Implementing a Successful Bedside Handoff
Bedside handoff in a nursing unit is an excellent way for nurses to encourage a patient to participate in their own care. It is an excellent practice for nursing units, as it prevents errors stemming from poor communication. Because of these benefits, bedside handoff is quickly becoming the standard in most hospital inpatient settings.
Below are case studies illustrating two different hospital implementations of bedside handoffs. One is an example of a poorly implemented practice, while the other is a success story.
The most significant difference between the two is in the follow-up, sustainable maintenance, and control on the part of leadership. Without steps to ensure the process is well-controlled, the initiative could fail.
These two case studies took place in the same hospital, approximately two years apart. See if you can identify the key practices of a successful implementation.
Case Study #1: Unsuccessful
A hospital initiates the practice of bedside handoff in the inpatient nursing units. Staff members are educated by word-of-mouth from management, emails, and posters.
For a while, management does rounds in the units to observe bedside handoff in action, but it doesn’t last long. In addition to emails and rounding, two instructional bedside handoff videos are uploaded to the hospital’s Intranet. Some staff take the initiative and immediately begin to practice bedside reporting, but most do not. One or two staff members are champions of this initiative, but ultimately it doesn’t take off. The initiative is unsuccessful.
Result: No follow up or control of bedside reporting were present. Thus, bedside reporting was slowly phased out.
Case Study #2: Success
A middle-management change at the facility the following year brings an MSN-prepared assistant manager into a particular nursing unit. Starting then, a safety initiative, nurse leader rounding, and bedside reporting are back at the forefront of best practices. Bedside handoff procedure is very important to this leader.
The AM makes plans to revamp and reinitiate the procedure. A variance of the Six Sigma DMAIC (Define, Measure, Analyze, Implement, and Control) is put into place. Education is provided in a step-by-step format, emphasizing the urgency and importance of this initiative. Staff is provided with new procedural videos, and bedside reporting education is provided during unit skills days. After the initial education process, questions arise about which patient populations should and should not have bedside handoff. As a result, the process is modified slightly.
During implementation, the leader is frequently present on the floor to observe staff performing the bedside handoff and to solicit feedback. At the same time, the leader encounters some pushback from both day and night-shift nurses who do not want to perform this procedure.
The early adopters are asked to be champions of the change and are given detailed instructions to pass on to their teammates. The few remaining staff who are still struggling to adopt receive hands-on instruction.
Occasionally, the leader comes in at 0400 in the morning and assumes care of a patient whose day shift RN is slow to adopt the process. When the RN comes on duty, the leader insists on performing bedside reporting in the room in front of the patient, providing step-by-step instructions, and answering questions. The leader stays late to support a night-shift RN with the same hands-on training.
The leader spends a lot of time role-modeling this initiative to the team. Staff who were slower to adopt the practice became more comfortable, and eventually, it becomes the standard. This process takes approximately 8-12 months to establish as a mainstream practice
Result: The control and subsequent sustainability were made possible by consistency. The unit leader regularly brought up bedside reporting, role modeling, and insisted on the team using this handoff method. After approximately a year, nearly 100 percent of the team in this unit were practicing bedside handoff.
Bedside Handoff Benefits Everyone
Bedside reporting benefits all parties – not only patients but their professional caregivers and upper management as well. It ensures a smooth, accurate transition between staff members while providing patients with the best care possible.
The second case study here is an excellent example of implementing a new process and following up with consistency.
There is no one-size-fits-all model for staff education. Some will be reluctant, but it is up to management to convince and guide them towards best care practices. Make sure to set a good example, and reward early adopters. Have a plan, take a hands-on approach, and follow up frequently. Seek feedback and be prepared to adjust accordingly.
Ultimately, it’s about being consistent. While the implementation of any new procedure takes a lot of time and patience, it will no doubt be gratifying for all involved.