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October 6, 2011

A patient-centred shift in nursing shift changes

A new, patient and family-centred approach to nursing shift changes is benefiting both patients and nurses at the Cypress Regional Hospital in Swift Current and the Royal University Hospital in Saskatoon.

The “bedside shift handover,” which brings patients and families into the conversation between outgoing and incoming nurses, represents a profound departure from the traditional shift handover model.

“It puts the patients at the centre of care, and that’s what we want to do,” says Cheryl McNally, manager of Royal University Hospital’s orthopaedic trauma unit — the first ward in Saskatchewan to move shift handovers to the patient bedside.

In most Saskatchewan hospital wards, nurses beginning a shift consult with those ending their shift, discussing patients’ care plans, medications, tests ordered, and other important information. While most nurses provide a verbal report to those just beginning their shift, some leave recorded messages so they can continue tending to patients while the newly arrived nurses listen to the reports. Under both of these models, important sharing of information usually happens at the nurses’ station and does not include patients or their families.

For patients at the RUH orthopedic trauma unit, shift handovers look quite different. Inspired by a presentation at a recent conference of the Canadian Orthopaedic Nurses Association, nurses in this unit now provide their shift-change reports at the patients’ bedside, often with family members present.

Not only do patients and families get the opportunity to hear the care plan, they are also able to ask questions and contribute information of their own.

Cheryl McNally says patients and families “absolutely love” the new approach to shift handovers. Since implementing the bedside protocol, the unit has received letters from patients and families expressing their delight.

McNally says that while care plans were previously discussed “in a huddle behind the desk,” the bedside conversations ensure that “there’s nothing hidden” when it comes to the plan for a patient’s care.

“It’s their body, their care, their medical issues, so really, we shouldn’t be hiding anything from them,” she says. “Now they can hear what’s going on firsthand. You develop more trust with the patients and families.”

Recently, the women’s and children’s unit at Cypress Regional Hospital has also begun implementing the bedside shift handover. Tyler Kannenberg, interim director of strategic planning and performance at Cypress Health Region, says the initiative “fits well with the strategic direction of the region — in particular, our values of safety, compassion, respect, accountability, and excellence.

“It improves patient safety and puts the patient first by involving them as a partner in their care,” Kannenberg says.

In implementing the changes, both wards have been guided by the Health Quality Council’s Releasing Time to CareTM (RTC) program, a ‘menu’ of care modules that nurses can choose from and adapt to improve their wards’ functioning and free up more time for direct patient care.

Kyla Avis, director of the program, says that while bedside shift handovers have always been an available component for care units implementing RTC, “it’s never really been pushed as something that must be done.” However, as health regions become accountable to implement patient- and family-centred care practices, the bedside shift handover may represent “a huge opportunity to make a significant step in the right direction,” Avis says.

She also notes that initial concerns about overly lengthy shift changes or compromises to patient privacy have been successfully addressed by the wards implementing the new shift-change approach.

“We’re really supportive and proud of the RTC wards that have taken this step,” she says. “We hope their example and leadership can inspire other wards and facilities to do the same.”

On the Health Quality Council’s YouTube channel: See a bedside handover in action on the Women’s and Children’s Unit at Cypress Regional Hospital and hear what patients, families, and staff have to say about this new approach to shift changes.