Process Improvement Through

Bedside Report

Maren Bashor, Kathlene Bouzek, Madelynn Buckman, Elizabeth Goetz,1

& Shelby Welsh
 Overview of Patient Care Delivery System
Southern Arizona Veteran Affairs Health Care Systems - Tucson
● Medical-Surgical unit (3 East)
○ 25 beds, 5 “pods”, 1 pod = 1 nurse
○ Nurse to patient ratio: 1:5 or 1:6
○ 2-3 PCTs, pharmacist, rounding medical teams, nurse manager,
and assistant nurse manager
○ Available resources: social worker, case management,
PT/OT/ST, nutrition, respiratory therapist
● Focus:
○ Ineffective process for healthcare delivery related to lack of
bedside report due to time management concerns and absence of
bedside report policy as evidenced by increased occurrence of
“never-events” on the unit (Marquis & Huston, 2017)
(Johnson, 2001) 2
 Leadership

3E leadership
● Charge nurse
○ Based on experience
○ Leadership style varies per individual
■ In rotation: Laissez-Faire style
● Little or no control
● Permissive, little to no direction
● Doesn’t criticize, motivates by support
● Nurse Manager and Assistant Nurse Manager
○ Ensures understanding of unit goals and
expectations

(Marquis & Huston, 2017, p. 47)

3
(Johnson, 2001)
 Organizational Culture and Support

Unit Management
● Nurse Manager and Assistant Nurse Manager: Democratic style
○ Directs through suggestions & guidance
○ Involves others in decisions
○ Emphasis on “we”
● Provide recognition, information, & resources
● Daily huddles: Mon-Fri AM
○ Discuss improvements, resource & equipment needs, and
current events of the hospital

(Marquis & Huston, 2017, p. 47)

(Johnson, 2001) 4
 Patient Focus & Staff Focus

Patient Focus: Staff Focus:

● Continuity of care ● Continuing education
● Attentive to patients modules
needs/concerns ● Unit promotes furthering
● Hourly rounding education/training
● Patient education ● Opportunities for growth
● Involvement of family ● Benefits
○ PTO, competitive pay,
yearly bonuses

(Wasson, Godfrey, Nelson, Mohr,& Batalden, 2003) 5

(Marquis & Huston, 2017, p. 416) (Johnson, 2001)
 Interdependence of Care Team

● Trust and Collaboration

○ Nurses depend on one another - family-like unit
○ Interdisciplinary focus - grand rounds
○ Case management and social work involved in care
● Communication
○ Interdisciplinary collaboration
○ Unit managers and supervisors in constant contact with nurses
○ Supportive communication
○ Clear delegation

(Marquis & Huston, 2017, p.364, 496)

6
(Johnson, 2001)
 Use of Information and Healthcare Technology
● CPRS/BCMA
○ EMR & medication administration
● Patients:
○ May request medical records from staff
○ Individualized discharge information
● Providers/staff:
○ Each nurse has work phone
○ CPRS provides access to online resources
● Technology:
○ Each pod has a WOW available, computers at nurses station
○ 24-hr IT support
(Johnson, 2001) 7
 Process for Healthcare Delivery Improvement
● Process Improvement
○ EKG classes and online safety/training modules are encouraged
○ Continuing education is encouraged and financially supported
○ Charting audits
● Huddles with nurse manager and nurses in the mornings
○ Topics include ways to improve and events in the hospital
○ Improving bedside report
● “Never Events” Process Audit
○ Top 3 “Never Events” that are tracked: CAUTIs, falls, and
pressure injuries
○ These events are continuously monitored
(Fencl & Willoughby, 2019) 8
 Staff Performance Patterns

● Bulletin Board
○ Tracking “never events”: falls, CAUTIs, and pressure injury
○ Dates and statistics of the last “never event”
● Yearly performance reviews
○ Nurses fill out competency chart every year
● Patient satisfaction survey

9
(Johnson, 2001)
 Specific Aspect Targeted for Improvement

● Incorporating Bedside Report

○ Ineffective process for healthcare delivery related to lack of
bedside report due to time management concerns and
absence of bedside report policy as evidenced by increased
occurrence of “never-events” on the unit
● Never events: CAUTI, flu transfer, & pressure injury
● Bedside report helps to:
○ Eliminate preventable errors
○ Improve patient safety
○ Improve patient quality of care and experience
(Clark, Wolgast, Mazur, & Mekis, 2020)
(Ofori-Atta, Binienda, & Chalupka, 2015) 10
 Integrative Nursing Principle

● “Integrative nursing is person-centered and relationship-based”

● Includes:
○ Reflecting on nurse-patient encounters
○ Developing patterns that lead to the consistency of care and
nurse-patient relationships
○ Setting intentions to be a “healing presence” each shift
● Mandatory bedside report reaffirms the continuity of care and
starts the shift with a healing presence by ensuring that patient-
centered care is implemented

11
(Kreitzer & Johnson, 2015)
 Implementation Timeline

Months:

0-1 1-2 3 4-8 9 10-12

Formulate Create In person Incorporate Evaluate Policy

bedside resources training bedside RN developme
report team about session report perspective nt and
bedside with and patient incorporati
report bedside outcomes on on
report other units
team
12
 References
Clark, A., Wolgast, K., Mazur, N., & Mekis, A. (2020). Leading change in nurse bedside shift report. Nursing Clinics of North America, 55(1),

21-28. doi: 10.1016/j.cnur.2019.10.002

Fencl, J. L., & Willoughby, C. (2019). Daily organizational safety huddles: An important pause for situational awareness. AORN Journal, 109(1),

111-118. doi: 10.1002/aorn.12571

Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from http://clinicalmicrosystem.org/uploads/documents/microsystem_

assessment.pdf

Kreitzer, M., & Davidson, J. (2015). Integrative nursing: Application of principles across clinical settings. Rambam maimonides medical journal,

6(2), 1-8. doi:10.5041/RMMJ.10200

Marquis, B.L. & Huston, C.J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed.). Philadelphia:

Wolters Kluwer Health

Ofori-Atta, J. Binienda, M., & Chalupka, S. (2015). Bedside shift report implications for patient safety and quality of care. Nursing2019, 45(8),

1-4. doi: 10.1097/01.NURSE.0000469252.96846.1a

Wasson, J. H., Godfrey, M. M., Nelson, E. C., Mohr, J. J., & Batalden, P. B. (2003). Microsystems in health care: Part 4. planning patient-

centered care. Joint Commission Journal on Quality and Safety, 23(5), 227-237. Retrieved from

https://d2l.arizona.edu/content/enforced/854111-665-2201-1NURS478001-
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2/Week%207/Microsystems%20in%20Healthcare%20Part%204.pdf?_&d2lSessionVal=eG1G0EUsqTo9h39VHaSDb3Z1y&ou=854111