Enhancing Patient Safety by Implementing Bedside Handovers in the Emergency Department
Background
No one type of nursing handover has been shown to be effective in terms of nursing process outcomes and patient outcomes (Smeulers et al., 2014). Evidence indicates that bedside handover can minimize incidences of patient falls, over-time costs, and discharge times (Sherman et al., 2013; Mardis et al., 2016; Gregory et al., 2014). At the workplace’s Emergency Department (ED), the handover is informal and only occurs at the nurse station. Some of the errors that take place because of such a handoff include but are not limited to disorderly rooms, failure to give patients their medications, incomplete orders, and IVs, which are infiltrated.
Clinical Problem Statement
Health organizations and hospital leaders are working to change nurse satisfaction and patient safety and aim to achieve both simultaneously. The Joint Commission has gone on record reporting that approximately 70 percent of all sentinel events happen because of a communication breakdown. As a result, this information fuelled the national patient safety goals implementation of standardized hands-off communication and encouraged patients to be actively involved in their individual care (Mardis et al., 2016). Ensuring that shift handoff takes place at the patient’s bedside, where the patient will be involved, rather than at the nurse’s station, is an avenue for allowing patients as well as their kin to take part in the retreatment plan. The patient and kin can clarify any information and correct any inaccuracies that may be made (McMurray et al., 2011)
Purpose of the change proposal in relation to providing patient care in the changing healthcare system
When shift handover takes place at the patient’s bedside as opposed to the nurse’s station, it allows for several things to occur. For starters, the incoming nurse can visualize the environment and the patient and have any queries they ask to be answered (Evans et al., 2012). Bedside handover is also preferable to the traditional handover because of its accuracy based on direct communication between the incoming and outgoing nurse and the patient. This kind of handover also allows for trust to be transferred between the nurses (Baker, 2010). Lastly, bedside handover encourages a successful transition for nurses entering practice environments (Evans et al., 2012).
PICOT
In the Adult Emergency Department, will involving patients in the handover process compared to reporting at the nursing station effectively decrease patient outcomes over an 8-week time frame?
Literature search strategy employed.
Literature was searched from reliable sources with keywords including bedside handover, patient’s involvement in the traditional handover, patient outcomes, and benefits of bedside handover. The articles used to garner information had to be published in reputable journals, not more than 5 years old and peer-reviewed, to establish credibility and viability for implementation in the EBP.
Evaluation of the literature:
In the first article, the authors identified that bedside handover shifts are often fast-paced. It proposed that there needs to be an improvement in time and communication constraints in the bedside shift handover to promote safety and ease of continuity in patient care. The second article pointed out that the tailored bedside shift handover model was well-designed to contain the vital elements of the process. Therefore, all nurses need to ensure that they comply with the provisions of the compliance tool. Identifying some of the omitted parts, such as identifying the patent and poor patient interaction, proved useful in improving the implementation procedure. In the third article, several items, such as time, facility model, structure, patient involvement, communication, and sharing of information between the nurses, were identified as the standard protocols for bedside handover. The fourth article observed that a greater number of patients preferred the patient handover at the bedside owing to feelings of security and continued care. However, owing to time constraints, the nurses preferred being off-site. In the fifth article, the author showed that bedside handovers are effective evidence-based approaches that promote care continuity and, contrary to the traditional handover approaches, are safer. The fifth article highlighted the purpose of this current study; that is, there ought to be better inculcation of patients to the bedside handover process through better communication and reporting. In the sixth article, the researchers asserted that there is a need to amend the handover practices to enhance patient safety. The study identified that most facilities need culture, role, and structure change to ensure the nursing handover processes are tailored to ensure patient safety. Through the patients’ accounts, the eighth article identified some of the challenges associated with bedside shift handovers, for instance, the burden on nurses and a lack of proper understanding and handover during bedside handovers.
Applicable change or nursing theory utilized
The current EBP project will look at the effects of changing the handover process from the nursing station to the bedside, where the patient will be involved in the process. The patient outcomes will be measured over an 8-week period to determine if there are any positive or negative changes. The applicable theory for this project is Peplau’s Interpersonal Relations.
Proposed implementation plan with outcome measures
The current workplace has varied handover procedures, as observed by the different departments. The ED is the busiest department, and many patient-related errors occur in different dimensions. One such dimension is during nurse handover, which currently occurs at the nurse station. The orthopedic department has implemented the bedside handover, which has proven successful. However, the department is not as busy as the ED, and this could account for the Orthopedic Dept. success. This project will seek to implement the bedside handover process at the ED and focus on involving patients in the process. By doing so, the researcher will seek to minimize errors that often occur at the ED during handover. Some of the notable errors that occur, especially when the ED is abnormally busy, include incomplete patient orders, failure to give patients their medication, infiltrated IVs, and disorganized rooms, among others. Fewer reports on the aforementioned areas increased patient satisfaction (this will be measured using a Likert Scale questionnaire), reduced patient stay, and increased nurse satisfaction rates will determine the success of the implementation.
Discussion of how evidence-based practice was used in creating the intervention plan:
The literature review carried out earlier showed a need to change from the traditional nurse handover to one involving patients. The latter, bedside handover, has the potential to improve patient outcomes and save on hospital costs and resources. Additionally, the orthopedic department at the researcher’s place of work has successfully implemented the bedside handover, although the department is not as busy as the ED. This project will aim at replicating the success of the orthopedic department.
Plan for evaluating the proposed nursing intervention
Prior to the start of the project, the ED staff will need to be informed of the aims and expected outcomes of the same. This will also call for staff to go for a short half-day training that will help them know the do’s and don’ts when running the project. The training will also allow the nurses to ask any questions and also give their views on the changes they expect based on the current challenges they face with the traditional handover. The patient questionnaires will be prepared, as well as the nurse questionnaires. These will be administered to the patients at the end of their stay. The nurses’ questionnaires will be administered midway through the project and at the end. This will help assess any changes and challenges that may occur during the project implementation. Additionally, patient records that run 8 weeks prior to the project will be assessed to determine the average length of stay. The researcher will also look at the available data on patient-related errors that occurred during this period. These pieces of information will be useful in making comprises on the error rates prior to and after the project commences.
Identification of potential barriers to plan implementation, and a discussion of how these could be overcome:
A lack of commitment from the nurses can be a major barrier where the nurses may go back to the old way of doing things rather than commit to the new process throughout the 8-week period and thereafter. Inferior information, often referred to as the ’grapevine’ information, can be propagated among staff and could be false information that may deter the progress of the project. Additionally, change to resistance, especially among older staff, is possible as they may prefer to continue with the old system. Lastly, the HR department may delay the process if they do not approve the training sessions within the given time frame for the project. To address these issues, the departmental head at the ED will need to be involved, and they too must buy into the proposed change by having the management on board; he can ensure that all staff members comply with the new process. Further, the management will ensure that HR allocates sufficient time to conduct the half-day training within the given time frame. Non-compliance and resistance to change will also be met with disciplinary action.
References
Abuajah, G. (2020). Effectiveness of End-of-Shift Bedside Report
Baker, S. J. (2010). Bedside shift report improves patient safety and nurse accountability. Journal of Emergency Nursing, 36(4), 355-358
Bressan, V., Mio, M., & Palese, A. (2020). Nursing handovers and patient safety: Findings from an umbrella review. Journal of Advanced Nursing, 76(4), 927-938.
Evans, D., Grunawait, J., McClish, D., Wood, W., & Friese, C. (2012). Bedside shift-to-shift nursing report: Implementation and outcomes. MEDSURG Nursing, 21(5), 281-292
Forde, M. F., Coffey, A., & Hegarty, J. (2020). Bedside handover at the change of nursing shift: A mixed‐methods study. Journal of Clinical Nursing, 29(19-20), 3731-3742.
Gregory, S., Tan, D., Tilrico, M., Edwardson, N., & Gamm, L. (2014). Bedside shift reports: what does the evidence say?. JONA: The Journal of Nursing Administration, 44(10), 541-545.
Joshi, M. S., Currier, A., & O’Brien, K. (2011). Bedside change-of-shift reporting: A strategy to increase patient safety. National Patient Safety Foundation.
Malfait, S., Eeckloo, K., Van Biesen, W., Deryckere, M., Lust, E., & Van Hecke, A. (2018). Compliance with a structured bedside handover protocol: An observational, multicentre study. International Journal of Nursing Studies, 84, 12-18
Malfait, S., Eeckloo, K., Van Opdorp, L., Van Biesen, W., & Van Hecke, A. (2020). The impact of bedside handovers on relevant clinical indicators: A matched‐controlled multicentre longitudinal study. Journal of Advanced Nursing.
Mardis, T., Mardis, M., Davis, J., Justice, E. M., Holdinsky, S. R., Donnelly, J., … & Riesenberg, L. A. (2016). Bedside shift-to-shift handoffs: a systematic review of the literature. Journal of Nursing Care Quality, 31(1), 54-60.
McMurray, A., Chaboyer, W., Wallis, M., Johnson, J., & Gehrke, T. (2011). Patients’ perspectives of bedside nursing handover. Collegian, 18, 19-26.
Oxelmark, L., Whitty, J. A., Ulin, K., Chaboyer, W., Gonçalves, A. S. O., & Ringdal, M. (2020). Patients prefer clinical handover at the bedside; nurses do not: evidence from a discrete choice experiment. International journal of nursing studies, 105, 103444.
Rifai, A., Afandi, A. T., & Hasanah, A. (2020). Bedside nursing handover: patient’s perspective. NurseLine Journal, 4(2), 123-130
Sherman, J., Sand-Jecklin, K., & Johnson, J. (2013). Investigating bedside nursing report: a synthesis of the literature. Medsurg Nursing, 22(5), 308.
Smeulers, M., Lucas, C., & Vermeulen, H. (2014). Effectiveness of different nursing handover styles for ensuring continuity of information in hospitalized patients. Cochrane Database of Systematic Reviews, (6).
Tacchini-Jacquier, N., Hertzog, H., Ambord, K., Urben, P., Turini, P., & Verloo, H. (2020). An Evidence-Based, Nursing Handover Standard for a Multisite Public Hospital in Switzerland: Web-Based, Modified Delphi Study. JMIR Nursing, 3(1), e17876.
Weigand, L. (2013). Customer service: The nursing bundle. Journal of Emergency Nursing, 39(5), 454-455
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Question 
Enhancing Patient Safety by Implementing Bedside Handovers in the Emergency Department
Capstone EBP Project Proposal
In this assignment, students will pull together the capstone project change proposal components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. For this project, the student will apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.
Develop a 1,250-1,500 written project that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:
- Background
- Clinical problem statement.
Capstone EBP Project Proposal
- Purpose of the change proposal in relation to providing patient care in the changing health care system.
- PICOT question.
- Literature search strategy employed.
- Evaluation of the literature.
- Applicable change or nursing theory utilized.
- Proposed implementation plan with outcome measures.
- Discussion of how evidence-based practice was used in creating the intervention plan.
- Plan for evaluating the proposed nursing intervention.
- Identification of potential barriers to plan implementation, and a discussion of how these could be overcome.
- Appendix section, if tables, graphs, surveys, educational materials, etc. are created.
Review the feedback from your instructor on the Topic 3 assignment, PICOT Question Paper, and Topic 6 assignment, Literature Review. Use this feedback to make appropriate revisions to these before submitting.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.