Bedside Reporting: Including Patients in Care Planning at a 119-bed Hospital, Exercises of Nursing

Download Bedside Reporting: Including Patients in Care Planning at a 119-bed Hospital and more Exercises Nursing in PDF only on Docsity! 1 Bedside Reporting Across the Board Innovation Proposal Role of Innovative Nurse Leader Nurse innovators work to improve patient cares through changes and improvements. With that being said, nurses have always been considered innovators without the formal title. There is always new and improved methods and procedures being discovered to maximize results for patients. Some responsibilities of nurse innovators include research of new methods to improve patient care, reduce cost to both facilities and patients, and increased efficiency. Innovators need to be able to collaborate with other healthcare professionals and institutions to advocate the development of new processes. Some optimal characteristics and skills for a nurse innovator include having creativity, being a critical thinker, being able to problem-solve and make tough decisions and being able to effectively communicate (University of Louisiana at Lafayette, 2020). A nurse innovator’s position specifically relates to this proposal because the innovation is directly trying to improve a method to maximize patient’s cares. For this idea to become a reality, the innovator sat down and brainstormed with stakeholders some different ideas that could improve patient cares and maximize their outcomes. After much discussion, the decision of mandating bedside reporting for all different departments was decided upon. Since this facility already performs care conferences amongst the different interdisciplinary teams, they will simply move this from a conference room to the bedside if the patient. This allows for open discussion amongst the team and the patient and their family. In turn, having better communication will results in the patient understanding their plan of care more thoroughly, all interdisciplinary teams being on the same page when it comes to discharge planning, and an overall better relationship between the hospital staff and patients. 1 Summary of Community of Practice The community of practice is a 119-bed hospital that provides primary care and a variety of specialties. The focus is going to be on inpatient departments like the medical floor, intensive care unit, and surgical unit but not excluding areas like the emergency department. The medical and surgical floor hold approximately 50 beds and the intensive care unit holds 10 beds. Within each department there is typically a charge nurse that manages the floor with addition to the house supervisor who stations in the emergency department and is a resource for all different areas. Then typically a director will oversee a couple different departments. Many different populations are served at this hospital ranging from pediatric to geriatric along with a variety of races and ethnicities. The town this hospital serves has a population close to 28,400 with the majority race being white, with the other races and ethnicities include African American, American Indian, Asian, and Hispanic. The team members chosen to help move forward this innovation include the chief nursing officer, the director of the medical/surgical floor and intensive care unit, the nurse educator, and the project specialist. The chief nursing officer, who acts as a representative and oversees the nursing staff, is needed as a stakeholder to give this innovation a good start. With her support, she has the power to ensure that the innovation will reach the necessary departments. Since this director oversees most inpatient services, her support is also needed to move this innovation forward. This director is the nursing staff’s “go-to” for larger issues that their charge nurse cannot assist with. She will be the one to ensure that their staff is implementing the changes set in place. The nurse educator and project specialist will work together to figure out the logistics of this innovation and get the “leg work” going. The project specialist will continue to monitor and review where changes need to be made and if things will need to be adjusted. 1 Anyone who has stayed, visited, or worked in a hospital are aware of the hectic, many- moving parts that are involved in a patient’s care. When there are so many different areas working together, there is a high possibility for miscommunication. By enforcing bedside rounding for staff involved with a patient’s care, it will drastically reduce the chance for miscommunications and errors while improving the patient’s overall care. Bedside nurse report is already something that is being implemented at this organization, so integrating bedside reporting amongst the interdisciplinary team is a realistic measure. Key team members include the physician, nurse, social worker, and physical therapist. Depending on the patient there may be other key team members that would need to be included with rounding. The team already meets daily in a conference room to discuss the plan of care for each patient, so simply moving this to the bedside is an easy way to include the patient in care planning. Goal for the Innovation The main goal for this innovation is to include the patient on care planning to achieve a well-rounded plan of care that is most efficient for both the patient and the hospital. “Team use of a collaborative care plan holds great potential to improve the quality and cost of patient care” (2013). To achieve this goal, care rounds that are typically done amongst the physician, nurse, social worker, and physical therapist will now be moved to the bedside so the patient will be able to actively listen and give input. This is measurable by patient satisfaction scores and readmission rates at the patient standpoint. Patient satisfactions scores should improve since patients are able to play a more hands-on role in their care. Also, readmission rates should decrease because discharge plans are made in conjunction to best suit the patient’s lifestyle and needs. To measure staff compliance, tracking will need to be done when bedside care conferences are done. A goal of at least 90% should be reached, as it may not be possible to do this with every patient every single day. Now that Coronavirus numbers are starting to decrease, 1 bedside reporting is becoming mandated again so implementing this innovation is attainable. This innovation is realistic and relevant for patient’s cares and minimal resources will be needed. As soon as education is given to staff on the implementation and why it is being done, staff can move forward with performing the bedside conferences. As an example, education would need to be done within a two week’s timeframe with implementation starting the day after the deadline. The overall challenge of this innovation is moderate. Ensuring that all team members are doing their part to participate is difficult since there are multiple areas that are needed. Timing is also difficult as patient may not always be in the room when rounds are being done or family may not be available to be at bedside. However, since the rounding is currently already being done simply moving it to the bedside should be relatively simple. Relevant Sources Review Table 1 Relevant Sources Summary Table Reference Citation Relevant Findings Evidence Strength Evidence Hierarchy McCloskey, R., Furlong, K., & Hansen, L. (2019). Patient, family and nurse experiences with patient presence during handovers in acute care hospital settings: a systematic review of qualitative evidence. JBI Database of Systematic Reviews and Implementation Reports, 17, 754-792. https://doi.org/10.11124/JBISRIR-2017- 003737 The authors conducted a three-step search strategy to synthesize the best evidence on experiences with bedside handovers in acute care settings. 12 publications were reviewed with key findings extracted and classified. They then were extracted into 14 categories to develop five synthesized findings: becoming more informed, upholding confidentiality and privacy, varying desire and ability to participate, individualizing patient care, and challenges in conducting bedside Level V Meta- Synthesis 1 handovers can be overcome with adaptive practices. Although there are challenges to work through, they can be overcome through education and the adoption of a flexible and individualize approach. Malfait, S., Eeckloo, K., Biesen, W.V., and Hecke, A. V. (2019). “Barriers and Facilitators for the Use of NURSING Bedside Handovers: Implications for Evidence‐Based Practice.” Worldviews on Evidence-Based Nursing 16 (4): 289–98. https://doi:10.1111/wvn.12386 The authors conducted structured individual interviews on 14 nursing wards in eight hospitals before implementation of bedside handovers. Pearson’s Chi-square analysis was used to determine whether there were associations between the care systems concerning the presence of barriers for implementing bedside handovers. Twelve barriers were identified. Overall nurses working in decentralized nursing care systems reported fewer barriers than those working in two-tier or centralized systems. Level IV Non- experiment al Ratelle, J., Sawatsky, A., Kashiwagi, D., Schouten, W., Erwin, P., Gonzalo, J., Beckman, T., & West, C. (2019). Implementing bedside rounds to improve patient-centered outcomes: a systematic review. BMJ Quality & Safety, 28, 317- 326. https://doi.org/10.1136/bmjqs-2017-007778 The authors used random effects models to calculate pooled Cohen’s D effect size estimates for the patient knowledge and patient experience outcome domains. There were 29 studies that met inclusion criteria- 20 of them from adult care and 9 from pediatrics. There was moderate to high risk of bias due to selective reporting, low adherence rates, and missing data. Level I Systematic Review Sturdivant, T., Herrin, K., Reynolds, M., & Mestas, L. (2020). Improving Patient Satisfaction through a Nurse Leader- Physician Bedside Rounding Protocol: A Pilot Project. Nursing Economic$, 38(3), 158-163. The authors discuss the ties between hospital reimbursement and patient satisfaction of care. A study was done after nurse leader- physician bedside Level VII Expert Opinions 1 see whether they are getting better or worse. There is some potential for bias due to selective reporting and potential missing data. Methods Process to Generate Ideas To achieve a consensus decision in a group there needs to be an agreement between all members. Consensus with an idea allows for shared power in the decision and gives all members equality, cooperation, and respect for each other's needs. First step is to establish a goal that needs to be achieved. Voting is a commonly used method to make decisions, which usually is effective for finding a majority vote. However, decisions can at times be swayed if they do not want to vote against the majority and worry about what others think about their stance unless the voting is done anonymously. The Delphi method is when members will make suggestions and then are given anonymous feedback from the other group members. Then those suggestions are reconstructed to better suit the group's opinion on the matter. This allows for the modification of ideas rather than just throwing out options. The Delphi method was chosen for decision making for this meeting. This specific method was chosen because sometimes ideas just need a little modification to make them great. This eliminates the immediate throw out of an idea but rather it allows for the group to discuss what could make the idea better. This allowed for the stakeholders to speak freely of ideas and also give input on other ideas until we came up with something that was agreeable amongst the group. To promote engagement, each member was asked what one area they thought could be improved on in the hospital. From there, the ideas were voting on which best suited the hospital and refined the ideas that were thought of. After the discussion we came up with patient satisfaction and engagement in care as being something we would like to improve on. From there we discussed bedside nursing report and how it has gone to the wayside since the Coronavirus. 1 We discussed how bedside reporting increased patient satisfaction scores and helped the patients become more engaged in their cares. We decided to take one step further from bedside nurse reporting to having the care team do bedside rounding. Examples of Big and Small Data in the Organization Big data in an organization is large “chunks” of information that can be structured or unstructured. Big data is used to review large volumes of data and analyze them for patterns. This type of data can be characterized into 3Vs: volume, variety, and velocity. Volume refers to the amount of data, variety is the types of data, and velocity is the speed at which data is generated. In this organization an example of big data includes the electronic health records (EHRs) of patients. All the patients seen at this hospital get registered into the system, whether they are being seen in the clinic, emergency department, or having surgery. The patient is assigned a medical record number and each visit gets filed under a visit number. Each note that has ever been written, all their allergies and medication, etc. will all be stored in their chart. This allows for tracking and storing of information and could also be used for analyzing. Small data is needed to provide meaning for big data. Small data tends to be more detailed and focused on a smaller area of data. Some characteristics of small data may include meaningful, organized, accessible, and understandable information. This type of data is directly related to patient care. For example, information is taken from the EHR on one specific patient and certain aspects of their care is analyzed such as blood sugar readings for one week. Overall, small data is focused on a specific patient or department while big data analyzes many patients or a hospital to watch for risk patterns. How Big Data Supports the Innovation Big data supports this innovation by looking at the bigger picture of this organization with a special focus on patient satisfaction and readmissions. One of the questions that were 1 asked was does patients’ satisfaction with their health care during a hospital stay impact their outlook on their health? By creating a positive, engaging experience while a patient is in the hospital will it then in turn inspire them to become more involved with their health? Aspects of healthcare can be intimidating due to the complexity but being able to break things down and involve a patient in their care may make it a more pleasant experience for them. Technology Enhancements for the Innovation There are no technology enhancements needed for the innovation, since the big implementation is going to be switching from doing care rounds in a conference room to the bedside. Education can be done through the already established software that is currently used. Also tracking can be done through software already established such as something as simple as Excel. Interprofessional Collaboration and Disruptive Innovation Disruption of Innovation and Impact The organization is choosing to disrupt the normal flow in hopes for a positive change. This innovation impacts individuals, specifically patients, for the better. This allows for better one on one conversations between staff and the patients. However, the process of care round may become more difficult. Prior, the physician, physical therapist, and social worker would meet in a conference room and the nurse from each group of patients would enter one by one. It was convenient because nurses would stop by as they were able to meet with other care members. This may raise a challenge to have everyone meet at the same time for rounds as situations may arise making it difficult to do. Strategies to Address the Challenges As mentioned above the biggest challenge will be attempting to have all members of the care team be able to meet at the same time to do rounding. The best way to mitigate this 1 Innovation Action Plan Responsible Person (Role) Responsibilities Timeline Nurse educator Perform research on bedside reporting. 1-2 weeks Nurse educator Gather any tools or supplies that will be needed for education and training. 1 week. Directors/Managers Reach out to staff and inform of upcoming education and implementation. 1 week Nurse educator Put together online training for staff's viewing. 1 week Directors/Managers Ensure that staff views the education before the deadline. After deadline- follow up with staff who have not completed it within a week's time. Staff (nurses, physical therapists and social workers) Watch education and ask leaders about questions or concerns. Open for 2 weeks. Nurse Innovator/Educator Have in place a way to review whether implementation is working. 1 week to set-up. Physicians and Staff Start to think how to change daily routine to implement the change more fluently. 1 week Nurse Educator Meet with directors and managers to answer any questions and help with any implementation problems prior to starting. 1 week. Nurse innovator Make flyers or posters to post in nurses’ station as visual reminders that bedside reporting needs to be done. 1 week. Financial Implications During the planning phase of the innovation there will be a cost for the time of the employees meeting to get things in place for implementation. Even if they are salary, they are still taking time away from their regular job to sit through meetings. During the implementation phase, additional funds will be needed for staff to sit through the education as they will need to 1 be paid for their time because they will come in during their free time. For an example, the medical floor has approximately 70 nurses that will need to be trained, who are all hourly. If the nurses make an average of $30.00 an hour and the education is an hour, that is just a little over $2,000 for the nurses to do the education. This is not including other departments that also need to be trained. Funds for the nurse educator to put together the education will also be needed along with the cost for the software. Again, for the evaluation, staff will need to be paid for their time to go through data along with paying for software to do the calculations. However, the financial rewards will in turn make up for the start-up costs. It was mentioned earlier that high patient satisfaction results in higher reimbursements from insurance companies, which makes more money for the hospital. Interprofessional Communication Plan Since there is many departments and different members included in this implementation the most efficient way to communicate is by first talking with each department manager or director who will then need to relay the information to their staff. Specifically, the director or manager of the medical floor, intensive care unit, physical therapy, and social workers. A list of each department head and one head physician should be established as the person responsible to relay information to the different staff appropriately. To facilitate the best communication between managers, directors, and physicians, an initial meeting in person would be best for open discussions and questions. It would be hard to talk openly about this new concept via email or phone call just so everyone and visualize one another and see when someone is talking. Communication to staff members can be done by email, staff meetings, and daily line up since there are many more staff members to reach out to. Also, by the time the information is being directed to staff, there is not as much discuss about the matter and more relaying of information. 1 Question, comments, concerns, and ideas can still be expressed by other staff and possibly be implemented. Evaluation of the Innovation The overall evaluation of the innovation should be assigned to the project specialist that is employed at the hospital. It is her specialty to follow projects from the beginning to end and investigate the data that is associated with it. She can perform the rounding that done to ensure that the team is doing it the way it is intended and even follow up with patients to ask their experience with the bedside rounding. She also will analyze patient satisfaction scores and compare them with pre-implementation scores to see if there is any improvement after this innovation is implemented. Also, follow up with staff will be done to see if this innovation is something that is feasible for long term implementation. Conclusion The main goal for this innovation is to include the patient on care planning to achieve a well-rounded plan of care that is most efficient for both the patient and the hospital. By enforcing bedside rounding for staff involved with a patient’s care, it will drastically reduce the chance for miscommunications and errors while improving the patient’s overall care. The members involved with the care team all share the same value of patient’s care comes first. Even though everyone is in different positions within the hospital, they still want what is best for the patient and to maximize their health. Since this is a smaller hospital, the initial process of developing the innovation went well. The strengths of this innovation are that the implementation is fairly simple however, it does cause the disruption of the daily workflow. There may be some challenges with trying to get all team members to do the rounding together due to conflicts in schedules. One of the main lessons learned from this innovation is the amount of work, time and research that goes into it. These innovations do not happen overnight and need time to develop. I