The nursing shift change handoff occurring in patient rooms had been a process on 13 East Tower (surgical - orthopedic unit), but problems affecting patient satisfaction were identified in July 2022. This handoff workflow process included a review of medications, intravenous site and fluid checks, re-positioning and introduction to the next nurse. Due to multiple factors, including staffing shortages, new nurse hires and changes of the unit patient population to manage COVID-19 care, 13 East identified that nurses did not always provide handoff at the bedside.
In July 2022, unit leadership began auditing the completion of RN handoff at the bedside on 13 East Tower. The Press Ganey patient satisfaction survey includes the question, “At the change of shift my off-going nurse and oncoming nurse always discussed my care at my bedside.” The 13 East Tower score to this question in July 2022 was 23.91%. Because RN handoff is patient and safety-centered, a gap in the workflow process directly impacts overall patient satisfaction scores.
To improve the Press Ganey patient satisfaction score to the question, 13 East Tower created a team, to collaborate with patient satisfaction specialists in August 2022. Charge nurses and unit leaders continued to perform real-time shift change audits at 7 a.m. and 7 p.m. to assess the frequency of bedside handoff along with revising the workflow for bedside RN to RN handoff to increase the focus on safety. This included a scripted statement and specific roles for both the off-going and on-coming nurse.
The education on the change in workflow with enhanced activities for the bedside handoff, reinforcing all elements of the workflow and audits of correctly completed bedside shift handoff, directly impacted the gaps in the workflow and improved the compliance of nurses to always provide handoff at the bedside or confront peers who suggested doing handoff elsewhere for convenience. The handoff compliance by all nurses improved the patients’ satisfaction that their care is always discussed at the bedside.