Bedside Reporting: Embracing the Need for Clinical Change
Submitted by Dr. Kelly Duffy, EdD, MSN, RN
Communication is an essential part of the nursing role. Many aspects of patient care require thorough and complete reporting of conditions, procedures, medications, and follow up. The adverse events that may potentially follow from lack of appropriate reporting could be related to the lack of essential information acquired from professional communication within the patient room. The potential gaps in nursing communication, especially during shift reporting, may result in medical errors. While many clinical settings are adopting reporting procedures and handoff in the patient’s room, some are continuing antiquated reporting routine at the nursing station.
The traditional methods of reporting at the nursing station may result in mistakes or lack of addressing issues that may be otherwise discovered through providing rounds at the bedside at the beginning of each shift. The use of bedside reporting also allows for the patient to participate in his or her own care, providing an avenue for the patient to be an active part of the health team. As a part of the health team, the patient is routinely aware of care plans, interventions, progress, changes, and discharge plans. The communication at the bedside may also decrease anxiety in the patient, as the patient may distinctly feel part of the health team.
In the clinical setting, there are patients who may not be actively engaged in the plan of care due to induced sedation, coma, head injury or trauma. The benefits of bedside reporting, in cases where patients are unconscious, should be strongly considered by management when implementing change in critical care areas. Personal communication between nursing staff allows for a dual person review of accuracy for aspects of critical care, such as ventilator settings, IV drip rates, tube feedings, medications, and dressing specifications.
Communication breakdown, near misses, and adverse events are not new to the field of nursing. The urgency of the issue and recognition by Joint Commission resulted in change to the existing National Patient Safety Goal of 2006 regarding implementation of a standard approach to “hand off” communication, which includes the person-to-person opportunity to ask questions, in addition to providing a response (Joint Commission, 2012). A new goal was formulated to impact patient outcomes, including the encouragement of active patient and family involvement in care as an approach to patient safety practices (Joint Commission, 2012).
Reporting at the patient’s bedside promotes accountability of the staff and encourages participation by both the patient and family (Maxson, Derby, Wrobleski, & Foss, 2012). Bedside handoff procedures result in significant improvements in patient satisfaction, safety, professional communication, and overall patient experience (Bradley & Mott, 2012). Decreases in overtime at the end of shift results in overall fiscal savings for hospitals and nurse satisfaction rates with the process have also been reported (Tidwell, et al, 2011).
Some nursing staff may be accustomed to the tradition reporting procedures and initially resist implementation of change processes. Through extensive training and clinical education, evidence-based information can be presented to support the change in policy. Presentation of research supporting the practice of bedside reporting may even address issues and concerns of nurses impacted by the change. Information should be presented to all staff with emphasis on best practices and requirements of Joint Commission. Hospital administrators, managers, and staff educators must be aware and prepared for staff resistance and questions. Preparation for a collaborative-based approach to providing an internal training program and support of change are imperative to staff buy-in for implementation of change and continuation of safe clinical practices.
Change in reporting protocols may initially be viewed as a threat to the standing tradition of clinical procedures. Solutions aimed at improving clinical outcomes, standardization of reporting, decreasing adverse clinical events, and improving patient safety measures are imperative in clinical settings. Organized and detailed training and education within the hospital setting will provide nurses with the clinical tools and skills necessary to not only embrace new methods of reporting, but also succeed in new methods of reporting.
Bradley, S. & Mott, S. (2012). Handover: Faster and Safer? Australian Journal of Advanced Nursing, 30(1), 23-32.
Joint Commission. (2012). National Patient Safety Goals Implementation
Expectations. Retrieved from www .splashcap.com/JCAHO_2006-NPSG-3D.pdf
Maxson, P., Derby, K., Wrobleski, D., & Foss, D. (2012). Bedside Nurse-to-Nurse Handoff Promotes Patient Safety. MEDSURG Nursing, 21(3), 140- 145.
Tidwell, T., Edwards, J., Snider, E., Lindsey, A., Scroggins, I., Zarski, C., & Brigance, J. (2011). A Nursing Pilot Study on Bedside Reporting to Promote Best Practice and Patient/Family-Centered Care, 43(4)