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Bedside Report Initiative Final ReportJordan FurstenauFerris State UniversityAbstractThe purpose of this paper is to provide insight into a bedside report initiative in a surgical intensive care unit (SICU). The project was designed to improve health care outcomes and was completed over the course of the final semester of the author’s Bachelor of Science degree. The report includes an overview of the project, explains the project goals, and provides additional information helpful to understanding the project’s completion. Several recommendations from team members are also provided. The bedside report initiative involved interdisciplinary collaboration and an extensive time log was recorded during the projects entirety. The report also contains a project evaluation form and a sample staff survey. Bedside Report Initiative Final ReportProject name: ___Bedside Report Initiative__________Project Manager Name: __Jordan Furstenau_________Date of Report: ___August 2nd, 2013_______________A. Project OverviewThe final result of the beside report initiative involves a trial period of bedside report exchange between nurses in the SICU. Nurses will be required to exchange report at the bedside for at least a month or until staff surveys are distributed and reviewed. At the end of the trial period there will be a survey distributed (appendix A) to each staff member regarding bedside report. The staff will then discuss the results of both the survey and the trial at the next scheduled mandatory staff meeting. This will allow for evaluation of the bedside report initiative and suggestions to measure its effectiveness. The purpose of this project was to improve the current method of report utilized by nurses working in the SICU at McLaren Greater Lansing. Discrepancies in traditional nurse-to-nurse shift report were being noted. There had been verbalization of dissatisfaction of oncoming nurses regarding nurses from previous shifts in the SICU. The change involves utilizing bedside report as a method to improve the quality of care provided on the unit. The previous method of giving report involved a brief meeting between nurses at the nurses’ station. The purpose of the initiative was to develop a method of shift change report that improved patient health outcomes. A main goal of the project was to make bedside report mandatory. The initiative is intended to improve patient health care outcomes. There are many quality and safety concerns with the previous method of shift reporting. The previous method of report did not hold nurses accountable for the patient. It also did not provide an avenue of introduction to the patient. Nurses that have to give report at the bedside may be more accountable as the nurse taking over can do a quick evaluation of the patient and see what is needed. Bedside report also enables the relieving nurse to introduce the nurse taking over and provide a more effective transition. Change-of-shift handoff at the patient’s bedside allows the on-coming nurse to visualize the patient and ask questions of the previous nurse and the patient (Maxson et al, 2012). Communication is extremely important in all aspects of healthcare. Nurses must be able to effectively communicate in order to advocate for patient safety, delegate appropriately, and ensure professionalism. Bedside report improves the communication between nurses and has an impact on patient outcomes in the SICU. Report involves communication between nurses when transferring care of that patient while in the hospital. Many units use various methods of report and have different outcomes. In other words, what works here may not work there and vice versa. Nurses have many responsibilities in order to comply with the standards set forth by their employer as well as the standards provided by the ANA. According to the ANA, the registered nurse must strive to enhance the quality and effectiveness of nursing practice (2010). At my place of employment there are many opportunities for quality improvement and the nurses work hard to ensure standards are being met. This includes the current method of reporting and the quality improvement needed in this area. An article by Cairns, Dudjak, Hoffman, and Lorenz describes the quality improvements that occurred in a project utilizing bedside shift report. They concluded that, “project outcomes confirmed positive relationships between bedside shift reporting and end-of-shift overtime, call light usage, and patient and nurse satisfaction” (Cairns et al., 2013). Another article supported the effectiveness of bedside report as well. An article by Reinback and Fitzsimons concluded that, “Bedside report has been shown to empower staff, improve patient involvement, and allow for a safe transition of care... It establishes and promotes trusting relationships between patients and staff members, which serve as a foundation for teamwork” (2013). There is plenty of literature available supporting the positive impact of bedside report on patient outcomes. B. Project Goal(s) and Objectives/Deliverables Objectives MetA detailed list of the objectives completed for the bedside report initiative is provided. There was a lot of activity within the group and a few improvements to the project have been made since the progress report was written. I was able to meet with the unit supervisor and the unit training supervisor and discuss the implementation of the bedside report initiative. They were both very supportive and offered suggestions for increasing the success of the project. The unit training supervisor has joined the team and they will discuss the project at the next staff meeting to increase participation and moral on the unit. We had our first official team meeting on 6/20/2013. The topics discussed included the work packages, individual schedules, and a group contract. We assigned roles and figured out what each person would be responsible for. There was no official group contract but we discussed the terms of our group and individual expectations. It was a very exciting meeting and everyone seemed very positive. I was able to spend a lot of time with individuals while working on the unit and received a tremendous amount of feedback. I met with several nurses that had extensive nursing backgrounds, respiratory therapists, and physicians. A resident suggested that when they receive report from the Intensivist they do it at the bedside. She said it gives a better picture of the patient. I couldn’t agree more and was glad to hear all the positive feedback.I designed the staff survey that will be distributed among staff members at the mandatory staff meeting in August or September, 2013. It offers the staff the chance to be involved with the project and we also may pick up some interesting suggestions. It is anonymous and the supervisor would really like to have staff support for an easy transition. I was able to develop an individual leadership plan that will definitely help me develop into a more effective leader. I really enjoy the pressure that comes with leading this project and researching methods and theories is a great way to pass some of my free time. I have been reading a lot of business articles and picking up little tidbits of information that will facilitate my growth as the project leader.The group will roll out the staff surveys by the week ending September, 2013. This is a few days behind schedule but it will allow for an appropriate trial period. The next team meeting was held on 7/15/2013 and will take place on the unit in the conference room. There was discussion of concerns among group members, planning and initiating the check sheet that may be implemented with the bedside report initiative. We actually removed the check sheet from the initiative due to it being too much change all at once. We discussed the perception of the project felt by staff members. The budget is completed. I was able to spend some time researching a developing a plan to apply quality management principles to the successful execution of the bedside report initiative. I was able to spend a lot of time on this subject. I prepared a group strategy for training the staff regarding the protocol change. A trial period requiring bedside report offers the staff to be involved and hopefully increases participation. This was decided upon at the 8/1/2013 team meeting. The group was able to finalize all supporting literature and submit it to me by 8/1 in order for me to put everything together for presentation on 8/10. This will be completed after my evaluation is completed. I will have to be ready to make last minute changes if necessary in order to meet the deadlines. I have planned accordingly by getting those days off of work in order to spend time on the project. I must finalize the project and present it to the staff at the staff meeting set for August or September, 2013. The date has not been set but I will present the data and address any concerns. The unit training supervisor will help put this presentation together. The staff survey will be reviewed upon completion and allow for an assessment of the direction of the bedside report initiative and to evaluation its effectiveness. Project DeviationsThe project did not follow every task from the project scope and plan but slightly deviated in an attempt to keep the project moving forward. Several dates were adjusted to accompany group members in order to increase attendance. This was necessary to the success of the project. The initial surveys were never released; instead the group members discussed the project and offered staff to make suggestions. The results of the project are still unknown. We are going to have a trial period to allow the bedside report initiative to take effect. A survey will be presented about a month after the trial and the unit supervisor will ultimately make the decision of whether bedside report is mandatory in the SICU. A poster was never created presenting the project but this may be developed at a later date at the request of the unit supervisor or training coordinator. C. CommentsThere were two issues that needed to be addressed in order to ensure success of the bedside report initiative. The first issue involved the limited participation among staff members that may have been a barrier to success. The second issue was the negative attitude of a particular team member towards the success of the project that may have inhibited the success of the group. The first issue was brought to my attention by the unit training supervisor and her experience with protocol changes in the SICU. She stated that she has realized that the more collaboration of unit nurses the more successful the protocol changes tend to be. I did some research involved with this subject and found that it may benefit the success of the project to focus on staff support. She stated that most of the unit did not know anything about the initiative and that increasing awareness may also increase support. The second issue was brought to my attention during our last team meeting in which an individual continually argued against bedside report and was very resistant to offer any positive input. I remember her specifically saying that, “just because report is at the bedside doesn’t mean that it will make it any more effective”. I actually thought a lot about what she said and I came up with the conclusion that the more supporting research I can find, the more likely this project would be a success. I developed a plan of action to overcome both of the current obstacles presented to the bedside report initiative. The first plan of action was to increase the awareness of the project among staff nurses. I did this by speaking directly with as many individuals as possible and clearly explaining the project, the benefits, and its potential effects on patient outcomes. I also involved patients in the project and allowed them to evaluate the effectiveness of bedside report and offer suggestions. Involving patients in their care and being receptive to suggestions is believed to promote patient safety (Chitty & Black, 2011). I increased the amount of group members for individuals that wanted to participate in the project. The more people that I could get involved with the project the more likely it would be successful and the less resistant to change the staff may be. The situation of the negative team member was first addressed with that individual with an open communication session. I presented the individual with my concerns and gave the individual a chance to vent his concerns in a hope to improve communication. According to Heldman, “There are things you can do as a project manager to help the team progress… including communicating effectively, asking team members input, and using effective conflict-resolution techniques (2005). I tried to expand upon the input provided by this individual and use it to improve the project. I also presented them with all the research that I had accumulated supporting the effectiveness of bedside report. I think that his resistance to accept the change may have reflected the opinions of much of the staff and addressing his concerns was the difference between success and failure of the project. Exchanging report between nurses is the time when accountability and responsibility for the care of a patient is transferred from one nurse to another and the communication that ensues during this process is linked to patient safety (Griffin, 2010). I explained this among other studies that support bedside report. I stayed positive during the entire exchange and tried to encourage her to remain positive as we moved forward with the project. D. Recommendations I received several recommendations that are critical to the success of future projects similar to this one. The first recommendation was presented to me by a staff member that I had discussed the project with. They recommended that I had presented the ideas for the project at the beginning of the semester, perhaps at a mandatory staff meeting in order to give the SICU staff a heads up. They also suggested that I could have more effectively communicated the project in order to allow the staff to have been more aware of the initiative. The second recommendation was made by the training coordinator and she suggested that I should have used expert judgment to ensure a more reasonable plan for the project. She stated that she had a lot of experience with this sort of project and could have helped me design the project from the start and could have improved upon its objectives. The third recommendation came from a team member that suggested that I needed to improve upon my abilities as a delegator. She said that I should have offered more direction to the group members as the leader. John Gardner’s tasks of leadership include many tasks that are important to the success of a project manager and can be used to address my first recommendation. Explaining is a very important task for a project manager. According to Gardner, “explaining requires effective access to the media of communication or broad alliances among those segments of the population that keep ideas in circulation– editors, writers, intellectuals, association leaders, advocacy groups, chief executive officers and the like” (2005). Explaining is a very important part of being an effective leader and involves adequate communication skills. Yoder-Wise suggests that communication at the workplace is not only important to good working conditions but critical in the improvement of patient safety (2011). Envisioning goals is another important task of an effective project manager. Effective leaders accept certain goals as given and select and reformulate their plans according to the most effective means (Gardner, 2005). I think that a leader must lead by example and motivation will follow. Gardner claims that a leader must “comprehend their constituents’ longing for a good future- or improvement of their own lot and better life for their children” (2005). The next project must ensure that the group views the project as a benefit to the unit. Heldman claims that communication is by far the most important skill a project manager possesses (2005). I think that communication is more than just handing out assignments and delegating tasks effectively. I think that the good qualities of an effective communicator include sincerity, an open mind, and timing. I think that all three of these qualities contribute to effective communication skills. Heldman states that, “communicating the right information to the right people at the right time helps assure project success. You can never over-communicate when you follow this rule” (2005). These strategies could be used to improve upon future projects that are initiated.In order to address the second recommendation I received I must be able to pursue expert judgment in order to improve upon my abilities as a project manager. I will use expert judgment in the future to ensure that I have set a reasonable plan. Expert judgment involves asking experienced staff members to give an estimate for planned activities (Heldman, 2005, p. 116). I will also use all available resources to closely manage the deadlines and make changes as necessary. If deadlines are not being met while following my business plan I will re-evaluate my project. With no experience with this sort of project I expected to make changes along the way. I had to take drastic deviations but I think that the foundation of the project was sufficient and I remained positive so that it would be a success. I expected many project constraints to arise and I wasn’t sure that I could cover all possibilities. In order for future projects to be successful I must work diligently to find a time that works for everyone by giving members plenty of time to make arrangements and considering everyone’s input. Heldman claims that, “active listening will tell you more than what the words alone convey” (2005). He is saying that active listening involves more than just listening to what words the speaker is offering.A project manager must be able to communicate effectively and delegate tasks clearly. This addresses my third recommendation. I think that I could improve upon my delegation skills as a project manager. Health professionals must understand that good delegation skills are needed to effectively implement patient-focused care changes (Johnson, 1996). Delegation is very closely related to communication. Nonverbal cues are an important aspect of communication. I have limitations in comfort while communicating and my goal would be to offer an open mind while communicating that offers the other party the comfort and opportunity to provide their most honest input and advice. I think this will greatly contribute to the success of future projects. Advanced delegation abilities are necessary for a project manager to ensure a successful and smooth sailing project. E. Interdisciplinary CollaborationThere was a tremendous amount of interdisciplinary collaboration within the bedside report imitative and the feedback was all very positive. I made it a personal goal as the project leader to incorporate feedback and research from different professions in order to improve the project. The first example of interdisciplinary collaboration involved some time that I spent with an emergency room resident physician. She offered some great insight into the effectiveness of bedside report. She stated that during her time working in the SICU she received bedside report from the day shift Intensivist when taking over for the night. She stated that while caring for up to 16 patients it is of extreme importance to get a mental picture of the patient in order to better care for the individual. I couldn’t have agreed more with this assessment of bedside report. After meeting with the resident I researched an extensive amount of medical journals looking for bedside report data. A model studied at the University of Colorado Hospital concluded that bedside report improves staff satisfaction, patient safety, nurse efficiency, and clinical effectiveness (Hagman et al., 2013). Many of the key determinants of success of the model were supported by what the ED resident discussed. This was a very important example of interdisciplinary collaboration in the bedside report initiative. The second example of interdisciplinary collaboration involved the recommendations of a respiratory therapist. He stated that he does not have any experience with bedside report but was able to offer some great insight into the project. He stated that when he receives report that they do it in a small group and do not exchange report at the bedside. He believes that most of the nurses will be reluctant to change protocol on the unit. He offered some advice on successfully implementing change. He has been involved with quality improvement projects throughout his career and believes that the more people that are involved with the project the more likely it would be accepted and approved. He suggested that I expand participation of the team. The increased participation would hopefully facilitate effective change on the unit. Improving the process for quality initiative changes in healthcare requires the effective use of interdisciplinary collaboration among professionals. A study completed by Sibbald, Wathen, and, Kothari concluded that, “ Information sharing in interdisciplinary teams is a complex and multifaceted process… specific interventions need to be improved such as formalizing modes of communication, better organizing knowledge-sharing activities, and improving the active use of allied health professionals” (2013). The increase in participation improved the success of the bedside report initiative. F. Quality AssuranceCompleted below, see appendix B. Ferris State UniversityNUR 495Project and Project Manager Evaluation Form:To Be Completed by Nurse Manager/Site RepresentativeProject Name________________________________________ Project Manager______________________________________ Nurse Manager/Supervisor______________________________________ Email____________________________Phone_______________________ Please evaluate the project and project manager by placing a check along the continuum. 1 = Needs Improvement 2 = Meets Expectations 3 = Excellent NA – Not app. /not observed123NACommentsProject Manager sought advice, suggestions and recommendations from appropriate nursing leadership before initiating the project. Project Manager presented the Project Scope and Plan clearly, concisely and professionally. Project met an organizational need. Project promoted a culture of quality and safety Project Manager demonstrated leadership throughout the project. Project Manager was assertive and empowering of others in professional communication throughout the project. Project Manager was flexible in responding to unexpected change. Project Manager demonstrated awareness of the organizational environment throughout the project. Project Final Report was presented and provided a clear picture of the completed project, the accomplishments of the project team, and recommendations. Nurse Manager/Site Representative Signature____________________________G. Time logProject Scope and Plan6 hours10 hoursTeam meeting/individual tasks #110 hours12 hoursIndividual leadership development plan15 hours10 hoursDevelopment and distribution of surveys7 hours4 hoursProgress report review and signature2 hours1.5 hourTeam meeting/ individual tasks #210 hours12 hoursTeam meeting/individual tasks #310 hours8.5 hoursFinalizing and evaluating supporting literature15 hours20 hoursComplete and review site representative evaluation2 hours1 hourComplete final presentation/work hours20 hours19 hours Activity Projected HoursActual HoursTotal hours: 98 hoursReferencesAmerican Nurses Association. (2010). Nursing: Scope and standards of practice. Silver Spring, Md: American Nurses Association. Baker, S. (2010). Bedside shift report improves patient safety and nurse accountability. JEN: Journal Of Emergency Nursing, 36(4), 355-358.Cairns, L. L., Dudjak, L. A., Hoffman, R. L., & Lorenz, H. L. (2013). Utilizing Bedside Shift Report to Improve the Effectiveness of Shift Handoff. Journal Of Nursing Administration, 43(3), 160-165Chitty, K.K., & Black, B.P. (2011). Professional nursing: Concepts and challenges (6th ed.) Maryland Heights, MO: SaundersEvans, D., Grunawait, J., McClish, D., Wood, W., & Friese, C. R. (2012). Bedside Shift-to-Shift Nursing Report: Implementation and Outcomes. MEDSURG Nursing, 21(5), 281-292. Federwisch, A. (2007). Passing the baton: bedside shift report ensures quality handoff. Nurseweek California, 20(21), 14Gardner, J. W. (2005). The Tasks of Leadership. In Volume IV: what works, what matters, what lasts. Retrieved from , T. (2010). Bringing change-of-shift report to the bedside: a patient- and family-centered approach. Journal Of Perinatal & Neonatal Nursing, 24(4), 348-355.Hagman, J., Oman, K., Kleiner, C., Johnson, E., & Nordhagen, J. (2013). Lessons Learned From the Implementation of a Bedside Handoff Model. Journal Of Nursing Administration, 43(6), 315-317.Heldman, K. (2005). Project management jump start. (3rd ed.) San Francisco, CA: Jossey-Bass.Maxson, P. M., Derby, K. M., Wrobleski, D. M., & Foss, D. M. (2012). Bedside nurse-to-nurse handoff promotes patient safety. MEDSURG Nursing, 21(3), 140-145.Radtke, K. (2013). Improving patient satisfaction with nursing communication using bedside shift report. Clinical Nurse Specialist: The Journal For Advanced Nursing Practice, 27(1), 19-25.Reinbeck, D. M., & Fitzsimons, V. (2013). Improving the patient experience through bedside shift report. Nursing Management, 44(2), 16-17.Sibbald, S. L., Wathen, C., Kothari, A., & B. (2013). Knowledge flow and exchange in interdisciplinary primary health care teams (PHCTs): an exploratory study. Journal Of The Medical Library Association, 101(2), 128-137Yoder-Wise, P.S. (2011). Leading and Managing in Nursing (5th ed.). St. Louis, MO: Elsevier Mosby. Appendix A.Staff SurveyPlease circle the number that represents your answer in regards to the bedside report initiative. 1. Nurse-to-nurse shift report makes nurses accountable.1. Strongly agree 2. Agree 3. Neutral 4. Disagree 5. Strongly disagree 2. The report I receive is sufficient for me to provide care for patients.1. Strongly agree 2. Agree 3. Neutral 4. Disagree 5. Strongly disagree 3. Nurse-to-nurse shift report allows me to perform shift change medication reconciliation. 1. Strongly agree 2. Agree 3. Neutral 4. Disagree 5. Strongly disagree 4. I am able to communicate with physicians regarding patient care immediately after shift report.1. Strongly agree 2. Agree 3. Neutral 4. Disagree 5. Strongly disagree 5. Nurse-to-nurse shift report helps me prioritize my workload.1. Strongly agree 2. Agree 3. Neutral 4. Disagree 5. Strongly disagree 6. The report I received matches the patient’s condition.1. Strongly agree 2. Agree 3. Neutral 4. Disagree 5. Strongly disagree Your job title:MDRNCNASuggestions:ReferencesEvans, D., Grunawalt, J., McClish, D., Wood, W., & Friese, C. (2012). Bedside shift-to-shift nursing report: Implementation and outcomes. Med/Surg Nursing, 21(5). -43815021336000Appendix B. ................
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