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Change Proposal: Reimplementation of a Bedside Shift Report

The identified clinical problem that is relevant to nurses in the workplace is the bedside shift report (BSR). The bedside shift report may be used to help the development of teamwork, ownership, and accountability thus increasing the satisfaction of the nurses. The reason for selecting the reimplementation of a bedside shift report is because; at a targeted facility the implementation of the bedside shift report is becoming poor. This has led to the poor compliance with the standards of practice, and increased costs in the facility. Also, reimplementation of BSR will reduce operational costs by eliminating overtime pay and unnecessary legal fees that arise from preventable compliance errors.

The reimplementation of a bedside shift report is important for the nurses practicing in the organization. Bedside shift report assists in improving the experience of the client and improving the handoff care between the nurses through including the family and client in the delivery of care. Bedside shift report is leading to the introduction of a change in the nursing culture i.e. introduction of various methods of communicating patient-specific care at a shift transformation. Shift reports given at the bedside is helping in changing the manner in which nurses are communicating and practicing (Clark et al., 2020).

At the targeted facility, the execution of the bedside shift report is poor and this is associated to the lack of knowledge concerning the role of bedside shift reporting on the patient outcome. The healthcare providers at the facility are not directly engaged in the provision of healthcare. There is poor communication of the goals of the bedside shift reporting and their importance about the positive outcomes and benefits that are involved in the change (Clark et al., 2020).

According to the study by Gregory et al., (2014), the process of assessing the transformation in practice that involves transitioning of the bedside nurse shift handoffs is important. The evaluation process is helpful in the re-implementation plan to help in improving the areas of weaknesses. The evaluation process of the success in the implementation in the practice is assessing the perception of the nurses about the proposed changes i.e. the re-implementation plans. There is evidence showing the positive impacts of the bedside shift report in the safety of the patient, the control of the pain, the satisfaction of the patients, and improvement in the nurse to patient or nurse to nurse communication (Gregory et al., 2014).

A study by Dempsey et.al. (2014) highlights the necessity of looking at nurse-sensitive indicators such as the impact of nurses’ communication on patient satisfaction in the process of improving bedside shift reporting. The success of the reimplementation of the bedside shift reporting also depends on the education that is being provided to the nurses. Most of the cases of poor bedside shift reporting in the facility were associated with lack of understanding on its benefits and reasons for its implementation. Since there is no clear understanding of the need for the implementation, most of the nurses are not prepared to fully implement the procedure.

The poor process of implementing bedside shift reporting is associated with a lack of understanding of the importance of such practices. This leads to poor compliance with the necessary set of standards of practice and increases in the cost of healthcare. Therefore, the reimplementation of the bedside shift reporting is necessary to ensure that nurses are informed about the importance of such practices. It also helps in equipping nurses with the knowledge needed towards the implementation of the bedside shift reporting.

Justification of Need

During the change of shift report, lack of proper communication has resulted in about 65% of sentinel events (Joint Commission, 2016). With healthcare's focus shifted to patient-centered care, many concepts and proposals have come about to improve the patient experience. With my facility needing to improve upon patient experience and satisfaction, the goal for my clinical practice project was to implement a change that would positively affect all involved, including the patient and their families, nurses, and the organization.

Pre-Implementation Plan

In this proposal, I decided to use Lewin's theory of planned change to ensure that my project implementation will be successful and achieve its primary purpose. Lewin's Theory of Change is straightforward and execute as it centers on changing people's behaviors. Also, this theory is excellent to influence a change of mentality among employees at the facility. Lewin’s theory of planned change creates awareness about the advantages of accepting change thus it will be effective to promote the reimplementation of BSR. Support from the organization group and key leaders to the nursing staff during the moving and refreezing stages is fundamental for the viability and consistency of the change. As per Lewin’s theory, the first step of implementing the proposed change will be unfreezing. This phase involves creating awareness about the negative implication of the current procedures at the facility. Implementing the proposed change, in this case a reimplementation of BSR, will be the next step. Finally, the last step involves reinforcing the implemented change. This will be done by formulating relevant policy to support the BSR and prevent reverting change. It is an excellent method to bring about a mentality change among employees and creating awareness of the advantages of change.

Our facility's mission is to care, serve, and heal with a mission to provide world-class care to our patients and community. Right now, there is no standard in nurse handoffs or changes in inpatient care. Every unit unexpectedly performs shift change handoffs. During transitions in care, research shows that patients are being ignored and left unattended (Grimshaw et al., 2016). Patients are avoided from accessing their plan of care, frequently not realizing what prescriptions they are on, what they are going after, where their treatment plan is going. My proposed solution to improve patient perception, experience, and fulfillment was to execute mandatory bedside shift reporting for medical attendants. The objective of the bedside shift is to promote a more patient-centered approach to care (Meyers, 2020).

To implement the plan, education and tip sheets will be provided to every nurse and then each nurse will participate in bedside shift reporting for both day and night shifts. The nursing staff will observe, and assess the impact of implementing bedside shift reporting in both night and daytime shifts. Direct feedback on how the patients felt about the new adjusting process, their preferences of the procedure, and what should be possible contrastingly to improve their experience during a move change has to be recorded. Lastly, I must assess the staff's thoughts and emotions on bedside reporting and evaluate criticism from the patients with the team and make changes accordingly.

My proposal will engage different healthcare professionals such as case managers, social workers, physical therapists, physicians' assistants, nurse practitioners, and physicians. My central organizational resource will be the Agency for Healthcare Research & Quality (AHRQ). The agency will align with my hospital's mission of providing quality care, safer healthcare, affordable, accessible, and equitable care. Also, my plan should comply with standards highlighted by other stakeholders such as the U.S department of health and human services to ensure evidence-based care is the ultimate aim of the program (Grimshaw et al., 2016).

Factors likely to affect the implementation of my recommended activities (Review appropriate headings in APA, for centering for Level I, and where to put Level II)

Several factors need to be considered when reimplementation of bedside shift report is taking place. One primary thing considered here is the quality of healthcare provided in the facility where the project will roll out. To minimize the number of medical errors, educating, and training all stakeholders within the facility is essential as it will improve hospital operations' effectiveness. Technology integration and raising funds are other necessary factors need considerations.

With the facility needing to improve upon patient experience and satisfaction, the goal for my clinical practice project is to implement a change that would positively affect all involved, including the patient and their families, nurses, and the organization. Compliance and rounding monitoring will be conducted following evidence-based protocols alongside side Lewin’s change three-stage model. This will sustain the new practice of standardized nurse bedside shift report (Gregory et al., 2014).

Technological challenges (Again review headings in APA)

My target floor for my project implementation is within the acute care rehabilitation centers. Patients in acute care rehabilitation centers require adequate follow-up care with their health provider team. Technological devices such as telehealth will be used to facilitate care by enhancing follow-up appoints and communication across departments. Telehealth devices are very important to the implementation of the BSR because they facilitate effective communication between patients, nurses, and relatives. Patients in the acute care rehabilitation centers will utilize the devices to present their concerns to their care givers. On the other hand, nurses will utilize the devices to relay crucial information to other attending nurses as well as relatives. Therefore, nurses receiving this project must learn and remain competent with telehealth technological services. Finding a group of health care providers that are willing to start treating patients this way is the first step.

Institutional structures

I do understand that implementing BSR changes is not an easy thing, and sometimes changes to take effect takes longer. However, the BSR program will ensure that nurses and other stakeholders are educated on how the new program will operate and how it will benefit patients and their families in reducing BSR medical errors. However, for changes to take effect, approval must be granted by different agencies. Once certification is given, all involved medical staff must receive a copy of the project plan document. Some of the concerned committees are audit and compliance committee, strategic planning, safety and quality, and finance department (Dempsey et al., 2014).

Strategies for building buy-in-among different stakeholders, including nursing

During the change process, case managers, social workers, physical therapists, physician assistants, nurse practitioners, as well as doctors, must be on board. Historically, nurses are stakeholders involved with resistance to change mostly (Gregory et al., 2014). (Awkward sentence, reconsider.)

Financial trends & anticipation of the availability of human resources & project funding.

There will be a financial constraint in implementing telehealth and electronic health record systems during BSR implementation. Mostly, training and educating both nurses and patients will cost money, which the organization will have to be prepared to put into their budget. It would be a financial benefit when the institution strives to remove the cost of readmissions in their plan (Joint Commission, 2016). (The last sentence does not fit here, reconsider.)

Hospital or governmental policy constraints (You can simply state there are no government policy constraints and administration support BSR. You do not need a heading for two sentences.)

It would be difficult for patients to work on their insurance policies while still under Medicare or Medicaid programs. It takes a long time while in the hospital to get a policy set into place.

Regulatory requirements

Regulatory acts that need some attention in this project would be the Medicare Access and CHIP Reauthorization Act of 2015 and The Health Information Technology for Economic and Clinical Health Act (HITECH) (Joint Commission, 2016). These two acts will be beneficial in balancing patient’s quality of care with the payment model as they will minimize readmissions rate that will automatically help with reimbursement (Meyers, 2020). (So are you stating that BSR will decrease readmissions? How?)

Patient diversity

Some factors have to be considered when educating patients about their well-being. Quality of care, according to Meyers (2020), is improved when nurses reduce the readmission rates for a specific population. It means, considering the technology used, family support, language spoken, and reading levels will determine how training and education will be conducted.

Evaluation Plan

Steps for Evaluating Change

The following steps will be used in the evaluation of the proposed change:

Team formation

The first step will be to form a team that will be involved in the evaluation process. This team will consist of the people who will be affected by the change, that is, the workers. The team will also consist of the people responsible for implementing the change. In this case, the team will involve the nurses as well as hospital management. The team will identify the problem along with the solution so that it can be easy to measure the success of the project.

Data collection

The data concerning the change will be collected and compared. The records on how the change implementation was made should also be done. Data collected after the change implementation will show if the change has been effective. In this proposal, data will be collected before the reimplementation of the bedside shift report, that is, the shortcomings of the initial implementation of the bedside shift report. The details on how the reimplementation will be done, will then be recorded and finally the change after the reimplementation. (Include a post survey to gather data on compliance with bed side report. This is how you will see if the change is effective.)

Data analysis

After the data has been collected, it will be analyzed to show if the reimplementation of the bedside shift report has been effective. This will help decide whether to stop or continue with the reimplementation. A comparison of the data before and after the reimplementation of the bedside report will show to what extent the change is effective.

Sharing results

For the change process to be complete, results from the analysis of data have to be shared with the people affected by the change. In this case, the results will have to be shared with the nurses and that way, they can predict if the reimplementation will continue or stop.

Indicators for Measuring Success

One of the indicators that will be used to measure the success of the project includes the effectiveness of communication. The way the nurses will understand the reimplementation plan will determine how the plan works out. The effectiveness of the communication will be reflected in the way the nurses will be able to train the patients effectively. Patient satisfaction or frustration in the training process will also be an indicator for measuring the success of the reimplementation plan.

Benchmarks to Measure the Effectiveness of the Change

Some of the benchmarks that will be used to measure the effectiveness of the change include previous studies that identified the need for the reimplementation of the bedside shift report. Hospitals that apply the bedside shift report will also be used as benchmarks in this case. A study by Clark et al, 2020, indicates how the bedside shift report is changing the nursing culture. This will be used to identify if the report is making the changes that it is expected to be making.

Dempsey et al (2014), highlight the necessity of improving the initial bedside shift report. The shortcomings of the initial bedside shift report that are identified in this study compared with the results after reimplementation will indicate the success of the bedside shift report. The study by Gregory et al 2014) outlines the positive impacts of the bedside shift report. The impacts outlined in the study will be compared to the results of the reimplementation of the bedside report to assess its effectiveness.

Processes of Gathering Feedback from Stakeholders

Feedback is very important in the implementation of change. In this change proposal, feedback will be collected from, nurses, patients, their families as well as other stakeholders. The first step will be to come up with an appropriate channel for collecting feedback. In this case, the best channel will be survey questionnaires that will be served to all the stakeholders. These questionnaires will involve questions that are relevant to each stakeholder. These questions will be carefully constructed and will cover only the information that is relevant to the implementation of the bedside shift report.

The complaints given as part of the feedback will especially be marked as the most important part of the feedback. This is because it will show the parts of the change that need to be revisited. The concerns raised in the feedback will be acted upon because that is the main reason for gathering feedback. Getting back to the respondents and assuring them that their feedback will be addressed is as important as gathering the feedback.

Time and Resource Allocation

Several factors must be considered in the process of implementing the proposed change of bedside shift report (BSR). Time and availability of resources are the most important factors that should be considered. The success of implementing BSR as per the change proposal depends on customized planning and the resources available for use. Selecting the appropriate timeline allows the change management teams to pull together the necessary resources. It also promotes the participation of key stakeholders in the change implementation process.

The resources required for the implementation of the proposed change include digital telehealth equipment, additional manpower, as well as financial resources. (Telehealth? For other members of the team to participate? This needs to be highlighted more.) Resources to facilitate extensive research are also required for the change implementation process. Financial resources are the most crucial in this process because everything else depends on the availability of sufficient funds. However, the required resources must be verified and approved by the board of directors at the facility before the change implementation process is officiated. For this reason, the timeframe must be designed to accommodate consultation with key stakeholders. The most appropriate timeframe, therefore, is six months beginning from the approval date for the change implementation project. Below is a detailed schedule of the activities to be undertaken, the resources and the time allocated for each activity.

Conclusion

In conclusion, the proposed change concerns the re-implementation of bedside shift reporting to enhance the quality of services offered to patients. The proposed change is consistent with modern nurse informatics systems thus it’s very relevant. Also, the proposed change will be implemented as per Lewin's theory of change management to ensure that the process runs smoothly. The anticipated outcome is an improvement in the communication between nurses, patients, and their relatives. The implementation process is scheduled to be completed by the end of 6 six months from the approval date.

References

(capitalize only first word of reference title.) C. Clark, A., Wolgast, K. A., Mazur, N., & Mekis, A. (2020). Leading Change in Nurse Bedside Shift Report. Nursing Clinics, 55(1), 21-28. You Dempsey, C., Reilly, B., & Buhlman, N. (2014). Improving the patient experience: Realworld strategies for engaging nurses. Journal of Nursing Administration, 44(3), 142-151. Gregory, S., Tan, D., Tilrico, M., Edwardson, M., & Gamm, L. (2014). Bedside shift reports: What does the literature say. Journal of Nursing Administration, 44(10), 541-545. Grimshaw, J., Hatch, D., Willard, M., & Abraham, S. (2016). A qualitative study of the change-of-shift report at the patients' bedside. The health care manager, 35(4), 294-304. Joint Commission. (2016). Guide to Patient and family engagement in hospital quality and safety. Meyers, S. (2020). Bedside Shift Report Improves Patient Safety.