In October 2008, staff members at Riverside Methodist Hospital (RMH) in Columbus, OH, approached Sheryl Tripp, MSN, RN-BC, nurse manager for the gynecology/gynecology-oncology (gyn/gyn-onc) surgical unit, in hopes of changing the way nurses were issuing patient reports.
Tripp reviewed the current process on the gyn/gyn-onc surgical unit for patient reports, along with the unit's Press Ganey patient satisfaction scores, and decided it was time to implement a new process for patient reports and end-of-shift reports. Press Ganey scores help facilities measure patient satisfaction with their care and offers guidance to help provide a higher level of healthcare.
Tripp led an effort to implement a new reporting process, Transferring Accountability at the Bedside (TABS), that includes an interaction between nurses ending and beginning shifts. Both nurses visit the patient's bedside together, as opposed to each nurse reporting separately.
The new process has improved the unit's Press Ganey scores dramatically, Tripp says.
Time for a change
For as long as Tripp could remember, nurses on her unit used tape recorders to create patient reports. At the end of each shift, the nurse would go into the designated recording room to record patient reports. The nurse coming in for the next shift would listen to that report and attend to patients and daily tasks.
"This process is all right, but most of the time nurses would end up doing verbal reports because the tape recorder would fail, or they had problems understanding what the nurse was saying on the recording," says Tripp.
The unit's Press Ganey scores were hovering around 50% for nurse-to-patient communication and safety during the patient's stay. Tripp knew it was time to honor her nursing staff members' requests to help improve patient safety and nurse communication.
To start, Tripp ran a series of two-week trial methods on her unit that involved doing a few different types of reports: with the tape recorder, a written report, a verbal report, and a bedside report.
"We told the staff members each week the style of reporting we would do, and then asked them to report back to us with any feedback," says Tripp.
While the trial period was going on, Tripp would visit patients' rooms and talk with them about each of the reports, specifically the bedside reporting.
On RMH's gyn/gyn-onc surgical unit, semi-private and private rooms are available, and there are patients who share rooms. Tripp wanted to make sure patients did not have any problems with bedside reporting with respect to fear of violating the patient's privacy.
"During this trial period, a majority of the patients I talked with liked the bedside process, so I decided this was the right process to move forward with and focus on developing," Tripp says.
Education and implementation
Tripp, her clinical nurse manager, the women's health clinical nurse specialist, and a research nurse at RMH formed an evidence-based practice team to research information on bedside reporting.
While researching, the team chose three different articles that highlighted the pros and cons to bedside reporting. Nursing staff members received these articles as education and to prepare for the upcoming change in reporting.
As part of the TABS process, when the two nurses enter a patient's room, the nurse coming off shift introduces the nurse coming on shift to the patient. Then, the nurse now on shift checks the patient's armband and asks the patient's name and date of birth.
The new nurse on shift writes his or her own name, along with the patient's name on the white board located in each patient room.
"The nurse also makes sure there is an opportunity for the patient to ask questions," says Tripp. "This allows the patient to comment on treatment or clarify why they are on a particular medication."
In addition to having the two nurses work together and converse more with the patient, a report sheet is kept outside the patient's room.
"The report sheet is used as a guideline for the nurses to communicate with one another, especially if a float nurse comes to the unit," says Tripp.
After a month of using the new TABS process, Tripp and her team sent out surveys to the nursing staff members along with the patients on the unit to solicit opinions about the new bedside reporting.
Overall, the new process of reporting was well received, and many nurses liked the process better than they had expected to like it.
"Nurses reported that they were now clocking out on time, as opposed to leaving a half an hour after their shift has ended," says Tripp.
Patients were also happy with the bedside reporting. "Some patients told me that they were considering having family members spend the night with them because they were scared," says Tripp. "But with the new bedside reporting, the patients said they felt safe because they were aware of what was going on and who was taking care of them."
Great success
In addition to receiving good reviews from the nursing staff members and the patients on the gyn/gyn-onc surgical unit, the TABS process vastly improved the Press Ganey scores.
The three areas on which RMH focuses are:
- How well nurses keep patients informed
- How well staff worked together to care for patients
- Whether or not staff includes patients in decision making
Prior to implementation, Tripp's unit scores were hovering around 26%, 50%, and 60% satisfaction for each of the three focuses. Just three weeks after implementing reporting at the bedside, each focus area reached 99% satisfaction.