference • Decreased average number of incidental OT hours for a yearly savings of $3,750.00. POSTER OBJECTIVES INTERVENTION • Provide 2 reasons why nursing report is important to quality patient care. • State 3 barriers to effective communication of patient information during change of shift report. • Identify 4 positive outcomes from introducing a standardized template for change of shift report. This new tool decreased the amount of time spent in group charge report from 20 minutes to less than 5 minutes. This improvement in time management has: INTRODUCTION Staff expressed dissatisfaction with our unit’s process for change of shift report. They felt they were often delayed in doing initial patient assessments because of group charge report. This was also causing them to stay beyond the end of their scheduled shift to give report to the oncoming nurse. Inour unit we are given 30 minutes to complete the 3 part process of our shift report. Our time was being inefficiently spent in group charge report causing nurses to rush through bedside nursing report and skip bedside neurological co-assessments in an effort to leave on time at the end of their shift. A group was formed to look at ways to improve time management. The objective was to improve staff satisfaction by decreasing incidental overtime secondary to the lengthy reporting process. EVIDENCE • FUTURE DEVELOPMENT • Continue to gather data on patient safety and quality indicators. • Perform quarterly audits to ensure continuous quality improvement • and to meet evolving unit needs. • Encourage other unit and areas to implement small changes to • make a significant impact on patient care and safety. SURVEY RESULTS Although the need for improving communication around handoffs in healthcare is well documented, there is little evidence on effective tools to do this. The Joint Commission recommendations for improving handoff communication include: standardizing critical content, developing standardized tools and forms and allowing opportunity for questions.3A review of handover practices in healthcare identified that although the ideal process for nursing handovers has yet to be identified, technological solutions need to be explored.1Nelson and Massey4 found that using an electronic template for change of shift report resulted in improved relevance of information transmitted, as well as reduced end of shift overtime. Performing shift report at the patient’s bedside has been shown to improve patient satisfaction with their nursing care as well as staff satisfaction with the pertinence of information received in shift report.5 • Effectiveness was measured using two methods. Nursing satisfaction and compliance performing the bedside neurological co-assessment were measured using a self-reported survey. A comparison of overtime data before and after implementation of the new group reporting process was used to determine if staff were able to leave on time at the end of their shift. INCREASED NEURO EXAM COMPLIANCE REFERENCES BIBLIOGRAPHY 1) Matic, J., Davidson, P., Salamonson, Y. (2010). Review: Bringing Patient Safety to the Forefront through Structured Computerization during Handover. Journal of Clinical Nursing. 20, 184-189. 2) Nelson, B., Massey, R. (2010). Implementing an Electronic Change-of-Shift Report Using Transforming Care at the Bedside Processes and Methods. The Journal of Nursing Administration. 40(4), 162-168. 3) The Joint Commission Center for Transforming Healthcare. (2011). Standards and National Patient Safety Goals. Retrieved from: http://www.centerfortransforminghealthcare.org/ projects/about_handoff_communication.aspx on 2/28/2011. www.uofmhealth.org Anderson, C., Mangino, R. (2006) Nursing Shift Report: Who Says You Can’t Talk in Front of the Patient? Nursing Administration Quarterly. 30(2), 112-122 Wilson, M. (2007) A Template for Safe and Concise Handovers Medsurg Nursing. 16(3), 201-206 Dufault, M., Duquette, C., Ehmann, J. (2010) Translating an Evidence-Based Protocol for Nurse-to0Nurse Shift Handoffs Worldviews on Evidence-Based Nursing. Second Quarter, 59-75 Contact InformationDeAnna R. Middleton, R.N. deakit@umich.edu 734-936-6520