Change Proposal Topic: Re-implementation of bedside shift reportMake an outline of Section VI and VII (Timeline & Resource Allocation and Conclusion) of your Change ProposalVI. Time and resource alloc
* Errors are in red that must be addressed or more points will continue to come off.
Clarification about the change process is needed; telehealth in ICU is mentioned but not explained as being relevant to BSR. There are many sentence structural issues. See my feedback throughout.
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 increase costs in the facility. Also, to have a reduced cost by removing overtime pay and scrubbing off legal errors which result in legal fees (Clark et al., 2020). (*Re-phrase this sentence, avoid slang).
The reimplementation of a bedside shift report is important for the nurse 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) reveals that the scores in the patient satisfaction with the nurse-sensitive indicators associated with communication are necessary towards improvement in the bedside shift reporting. (*Re-phrase this sentence, it’s confusing). 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.
Conclusion
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.
My present work environment has neglected to comply with The Joint Commission principles concerning patient-focused care and struggling to improve patient fulfillment scores based on Press Ganey overviews. (*Be careful making statements like this. Are you sure they are non-compliant? How do you know? If evidence, please provide, if no evidence please remove and fix)
Thus, my proposal plan will focus on the implementation of bedside shift reporting to facilitate collaboration between staff, patients, and relatives, promoting patient commitment and improve patient recognition, experience, and fulfillment. (*There are alot of "run-on" sentences here, break them into two or even three sentences for clarification.) The reason for implementing the bedside shift report is basically to meet patients' satisfaction by monitoring their wellbeing conditions since they listen to their wellbeing report as medical caretakers change shifts; reduced expenses by removing additional time pay and scrubbing off legal errors which bring about lawful charges, and improving quality of health care by allowing patients and relatives to contribute their emotions on their wellbeing and that of their friends and family (Meyers, 2020).
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 area please add and explain how Lewin's is appropriate and remember you have to convince the organization group and key leaders to support. Focus on how you are going to do that with detail.)
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. 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.
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 were provided to every nurse and then each one participated in bedside shift reporting for both day and night shifts. The nursing staff observed, and assessed during shift change implementing bedside shift reporting. (*Please fix this portion as you have written it as if it has already been completed?)
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
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.
Evidence-based rationales to propose how I will address them, incorporating my identified change theory.
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
(*Not clear about how telehealth will be important with BSR. Please change target floor to acute care rehabilitation patients in nursing home!)
My target floor for my project implementation is Intensive Care Units. ICU patients 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. However, ICU patients will be unable to navigate computers to monitoring these assignments as they frequently have critical problems.
(*Telehealth? And What assignments? 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).
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).
Hospital or governmental policy constraints
It would be difficult for ICU patients to work on their insurance policies while still under Medicare or Medicaid programs. It takes a long time while I 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).
Patient diversity
Some factors have to be considered when educating ICU 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.
References
C. Clark, A., Wolgast, K. A., Mazur, N., & Mekis, A. (2020). Leading Change in Nurse Bedside Shift Report. Nursing Clinics, 55(1), 21-28.
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.
