Overview
The major issue I have encountered from my first day as a nurse is the problem of SBAR reporting between outgoing and incoming nurses. Most nurses do not like taking reports at the bedside of the patient, especially when the patient is confused. Nurses who supposedly are friends talk bad behind their friends mostly at the nurse’s station about something, such as a non-working IV, non-existing central line, and others as foley catheter in place. My unit has a Key Performance Indicator (KPI) board that my hospital leadership team rounds periodically. The metrics are either changed every month or repeated if our targets are not met. My manager and the Shared Governance Committee, which I am a member of, developed a bedside report sheet for both nurses and nursing assistants. The outgoing nurse’ SBAR report is designed on the bedside report sheet and the incoming nurse co-signs it by each patient or room the handoff is done on. The sheets are then given to the chare nurse of the shift to be studied for the next KPI presentation. Any nurse that triggers a metric to turn “Red” is responsible for answering documented questions the reasons for the “Red.” This has reduced the problems nurses having misunderstandings against each other. I have the habit of asking a complaining nurse whether they did bedside report, if they answer in the negative, then we all demand the nurse fixing the problem without complaining. The introduction of the bedside reporting sheet was met with pushback mostly those that I call “I’m ready to retire or switch units” nurses. But as discussed by Don Berwick in his module of safety as the key dimension of quality of care, my manager and the shared governance committee required commitment, support and periodic feedback from every member of the unit. I recently heard the hospital is interested in adding it as one of the mandatory nurse documentations. Steve Spear recommended formal approach of “what went wrong, why did this go wrong, change, and work” cycle to aid in quality improvement projects. My Unit’s Shared Governance Committee meets once a month for two hours and deliberates over our KPI metrics and any other issues affecting us. We will meet with the manager during the meeting for this discussion. Our doctors’ group also organizes quarterly meetings with staff during Safety Hurdles to iron out any problems we have encountered over the quarter. The doctor’s group for my unit acknowledges that the bedside reporting system with its co-signings has reduced some errors they recognized before the introduction. This has indeed helped us see system changes and be able to measure improvements for the unit.