Purpose:

The purpose of this project is to improve patient safety through accurate communication between caregivers during shift report. The objectives of this project are (1) to develop a process for bedside shift report and (2) to develop a standardized tool for communication during shift report.

Significance:

In 1999 the Institute of Medicine published a report on the state of patient care in America. In this report, errors in communication were identified as a major factor in medical errors contributing to patients deaths.

Background/Design:

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) published the 2006 National Patient Safety Goals. Goals include, "Improve the effectiveness of communicationamong caregivers." Methods identified to achieve this goal include "implementing a standardized approach to 'hand off' communications, including an opportunity to ask and respond to questions."

Methods:

A project was initiated designed to address identified problems with shift-to-shift nursing handoffs. After benchmarking, a decision was made to include the following components: (1) A standardized nursing report handoff tool; utilizing a format called the 5P. The 5 Ps are: Patient, Plan, Purpose of Plan, Problems and Precautions. (2) Bedside shift-to-shift report. (3) Inclusion of the patient and family in discussion of plans and goals of care. (4) Two-person medical record check.

Findings:

Improved patient satisfaction, increased involvement between patients and caregivers, improved communication between nurses, and improved accuracy of information during shift report.

Conclusions:

Initial reactions from patients have been positive. Easy and early identification of their caregivers and having an opportunity to verbalize their concerns and questions regarding the plan of care are frequently cited advantages of this process. Nurses are able to rely on a standardized format for report, which enables verification of information.

Implications for Practice:

Increased patient satisfaction has been demonstrated with bedside shift report. In addition, it has been shown to improve teamwork and nursing accountability. Errors incommunication have repeatedly been identified as a factor in patient safety events. Further study needs to be done to understand the implications for education in both the academic and practice settings.