'All it takes is one near-miss and the nurses are sold'
Trillium Health Centre introduces nurse-to-nurse report at patient bedside
Tuesday December 2, 2008 -- Natalie Miller
At Trillium Health Centre, nurses are beginning to engage in more detailed conversation at the bedside during shift changes in an effort to improve patient safety and reduce risk for error at the Mississauga hospital.

It has been well-documented through research that communication breakdown is a major contributor to medical errors and shift change is one point in time where mistakes can happen.

Recognizing this, Trillium Health Centre has launched a new initiative in its orthopaedic in-patient surgical unit aimed at reducing the gap for error. After about 18 months of research, planning and education, the hospital is set to introduce nurse-to-nurse reporting during shift change at the patient bedside.

"We identified patient safety risks through previous incidents on the unit," says Kathy Elliott, manager of orthopaedic surgery, rehab 1B and the fracture clinic at Trillium Health Centre.

"Based on that, we developed a plan...to transfer accountability explicitly from one nurse to the next."

Elliott, and colleague Marcella Honour, clinical educator for the same areas of the hospital as Elliott, say there are a number of benefits to this new initiative, which it adapted from a successful model in place at Hamilton Health Sciences.

Most of all, when the outgoing nurse and incoming nurse communicate directly in front of the patient, there's a transfer of accountability, the opportunity to visually see the patient and the chance for clarification in regards to a particular patient's care.

"The nurse has a chance to check the patient for any potential risks or safety concerns," Elliott says. "It's an opportunity to speak and and it's an opportunity to listen."

Honour says the in-depth verbal report covers a gamut of patient care including diagnosis, treatment, allergies, special needs, family involvement and discussion about future procedures such as blood work or surgery.

"It's a head-to-toe assessment," says Honour.

Honour adds it's a better alternative than a quick verbal report at the nursing station because it allows the incoming nurse to make an accurate assessment and prioritize care needs of the patients on his or her roster accordingly.

A document called the "Nursing Standards for Patient Safety During Transfer of Accountability" is a bedside tool for nurses to use to help guide them through the new process of what to communicate to each other.

Honour says while there were initially some concerns from nurses including the time devoted to longer conversations, she notes the comfort level is growing and Trillium will support caregivers through the new process.

Elliott says it takes considerably less time for nurses to have a conversation than it does to deal with someone, for instance, who has fallen out of bed and broken her hip because caregivers didn't discuss that particular patient needs assistance getting out bed.

"All it takes is one near-miss and the nurses are sold," says Elliott.

"Our goal is timely, accurate information about the patient's care plan, treatment, current condition and any recent or anticipated changes."

Read more about how this new initiative is intended to impact patient satisfaction in an upcoming story on this website.

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