Path to Home B d id Shift Report Bedside R t ( (BSR) ) Bedside Shift Report • The Canadian Council on Health Services Accreditation (CCHSA) suggests patient safety can be impro improved ed b by emplo employing ing effecti effective e mechanisms for transfer of information at interface points including shift change change. Purpose of BSR • • • • • To place the patient central to all information involving their care To promote patient safety (PALE) To improve the effectiveness of communication among caregivers To allow opportunity for caregivers to ask and respond to questions To provide a standard approach to handoff communication Benefits Of Bedside Shift Report • Allows the incoming nurse to visualize their patients earlier in their shift hift • Allows confirmation of previous shift report information between the outgoing and incoming staff members • Gives patients and families the opportunity to ask questions and clarify information • Patients and families are seen as partners with staff and Physicians in enhancing patient safety and understanding their plan of care p Patient Participation Principles Patients are encouraged and supported to participate in the level of care and decision-making desired, building on their strengths to enhance control and independence. • Will vary from patient to patient. • Can vary from day to day: • Physical/emotional/cognitive factors • Clinical condition • Competing C ti responsibilities ibiliti • Home and work Patient Participation p • • • • BSR must happen in the patient’s room with the patient and/or family. This includes isolation rooms. Involving patients in report must be individually d t determined. i d Some patients may prefer passive engagement ( (e.g. jjustt listening). li t i ) Family Participation • The patient must give consent for any family members to be present during the BSR • Families are seen as active allies/partners in the patient’s plan off care • Families are encouraged and supported to participate in the nurse change of shift report when consent is given by the patient • Participation will vary from family to family. Benefits of Patient and Family Presence/Participation • • Opportunity for the bedside nurse to receive information from the patient and family. Patient’s Patient s and family may clarify misinformation • 4 Drains not 1 • CXR already done • Doctor said he can go home BSR Confidentiality Concerns • • • A Privacy Impact Assessment has been completed by Covenant Health’s Information and Privacy Department. Consent/permission for the BSR will be obtained with the patient at each shift change. If family members are present during the BSR, we need to ensure that we ask the patient’s permission to have the family present. Sharing g of Sensitive Information • • Use critical thinking/ judgment to guide the information that is discussed and your response to information that is being shared shared. If there is information that you feel should not be shared out loud, loud the outgoing/incoming Nurse can speak outside of the room after the BSR is complete. p The 4 Components of BSR • • • • BSR Forms & Patient Status Update to Charge Nurse Shift Introduction Outgoing Nurse & Incoming Nurse Roles Charge to Charge Report Bedside Shift Report Forms & Patient Status Update to Charge Nurse • The Outgoing Bedside Nurse will be filling out prior to the end of their shift to g discuss with the incoming Nurse. Bedside Shift Report (BSR) Diagnosis: _________________________________ ADOD: ______________ Patient Label Where the patient is from: _________________ Mobility: __________________ Goals of Care: _________ Additional Precautions: _______________________ Date: Nights Days Evenings Significant Vitals (T, HR, BP, RESP, O2 sats) Chem Strips IV – Rate / Site / Solution In/Outs Drains/Wounds/Skin Condition Elimination • The Bedside Nurse will update the Charge Nurse with patient status changes provide information for to p Charge Nurse to Charge Nurse Report. Diet Tests/Procedures Behavior PRN Medications Given Abnormal Lab Work Patient Concerns/Notes Safety Checks: (PALE) Up date every Shift:‐ Medworxx Kardex medicus White board Patient Identification Lines/Drains and Airway D Name Band Visible IV Pump & Line Verification/Dated Allergy Band/Allergies Reviewed O2 (Connected, Modality, Rate, Position) E Fall Drains/Foley/Suction (Patent, Connected, Empty) Risk Updated Alarms Environmental Scan (Ask 3, Room Tidy, Call Bell) N Prior to Change of Shift The outgoing/incoming Bedside Nurses must review the Unit Assignment Sheet to find out who they are giving/receiving report to/from. Shift Introduction Is a quick two-five minute team h ddl lled huddle db by th the Ch Charge N Nurse at the start of each shift summarizing: GNCH “Shift Introduction” Agenda (Test Concept Units) Date_____________ I. Unit____________ Key Concepts for the Day: A. Key Messages B. Commitment to Action C. Patient Safety • • • • Key Concepts for the Day Operational Review (How we are doing on measures of interest) What’s happening today on your unit Staffing Variances II. III. IV. V V. Introduction of New Staff to the Team: Education: Family Conferences: What’s What s Happening Today: A. Today’s Discharges/Patient Transfers B. Potential Next Day Discharges C. # of OCP beds D. Observation/Certified Patients E. Patient Appointments (Refer to Fasting Book) F. # of Isolations G. Diagnostic Imaging/Procedure Patient Preparations (Refer to Fasting Book) H. Sickest Patients on the unit/ Compassionate Care Charge Nurse to Charge Nurse Report After the Shift Introduction, the Incoming Charge Nurse and Unit Clerk will receive shift report (patient status updates) from the Outgoing Charge Nurse on each patient. p The Charge to Charge report will occur while the g bedside shift report Bedside Nurses are receiving Bedside Shift Report-Every Report Every Shift Change Outgoing Outgo g Bedside eds de Nurse u se Prior to end of shift completes the Bedside Shift Report Form & provides Patient Status Updates to the Charge Nurse for next shift At Patient Patient’s s bedside provides bedside shift report with Incoming Bedside Nurse & Patient Completes Patient “Safety Check” Incoming Bedside Nurse Receives shift report at the Patient bedside Updates the Patient Whiteboard Completes C l P Patient i “S “Safety f Check” BSR Introduction Script Outgoing Outgo g Bedside eds de Nurse u se “Hello Mr./Mrs. XXX, I’m going home now. XXX will be yyour nurse today/tonight. Is it ok if I discuss our time together with XXX ? Could you please Incoming Bedside Nurse “Hello (patient’s name), it’s nice to meet/see you” (as you are checking the patient’s wristband 2 p patient identification)) tell XXX your full name and date of birth”. “Please Please listen and share any other information you would like us to know” ***“I am going to update your bedside whiteboard”.*** hit b d” *** Giving Bedside Shift Report Outgoing Outgo g Bedside eds de Nurse u se Describe why the patient was admitted (Diagnosis/plan) Provide the patient status update from your shift (using the BSR form) Safety checks (PALE) with Incoming Nurse Prior to departure p from room-“You are in great hands. Thank you for allowing me to care for you” Incoming Bedside Nurse Receives report Safety checks (PALE) with Outgoing Nurse Prior to departure from room- “I will ill b be b back k shortly, h tl I will ill need d tto receive report on my other patients” Handoff Between Different Shifts As yyou are waiting g to g give/receive yyour BSR : • Start to update your bedside whiteboards (date and names)) • Review your patient MAR and organize your medication carts • Answer any call bells • Tidyy up/prepare pp p p patient bedside for the shift Bedside Shift Report Video http://www.youtube.com/watch?v=hbxPRhttp://www youtube com/watch?v hbxPR ra6RE Frequently Asked Questions What if the patient asks too many questions during the BSR? “Mrs. Smith, great question. Let Becky and I check all of these IV drips so we don’t don t make a mistake and then I will answer your questions” Frequently Asked Questions What if the outgoing g g nurse is delayed y due to an emergent situation (code blue on the unit at shift change)? • It will be the charge nurse’s nurse s responsibility to reassign patients or provide the BSR for the incoming g Nurse ((as they y would have received the patient status update from the outgoing nurse prior to shift change) Frequently Asked Questions What if the patient has not slept all night or has had a difficult/exhausting day? • You may choose to give the BSR outside of the patient room,, but the safetyy checks must still be p completed by the outgoing and incoming Nurses together. Frequently Asked Questions How do we get report for our partners patients? • You buddy nurse and other Nurses on the unit will have access to the BSR sheet to refer to at all times if need be • You will also give your partner nurse a handover report on your assigned patients when you leave the unit for a break. BSR Scenarios/Role Play Getting g Started: Create g groups p of threes & designate g roles • Outgoing Nurse -fill out a BSR form for one shift & review the outgoing nurse script on process tool & scenario cards • Incoming Nurse - review incoming nurse script on process tool • Patient P ti t / family f il memberb review i scenario i card d