Transforming Care at the Bedside

– At Cornwall Community Hospital (CCH) the health care providers’ vision is to provide each patient exceptional service with the integrity, care, accountability, respect, and engagement (ICARE) that they would expect to receive themselves. As part of providing excellent and safe patient care to achieve that vision, CCH has now instituted twice daily Bedside Shift Reports (BSR) and Safety Checks. CCH is the first community hospital within the Champlain LHIN to implement the BSR practice, and the first of all hospitals to implement the strategy in a Psychiatry unit.

BSR is a clinical expression of engaging patients and families as essential partners in the health care team. It gives an opportunity for the patient to be more involved in the care they are receiving, and is only carried out after obtaining consent. When units are changing staff members from one shift to another, nurses will discuss their chart at the bedside so all the information they have is shared right in front of the patient. This alleviates any uncertainty the patient may have and gives them a chance to ask additional questions. CCH hopes this practice will help keep patients better informed about their medications, tests, progress, and overall plan for care. BSR also comforts patients by reminding them that they are receiving the safest and highest quality of care throughout their stay. “Bedside shift reports allows for greater communication between staff members as well as opening the door to input from the patient. It will ensure that we are remaining 100 per cent transparent and are taking responsibility for all that we do,” said Gloria Hamel-Lauzon, RN and Professional Practice Leader.

Communication during nurse shift changes is extremely important for ensuring that the handoff is safe and effective. A recent study found that more than 70 per cent of adverse events are caused by breakdowns in communication among caregivers, and between caregivers and patients. Studies have also shown that BSR improves patient safety and service delivery. For example, a 2009 study showed a decrease in patient falls during change of shift, dropping from one to two patient falls per month, to one patient fall every six months, according to the Agency for Healthcare Research and Quality.

The World Health Organization’s Collaborative Centre for Patient Safety Solutions recommended that health care organizations should be implementing and standardizing their approach to handover communication between staff, change of shift, and patient transfer. BSR meets these recommendations along with Accreditation Canada’s standards within Required Organizational Practices, and the College of Nurses of Ontario practice standards. The Joint Commission International Center for Patient Safety contends that effective communication is the, “hallmark of health care organizations that are successful in providing safe, high quality care”.

The time it takes to complete a BSR should be no more than six minutes depending on the condition of the patient. The nurses will also conduct a thorough safety check and update the bedside care board to ensure that the environment is safe. The patient has the option of having one family member in the room with them while the report is being communicated, and can make arrangements with the nurse if they are not comfortable with the report at their bedside.

“This not only raises our level of accountability, it will also improve our engagement between staff and patients. By making the commitment to performing Bedside Shift Reports and safety checks, we are creating a healthier work environment and demonstrating how we live our ICARE values to their fullest every day,” said Jeanette Despatie, Chief Executive Officer.