Bedside Shift Report

Lorri A Bradley

October 3, 2021

Nursing Informatics
 Incompetent healthcare workers are responsible for almost half a million preventable

deaths each year. Preventable harm done in hospitals that contribute to the death of patients by

non-competent healthcare workers account for between 210,000 and 440,000 incidents a year

(Ofori-Atta, 2015). With these staggering numbers, it makes medical errors the third leading

cause of death (Ofori-Atta, 2015). High flow areas within the hospital, such as the emergency

room and critical care units, are high risk areas for medical mistakes and should have additional

safety measures in place to protect patients (Baker, 2010).  Nurse to nurse bedside reporting

(BSR) is an easy and efficient way to cut down and potentially eliminate medical errors.  

Registered nurses are the first line of defense to protect patients against medical errors (Ofori-

Atta, 2015).  Implementing BSR in a high- risk environment leads to a sense of security and

empowerment for the patient and their family (Caruso, 2007).  BSR also increases patient safety,

communication from nurse to nurse, as well as communication from nurse to patient, and holds

the outgoing nurse accountable for the patient care during their shift.  

  Traditionally, shift change reports are reviewed at the nurses’ station or in a designated

area.  Both the off going nurse and the oncoming nurse look over the electronic patient care

report without having any contact with the patient. BSR allows for interaction to take place

between the nurses, patients, and family members to hopefully increase patient involvement as

well as an understanding of care .  Before BSR takes place, the oncoming nurse should briefly

look over the chart to review the medical history, treatment, and any additional tasks that needs

to be completed (Baker, 2010).  Both nurses should enter the room and begin the shift report

using the numeric SBAR plus T pneumatic which is a tool in facilitating communication between

the nurse and other members of the healthcare team.  This provides a way to standardize care,

and make shift change efficient without missing important details and a uniform practice takes
place within any area of the hospital. The patient electronic care report should be accessed and

used to reference information such as: medical history, current medications, vital signs, and lab

results during the report.  The “S” in S.B.A.R stands for situation. The introduction of the new

nurse to the patient takes place, along with the verification of the patient by viewing their wrist

band, and asking the patient for name and date of birth (Ofori-Atta, 2015).  The white boards

should also be updated with the new team members name including the physician as well as the

patient’s tech or CNA. The “B” indicates the background position of shift report.  The off going

nurse provides the reason(s) to why and how this person became a patient.  Events leading up to

this admission, along with medical history and estimated length of the patient’s stay, are

discussed.  At the end of this segment, the patient is given a chance to add any additional

information about the events leading up to the hospitalization (Ofori-Atta, 2015). Assessment is

represented by the “A” and reviews the systems of the patient. The oncoming nurse can perform

a brief assessment of the patient and be able to compare to the assessment of the off going

nurse.  The electronic patient care report should be used to discuss vital signs, lab results,

radiological reports, diagnostic test results, and any trends associated with findings.  Any chest

tubes, IVs, or leads will be looked at and checked to see that they are functioning

appropriately.  The monitor will be checked along with the alarms' settings to make sure they are

adjusted according to the patient’s needs.  The IV pump and medications should be verified with

both nurses and checked for accuracy (Ofori-Atta, 2015). The "R” is for recommendations to be

discussed.  The plan of care, patient goals, and orders that are not yet completed are

discussed.  Any special needs of the patient are expressed at this time (Ofori-Atta, 2015).  The

“plus T” is the most important part of the SBAR plus T.  The nurses ask questions and thank

each patient before leaving the room (Ofori-Atta, 2015).  Throughout the reporting process, the
patient should be the center of attention and allowed to contribute to the discussion and their own

plan of care.  

BSR benefits the medical staff and patients, and also contributes to the National Patient

Safety Goals (NPSG) put out by the Joint Commission of Accreditation of Healthcare

Organizations (JCAHO). The NPSG were developed with the purpose to improve patient safety

(Fenner, 2018).  JCAHO uses the NPSG to accredited organizations in focused areas of health

care safety (Fenner, 2018).  BSR helps address NPSG goals one, two, three, and six.  NPSG

number one is to “use at least two patient identifiers when providing care, treatment, and

services” (NPSG, p.1).  During nurse-to-nurse BSR, within the introduction phase, the nurses

identify the patient by checking the wristband and ask the patient his or her name and date of

birth.  This is not a replacement for a two-person identifier when hanging blood products or

high-risk medications, but it will help the oncoming nurse to establish the correct patient at the

beginning of the shift.  NPSG number two is “report critical results of test and diagnostic

procedures on a timely basis” (NPSG, p.2).  The assessment portion is used to relay important

lab, radiological, and diagnostic test results by having the electronic patient care report accessed

during the BSR.  “Improve the safety of using medications” is NPSG number 3 (NPSG,

p.3).  During the assessment portion of the BSR, the medication that the patient has received,

medications that are currently running, and medications that are pending, are verified by both

nurses.  This leads to a reduction in medication errors.  Goal number six put out by the NPSG is

to “reduce the harm associated with clinical alarm systems” (NPSG, p. 7).  When the monitors

are checked during the assessment part of BSR, the alarms are reviewed to confirm the

parameters are set within appropriate limits and the alarm history is reviewed.  Nurse to nurse
BSR contributes to meeting the NPSG put out by the Joint Commission, which will lead to a

much safer environment and overall better health care provided to the patients.  

  Although there are many benefits for both the patients and the nurses, the staff may have

concerns about implementing bedside reporting.  One of the biggest concerns nursing staff have

is the possible increases in the time it takes to do shift reporting.  Utilizing a standardized

reporting system can make BSR very efficient.  A nurse can delay a lengthy response to a

question received from the patient by delaying their response and informing them that they

would like to come in after shift report to go into more detail (Ofori-Atta, 2015).  A second

concern for the staff is not knowing the visitors or family members in the room of the

patient.  On arrival of the patient to the unit, or sometime before shift change takes place, the

patient should be made aware of, and educated on the process of BSR (Baker, 2010).  They

should be asked who they would like in the room at the time shift report is given (Ofori-Atta,

2015).  This would also be the appropriate time to ask the patient if he or she would like to be

awake at shift change.  Sleep is important for patient recovery, but it is better for the patient to

have input or ask any questions.

It is the job of the medical team members to know critical information about their

patients’ condition.  There are often times when the patient has not been made aware or notified

of information by their doctor by the time of shift change.  This information can be exchanged

between nurses before entering, or after exiting the room (Ofori-Atta, 2015).  One of the biggest

concerns of medical staff is the legal issues with the Health Insurance Portability and

Accountability Act of 1996, better known as HIPAA, which deals with the privacy and the

security of medical information.  According to HIPAA, confidential information can be

exchanged and if someone overhears the information the staff is not at fault as long as the
healthcare provider has made every reasonable effort to protect the privacy of the patient (Ofori-

Atta, 2015).  By asking family members and friends to exit the room at the discretion of the

patient, closing the door, and speaking in a reasonable voice, the nurse will not be held

responsible if someone were to overhear the shift report.  With proper education provided for

staff and patients, the concerns of the staff can be easily addressed. 

  Implementation of BSR requires planning, education, and acceptance from the staff in

order to ensure a smooth transition from traditional shift reporting at the nurses’ station or

designated area, to reporting at the bedside.  Creating a plan to implement BSR can be completed

using a three-step method.  The first phase known as the unfreezing stage recognizes there is a

need for change, and introduces the concept to the staff (Caruso, 2007). Volunteers, or a small

unit within the hospital, are selected to conduct a pilot program designed to gather feedback on

what works and what does not work, and is then used to address the concerns of the staff (Ofori-

Atta, 2015).  The second phase is considered the moving stage.  This stage is where planning and

implementing take place (Caruso, 2007).  A plan is developed based on the pilot program results

and then the rest of the staff is educated of the plan. Staff concerns can be addressed and

displayed through role playing. Implementation takes place in this phase with help from the

development team coming in before shifts, and staying after to assist with any issues (Caruso,

2007).  The final phase in this process is the refreezing stage.  This is where permanent

integration through the changes in practices take place (Caruso, 2007).  Reminders of BSR

should be placed around the unit, and ongoing mentoring would be provided, as needed (Caruso,

2007). Evaluation of the process on a regular basis is vital and can be achieved through patient

and staff feedback, through the use of surveys and/or interviews.  Once the staff recognizes the

benefits to the nurses and the patients, implementation will be looked at positively.  
  BSR promotes good patient outcomes and supports communication between healthcare

providers, all while including the patient in their plan of care. This aligns with NPSG followed

by the JCAHO (Caruso, 2007). Patient satisfaction will increase, while medical errors

decrease.  Keeping patient safety as the main focus of care aligns with the ethical values put out

by the American Nurses Association.  Provision number two, addresses that the nurse’s primary

commitment is to the patient (ANA, 2015).  Proper education and training all staff will make the

implementation process efficient, while addressing the concerns of staff members.  BSR

empowers the patent, while providing security.  It creates an advantage for the oncoming nurse

to start their shift fully informed, and ready to care for their patients.  
 Shift change at nurses
station

Oncoming nurse and off

going nurse meet at nurses
station

Off going nurse briefly

reviews each patient

Off going nurse leaves the

floor

Oncoming nurse scans the

patients chart

Spend time searching for

Are all NO the correct answer
question decreasing possibilities of
answered? medical errors

YES

Oncoming nurse meets their

patients

Start patient care and

continue with the rest of the
shift
 Nurse to Nurse Bedside
Report

Oncoming nurse briefly

reviews the medical charts
of the patients

Both nurses review the

sensitive information
before entering the
patients room

Is there
sensitive
information?

Start patient care and

continue with the rest
of the shift
Both nurses walk into the
patients room. Introductions
and verification of the patient
are completed

Input and questions are asked by

the oncoming nurse, the patient,
Electronic patient care and family
records are accessed
and whiteboards are
updated

A brief assessment is done by the

Report is given using the oncoming nurse, medications are
S.B.A.R.T pneumonic to reviewed, monitor is checked, and
standardized reporting IV lines are assessed
 References

American Nurses Association (2015, January). Code of ethics for nurses. Retrieved from

file:///Volumes/STEVEN%20USB/Nursing%20410%20Informatics/Code%20of

%20Ethics%20for%20Nurses%20With%20Interpretive%20Statements%20(View

%20Only%20for%20Members%20and%20Non-Members).webarchive

Baker, S. (2010, July). Bedside shift report improves patient safety and nurse accountability.

Journal of Emergency Nurses, 38(4), 355-358. Retrieved from

https://doi.org/10.1016/j.jen.2010.03.009

Caruso, E. (2007, February). The evolution of nurse-to-nurse bedside report on a medical-

surgical cardiology unit. Medsurg Nursing, 16(1), 17-22. Retrieved from

https://studylib.net/doc/8752033/nurse-bedside-report-on-a---vanderbilt-university-

medical

Ofort-Atta, J., Biniena, M., & Chalupka, S. (2015, August). Bedside shift report: Implications

for patent safety and quality of care. NursingCenter, 45(8), 1-4. doi:

10.1097/01.NURSE.0000469252.96846.1a

The Joint Commission. (2018, October 16). National patient safety goals effective January 2019:

Hospital accreditation program. Retrieved from

https://www.jointcommission.org/assets/1/6/NPSG_Chapter_HAP_Jan2019.pdf