Bedside Reporting as a Nursing Practice Change Using SBART

Introduction: The Case for Bedside Reporting

There are numerous areas within nursing that demand change in everyday healthcare practice. More often than not, irrespective of the healthcare setting, an inventive group is required to conduct research and facilitate change. Working as a clinical educator in a hospital setting, there are numerous practices that require change or upgrading. Following a review and research analysis, the focus of this paper is bedside reporting, which is currently lacking within the hospital.

Bedside reporting occurs between the outgoing and incoming nurse at a patient's bedside during a shift change. The meeting is designed to facilitate patient engagement in the exchange of real-time information during the transition. This provides both the incoming nurse and the patient the opportunity to ask questions and verify significant information regarding the patient's history and care plan before the outgoing nurse leaves (Rush, 2012). Most importantly, bedside reporting is aligned with patient-centered procedures — in contrast to the provider-centered care model — and is anticipated to have a positive impact on both organizational nursing output and patient satisfaction.

Justification for Bedside Reporting as a Practice Change

At present, the hospital provides in-patient nursing services to numerous patients. Nurses are expected to change shifts at least two to three times every day. The problem currently being faced is that a significant amount of time is wasted in recording patient medical history, diagnosis, and medical status. In addition, the prevailing system of recorded handoff results in several medical errors within the organization. Some of the medical mistakes currently being experienced include patient blood incompatibility, air embolism, and catheter-associated urinary tract infections. There are also significant communication breakdowns between nurses and between nurses and patients. There is a clear need to introduce bedside reporting within the hospital, as it will generate significant benefits (World Health Organization, 2013).

The proposed practice change will enhance patient safety and quality. In particular, bedside reporting provides an opportunity to ensure efficacious communication between nursing personnel, patients, and their immediate families. This new practice will augment patient safety alongside service delivery. In addition, enhanced communication during the shift report can help identify and address medical errors. Bedside shift reports will also aid the hospital in improving patient experience of care. According to the World Health Organization (2013), hospitals that implemented bedside reporting demonstrated a rise in patient satisfaction scores and improvements in the relationship between nurses and patients. Furthermore, the proposed practice change is expected to produce a significant decrease in the average number of call lights activated by patients at the change of nursing shifts.

The proposed practice change will also have a positive impact on the hospital through increased nursing staff satisfaction. Nurses are able to visualize their patients more quickly, practical learning between senior and newer nurses is improved, and accountability increases. Nurses are also able to communicate more frequently and efficiently, resulting in fewer medical errors. For instance, research conducted by Anderson and Mangino (2006) found that bedside shift report produced numerous positive results, including the recovery of numerous hours of incidental time in the initial two pay periods of the study, increased staff satisfaction from patient visualization within 20 to 30 minutes of shift start, increased physician satisfaction owing to more informed patients, and an overall sense of improved patient safety.

Another justification for the proposed practice change is improved time management and accountability among nurses. According to the World Health Organization (2013), following the execution of bedside reporting, nursing staff reported a better capability to prioritize their responsibilities during shifts and a general decline in overtime. For instance, one research study demonstrated a decline in over-shift time by 100 hours within the first two pay periods on a general surgical unit of 32 beds. Another study demonstrated a cost reduction of $8,000 directly linked to decreased shift reporting time. This underscores the need for instituting bedside reporting to increase nurse accountability, improve shift-time efficiency, and generate cost savings across medical departments.

Key Stakeholders in the Proposed Practice Change

Determining the key stakeholders involved in the nursing practice can be both straightforward and challenging. The criteria used to identify stakeholders include the parties directly affected by the change and the parties with the authority to implement such a change within the healthcare setting. The following individuals within the hospital have been identified as key stakeholders in the proposed bedside reporting practice change: clinical operators, clinical educators, nurses directly involved in patient care, the facilities rendering treatment, and the organization as a whole.

Clinical operators will be impacted by the proposed change because they are the supervisors and managers responsible for oversight of clinical personnel. In this regard, clinical operators are responsible for endorsing and subsequently carrying out the change within the organization.

Clinical educators within the healthcare setting are responsible for teaching both new and existing personnel about the newly proposed practice change and for providing guiding principles to facilitate its effectiveness. In essence, clinical educators will provide instruction regarding the tools identified by the research. Clinical teaching deals with the acquisition of the skills and competencies required for effective practice in healthcare professions. Changes in practice for healthcare professionals place increasing significance on the systematic learning of key skills and demonstration of how to acquire and apply them. As a newly introduced hospital practice, clinical educators will be responsible for patient-based and patient-centered teaching and learning, which requires awareness of not only nurse learning but also patient welfare (Eta et al., 2011).

Nurses are the stakeholders who will be most significantly impacted by the proposed practice change, as they will be tasked with the primary duties of adopting and executing the bedside report on a daily basis. Nurses are responsible for the safe handoff of the patient between shifts, including engagement of the patient and family. Essentially, nurses are responsible for explaining the process, inviting the patient and family to participate in the bedside shift report, and providing the bedside report form to the patient. Without the nurses' full involvement, it will be difficult to assess the efficacy of the change.

Patients are also key stakeholders who will be affected by the practice change. Bedside reporting places patients at the center of care, giving them a more active role in the care being provided. Patients will largely benefit from the proposed change through increased patient safety and inclusion in their plan of care. By conducting bedside reporting during nursing shift changes, patients have the opportunity to ask questions, voice their concerns, and communicate care objectives — all of which are steps that increase patient safety.

Recommended Best Practice and the SBART Tool

The best practice recommended for implementation in the hospital setting, based on the evidence summary, is the SBART tool. The key advantage of this practice is that it offers an organized framework not just from nurse to nurse, but also from nurse to patient. Owing to its structure and context, the SBART tool is anticipated to provide accurate and concise patient and healthcare information without overlooking critical facts, while providing the oncoming nurse with an appropriate picture of the patient and his or her healthcare needs.

Moreover, this tool will place patients at the center of care, enabling both the oncoming nurse and the patient to ask questions. Therefore, any information that might have been overlooked or lost during the traditional shift change is retained. According to Blom et al. (2015), SBAR provides a framework for communication between members of the healthcare team regarding the patient's status and medical condition, and enables the gathering, organization, and exchange of data and information, along with an effective strategy to cultivate and enhance teamwork. It offers an opportunity to maintain focus during the transfer of information and to ensure that the information is concise, precise, and easy to understand. Furthermore, this practice will improve patient safety by providing a structured framework for the content of patient-related communication.

Conclusion

One of the key practices lacking in the hospital is the introduction and implementation of bedside reporting. Changes in nursing shifts necessitate the effective transfer of information between the outgoing and incoming nurse to avoid adverse events and medical errors. Bedside shift reporting is a clinical expression of engaging patients and families as indispensable partners in the healthcare team. This proposed practice change will facilitate proper communication during care transitions — such as nurse shift changes — which is critically important for ensuring that patient handoff is both safe and effective. Permitting patient involvement during the bedside reporting process allows them to learn and gain insight into what has occurred during the shift and what the next steps in their care plan will be. Moreover, this practice will give patients the opportunity to ask questions and contribute input into the healthcare process. Overall, this proposed practice change will significantly benefit the hospital through improved patient safety and quality, enhanced patient experience of care, greater nursing staff satisfaction, and improved time management and accountability among nurses.

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