Research suggests that by moving handover process to the patient’s bedside, nurses can empower patients to become involved in their own care, which supports an improved care experience and patient safety. Shift change is generally the most vulnerable time on the patient care continuum. (Patterson, 2008).
Eastern Health is the largest, integrated health authority in Newfoundland and Labrador employing approximately 13,000 dedicated employees and serves a population of more than 300,000 people. The authority offers full continuum of health and community services including public health, long-term care, community services, hospital care and unique provincial programs and services. Throughout the health authority there are diverse practices in the transfer of information and care responsibility from one nursing shift to the next depending on the program or unit. Over the past couple of years Eastern Health has had an improvement lens focused on the electronic shift handover. While working on standardizing the shift change information that is documented, reflection resulted in the question of what was missing? What was identified as missing was the engagement of the patient and family as part of the shift handover process.
The Regional Medicine Program, as part of the CPSI Patient Engagement Collaborative, established a bedside handover project with an aim to improve patient and family satisfaction, and increase meaningful engagement of patients and family at the bedside using a standardized approach and tools during the handover process.
A team that included 5 nursing unit champions, 2 client and family advisors (and an advisory council which included 6 more advisors for additional input), a site clinical educator, a quality and safety leader, director, managers and executive sponsorship was established to work with an identified pilot site—The Carbonear General Hospital, 6th and 7th floor Medicine Units.
Pre-project implementation activities included:
- Project planning and preparation- literature review, current state analysis, preliminary discussions with leadership, development of info sheet and presentation for initial engagement session
- Initial engagement planning session- included nursing unit champions and key stakeholders, short presentation (benefits, anticipated challenges, video demonstration), client and family advisors to share the pt./family perspective and the quality leader to address staff concerns for privacy and confidentiality).
- Onsite staff education sessions
- Pt. pre-engagement surveys
- Pt./family onsite education sessions (prep sessions)
- Pt./family bedside handover consent
Post- project implementation activities included:
- Onsite staff coaching and support
- Pt. post implementation engagement surveys
- Frontline staff round table discussions and survey.