6 Center C.A.R.E.S. © a NKE (Nurse Knowledge Exchange) project Please include these points during shift change reports/handoffs with ALL patients. Collaborate with patients to establish daily goals Ask patients and/or family members if they have any questions regarding their individual care, plan for the day/hospital stay, and/or medications RN introduction Explain and UPDATE care board Summarize above, and encourage patient feedback as well as them verbalize what they understand Covering these points with patients during shift change has been proven to improve overall patient satisfaction and HCAHPS scores. |
C.A.R.E.S. - The Effectiveness of Standardized Reporting on
Patient Satisfaction
According to Laws & Amato (2006), "Communication failures during shift reports are a leading cause of sentinel events in the United States. Providing information during change-of-shift reporting is essential to promoting patient safety. In addition, patients want to be more involved in decisions regarding their plan of care" (p.70). There has be a great deal of research done on the effectiveness of bedside reporting in regards to improving communication among caregivers and encouraging patients to become more involved in their plan of care. There are many benefits for both and this is the primary reason 6 Center created the C.A.R.E.S. initiative.
In 2007, as part of their National Patient Safety Goals for Hospitals, Joint Commission on Accreditation of Healthcare Organizations (JCAHO) determined that in order to foster and improve communication among health care providers during shift change and allow patients to become a part of this process, a standardized system for intershift reporting should be implemented. The C.A.R.E.S. initiative is 6 Center's standardized bedside reporting template. This initiative allows our staff to effectively and efficiently communicate among each other, and also with patients while keeping them involved in the plan of care.
Several benefits of structured bedside reporting have been identified and all maintain the central theme of patient safety and patient centered care. Bedside shift report allows staff to resolve any potential discrepancies together in order to assure that the transfer of information from one shift to the next is accurate and relevant. Another benefit to bedside reporting is the promotion of teamwork and accountability among staff. "By working together, patients witness a safe transfer of responsibilities" (Laws & Amato, 2006, p. 71) and an assurance that everyone knows the plan of care.
Traditionally, unstructured change-of-shift report (report which is non standardized and away from the bedside) tends to lack consistency and at times the transfer of vital information. In a study by Jordan (1991), only 12% of unstructured intershift reports included important plan of care information. Without the handoff of this crucial information during report it becomes almost impossible to provide effective care and meet the patients treatment goals. Shifting this standardized approach to reporting at the patients bedside is critical to the sharing of vital information, promotion of patient involvement, patient safety, and overall satisfaction (Schroeder, 2006).
There were three main factors that aided in the development of the C.A.R.E.S. initiative. The most important of these was our desire to improve the communication among staff and actively involve our unique patient population in their plan of care. The second influencing factor was our medical centers adoption of Jean Watson's Human Caring Theory. The ten caritas factors outlined in this theory guided us towards a standardized intershift report system which was truly patient centered. Finally, the creation of the acronym C.A.R.E.S. allowed us to achieve a National Patient Safety Goal, while improving the effectiveness of communication on 6 Center and emphasizing the role of patients in their care.
Since our implementation of the C.A.R.E.S. standardized reporting initiative in November 2010 our HCAHPS scores have significantly increased in nearly every area and has remained consistent.
Figure 1. Preimplementation: November 2009 - October 2010
There were three main factors that aided in the development of the C.A.R.E.S. initiative. The most important of these was our desire to improve the communication among staff and actively involve our unique patient population in their plan of care. The second influencing factor was our medical centers adoption of Jean Watson's Human Caring Theory. The ten caritas factors outlined in this theory guided us towards a standardized intershift report system which was truly patient centered. Finally, the creation of the acronym C.A.R.E.S. allowed us to achieve a National Patient Safety Goal, while improving the effectiveness of communication on 6 Center and emphasizing the role of patients in their care.
Since our implementation of the C.A.R.E.S. standardized reporting initiative in November 2010 our HCAHPS scores have significantly increased in nearly every area and has remained consistent.
Figure 1. Preimplementation: November 2009 - October 2010
Figure 2. Postimplementation: November 2009 - August 2011
The success of this project is directly related to the front line nursing staff who wholeheartedly adopted this initiative from its beginning phases. Achieving such results would not have been possible without the hard work and dedication of the 6 Center team. Through our efforts, we have demonstrated our commitment to providing excellent patient care. Thank you all and keep up the great work!
References
Joint Commission on Accreditation of Health Care Organization (JCAHO). (2000, July). Sentinel event alert: Fatal falls. Retrieved September 24, 2011 from www.jointcommision.org/SentinelEventAlert/sea_14.htm.
Jordan, P. (1991). Psychiatric unit handovers. Nursing Times, 87(43), 40-42.
Laws, D. & Amato, S. (2010). Incorporating Bedside reporting into Change-of Shift Report. Rehabilitation Nursing, 35(2), 70-74
Schroder, S.J. (2006). Picking up the PACE: A new template for shift report. Nursing, 36(10), 22-23.
