Bedside Hand-Off Reporting Improves Nursing, Patient Care

Deciding to move the "buzz" from a crowded nurses' station to the bedside resulted in creation of a new hand-off tool.
Deciding to move the "buzz" from a crowded nurses' station to the bedside resulted in creation of a new hand-off tool.

ORLANDO, FL—Deciding to move the “buzz” from the beehive of a crowded nurses' station to the bedside resulted in creation of a new hand-off tool, with 99% of patients giving a “thumbs up” to the best practice, a study reported at the ONS 40th Annual Congress.

The project's goal was to “enhance therapeutic relationships with cancer patients by further developing oncology nurses' professional practices,” said Marie Decker, MSN, RN, AOCN®, NE-BC, HN-BC, of the Cancer Treatment Centers of America in Philadelphia, PA.

Hand-off reporting at a nurses' station can be ineffective when the “loud, escalating hum of voices” leads to occasional misunderstandings, potential errors, and important information being omitted.

However, “because the need for 24-hour care is often provided by multiple disciplines and services, communication among health care personnel is an essential component of safe, effective care,” Decker reported.

Results of a rigorous literature review educated the staff as well as facilitated the nurses' autonomy to be engaged, pilot bedside reporting, and accept the challenge of the quality improvement initiative.

A “Plan, Do, Study, Act method” was introduced along with pre- and postsurveys, scripting, and role playing. Those who championed bedside reporting were allowed to assist their peers and address challenges.

“A positive culture shift transformed the unit, as unseasoned nurses championed the practice change,” she said.

When the need for a new hand-off tool was identified, the nurses collaborated to generate an intervention in the Situation Background Assessment Recommendation (SBAR) format to provide the necessary report information. The SBAR is updated throughout the day to prevent errors and missed information, capturing a patient status synopsis within a 24-hour window.

Based on a return rate of 83%, post-SBAR implementation surveys revealed significant improvements in two dynamic measurements: communication in hand-off report increased by 86.2%, and professional practice improved by 75.8%.

“Patient feedback from qualitative surveys during this month-long pilot indicated that 99% of the patients felt more informed and endorsed full implementation of this practice,” Decker said.

This aligns with the Staggers and colleagues 2013 article, which states, “The majority of oncology inpatients would like to participate regularly in nurses' hand-offs as long as they are awake and feel well enough to do so.”

Decker reported this best practice has sparked interest from other nursing units. They plan to share their success and drive improvement by implementing bedside report and the SBAR format. “Education and coaching is ongoing,” she concluded.

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