Patients' Perceptions of Bedside Handoff: Further Evidence to Support a Culture of Always

Improving Communication From Hospital to Skilled Nursing Facility Through Standardized Hand-Off: A Quality Improvement Project

Background: Inadequate hand-off communication from hospital to skilled nursing facility (SNF) hinders SNF nurses’ ability to prepare for specific patient needs, including prescriptions for critical medications, such as controlled medications and intravenous (IV) antibiotics, resulting in delayed medication administration. This project aims to improve hand-off communication from hospital to SNF by utilizing a standardized hand-off tool. This project was conducted in an inpatient, 50-bed, post-hospital skilled nursing care unit of a local SNF. The participants included all 32 staff nurses employed by the SNF. Methods: Lewin’s change management theory (CMT) guided this quality improvement (QI) project. Baseline assessment included a one-month chart review of 76 patient charts that was conducted to assess the disparities related to ineffective hand-off and medication delays in the SNF before intervention. The wait time for the availability of prescriptions for controlled medications and IV antibiotics, and delays in medication administration were assessed. Intervention: Multiple randomly selected hospital-to-SNF hand-offs were observed. Semistructured interviews with all staff nurses were conducted using open-ended questions about hand-off structure and process matters. Data gathered from observation and interviews were used to create the standardized hand-off tool used in this project. In-service training on hand-off tool utilization for SNF nurses was conducted. Champions for each shift were cultivated to assist with project implementation. Results: After six weeks of implementation, a chart review of 101 patient charts was conducted to evaluate the effects of the hand-off tool on the wait time on the availability of prescriptions for controlled medications and IV antibiotics, and medication administration. The wait time of prescriptions availability during the hospital-to-SNF transition was decreased by 79% for controlled medications, with an associated 52.9% reduction in late administration, and decreased by 94% for IV antibiotics, with a 77.8% reduction in late administration. Conclusion: The use of standardized hand-off resulted in improved communication during the hospital-to-SNF hand-off and significantly decreased the wait time for the availability of prescriptions for controlled medications and IV antibiotics. Integrating standardized hand-off into the SNF policies can help sustain improved communication, medication management, and patient transition from hospital to SNF.

Enhancing Family-Centered Care in Cardiothoracic Surgery

The psychological impact of critical illness is far reaching, affecting patients and their loved ones. Family members face a multitude of stressors, ranging from concerns about death or permanent disability to stress over health care costs and lost wages. Patients are at risk for developing post-intensive care syndrome. Professional groups and patient safety organizations have crafted family-centered care (FCC) models that support hospitalized patients and their families. There is a paucity of data on use of FCC in cardiothoracic intensive care units. This article discusses FCC models and why they are beneficial to the needs of families of postoperative cardiothoracic surgery patients.

Patients experiences of bedside handover: findings from a meta-synthesis

BACKGROUND

Bedside shift reports have been recently recommended to ensure handovers. However, no evidence summarising studies designed to determine the qualitative approaches capable of better understanding patient experience have been published to date.

AIM

The aim of this study was to acquire a deeper understanding of the experiences of patients regarding bedside shift reports.

DATA SOURCES AND REVIEW METHODS

A systematic review of qualitative studies followed by a meta-synthesis method based upon Sandelowski's and Barroso's guidelines was performed. Four databases were systematically explored (PubMed, CINAHL, Scopus and PsycINFO) without any limitation in time and up to the 31 August 2018. A total of 10 studies were included and evaluated in their methodological quality; then, a thematic synthesis was developed to synthetize the findings.

RESULTS

Three major themes reflect patients' experience regarding the bedside shift reports: (i) 'Being involved'; (ii) 'Being the centre of nursing care processes'; and (iii) 'Experiencing critical issues'. Patients are supportive of bedside shift reports as a right, as an opportunity to be involved, and of being in the centre of the nursing care process. By designing and implementing bedside shift reports, nurses also have an opportunity to increase patient safety and to provide concrete proof of the advancements achieved by the nursing profession in recent years.

CONCLUSIONS

The bedside shift reports experience has been little studied to date from the perspective of patients. According to the findings, implementation of the bedside shift reports should include providing education to nurses with regard to the preferences and expectations of patients, as well as the critical issues that they can experience during the bedside shift reports. Presenting the bedside shift reports method, asking patient consent, discussing potential critical issues and the degree of involvement preferred at hospital admission, is strongly recommended.

Family Caregivers' Experiences of Within-Hospital Handoffs for Older Adults in Acute Care

Family caregivers' experiences during within-hospital handoffs between acute care units are not well understood. Qualitative description methodology was employed to describe family caregivers' experiences during their loved ones' handoffs. Semistructured interviews were conducted with 10 caregivers of hospitalized older adults. Three themes emerged: Lack of care coordination, Muddling through handoffs alone, and Wariness toward the care delivery system. Findings can help clinicians shape their interactions with caregivers to maximize their involvement in post-hospital care.

Impacting the Patient's Experience in a Children's Hospital Using a Communication Bundle Strategy

BACKGROUND

The aim of this quality improvement project was to determine whether a communication bundle would impact parents' ratings of nurse-child communication in relation to (a) how often the nurse listened carefully to the child and (b) how often the nurse explained things in a way easy for the child to understand.

LOCAL PROBLEM

The Child Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores on the unit lagged behind the hospital's 75th percentile external benchmark established by the National Research Corporation.

METHODS

A convenience sample of the unit's staff participated in the project.

INTERVENTIONS

The outcome measure was a comparison of Child HCAHPS scores and percentile ranks for the questions pre- and postimplementation of the communication bundle.

RESULTS

Following implementation of the communication bundle, the unit's patient satisfaction scores for both questions exceeded the 75th-percentile benchmark.

CONCLUSIONS

This project enhanced nurse communication at the bedside and the parent's perception of nurse-child communication.