A different approach to critical care
Submitted by Megan Birnie, senior communications specialist, Communications & Public Affairs
(Above: Ebony Lees and Sabrina Benzinger, RNs at St. Paul's CICU, perform their shift report at a patient's bedside)
Patient and family centred care initiatives at Providence Health Care have made significant changes to the way we deliver care, and the critical care areas at St. Paul’s Hospital are no exception.
Beginning July 11th, the nurses in the Cardiac Intensive Care Unit (CICU) at St. Paul’s Hospital will adopt bedside shift report (BSR) – moving end-of-shift report between nurses from behind closed doors to the bedside and inviting participation from patients and families. This is just the latest step in a shift towards greater information flow and collaboration with patients and their families.
So how does this ultimately benefit patient outcomes?
Information sharing is one of the four core concepts of patient and family centred care. This initiative increases transparency and provides an opportunity for patients and family members to clarify information and ask questions.
“Giving the handover at the bedside increases the quality of information transfer and responsibility between nurses,” says Dione Nordby, an interim nurse educator who was brought on to help support the transition. “At the same time, it helps patients and families develop knowledge regarding their illness.”
Martha Mackay, clinical nurse specialist, agrees: “Families help to improve the patient’s outcome. The family is part of the patient. The more the family is involved, and participating in decision making, the more likely the patient will be engaged and will adhere to treatment.”
The process in the CICU was developed and guided by input from three Patient and Family Partners, and refined through multiple small-scale PDSA cycles to help smooth the transition.
“Nursing shift report is a crucial process that allows nurses to pass on information from one shift to another to ensure continuity of care,” says Sara Charlton, practice consultant for the Care Experience Strategic Direction. “BSR will not change that but will add another important element – the patient and family. Inviting partnership from patients and families builds in an additional safety check.”
However, completing shift report at the bedside may not be ideal for every patient, and a patient may decide that they are not comfortable with their information being shared in a room with other patients present.
“Getting a patient’s permission is part of the process,” explains Martha. “There will initially be a more formal discussion with the patient about what the handover entails, and the opportunity for the patient to give permission or refuse. Then the patient’s agreement will be sought each time afterward. We ask them who they would like to be there, if there is anyone they would not want to be present, and if they’re OK with information possibly being overheard by other patients in the room. So it’ll be a pretty dynamic process, and will unfold a little differently for each person.”
While the primary goal of this initiative is increased safety, a secondary benefit is that it makes visible a lot of the nursing work that is often invisible to patients and their families. Witnessing the detail and thoroughness of the handover added to patient and family satisfaction in early trials of the process.
“When facing critical illness, patients and families are thrust into a world of uncertainty and potential chaos,” says Dione. “Providing a consistent opportunity for patient and family members to be seen, heard and contribute to their own care can enhance overall satisfaction and alleviate anxiety.”
For more information on bedside shift reports, please see attached Q&A.
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