Change-of-Shift Reporting

May 8, 2012 — 1,467 views  
Become a Bronze Member for monthly eNewsletter, articles, and white papers.

Hybrid change-of-shift reports are an important step toward improving accountability and patient safety. While technology has taken over many industries, it has not made verbal reports obsolete. By combining written data with bedside reporting, patients receive the highest level of care. Studies have shown that bedside reporting is reassuring and reduces patient anxiety while making it more likely patients will follow health care instructions.

There was a time in the 1990s when less than 12 percent of change-of-shift reports included details on care planning. Today, change-of-shift reports are much more detailed. By using a hybrid approach that combines bedside reporting and written records, oncoming nurses have an opportunity to review written reports and clarify information verbally before the outgoing nurse signs off. Written reports eliminate a reliance on memory in busy health care environments. Bedside reporting has several key benefits. Nurses can visualize the patient and obtain an initial baseline assessment. Direct observations are more effective than reviewing paper records or electronic data alone. Patients also have a chance to ask questions and contribute valuable information, which is reassuring and helps the patient see that oncoming and outgoing providers are working together as a team.

In 2009, the Journal of Nursing Care Quality published a study completed by a Progressive Care Unit in La Mesa, California. This innovative health care facility compared changes in care related to hybrid change-of-shift reports versus traditional group reports completed in conference rooms. By combining written reports and verbal exchanges at the patient's bedside, the team spent less time on reports, the facility reduced overtime wages and the department saw a decrease in patient falls and call lights per shift.

A written change-of-shift report must conform to a standardized format that includes thorough patient assessments. Key points include the following items:
• Reasons for the patient's admittance
• Short-term and long-term expectations
• Patient condition, including physical and emotional status
• Fluid levels, including intake and output
• Successful and unsuccessful treatments, including critical procedures
• Information needed to provide optimal care
• Teaching requirements for patients or family
• Consultations, such as discharge planning and social services
• Changes in physician's orders
• Oncoming nurse's role
• Safety concerns
• Post-op reports
• A summary of priorities

By following best practices for change-of-shift reports, oncoming and outgoing nurses can successfully transfer responsibility, improve care planning, identify safety concerns and facilitate a continuum of care that reduces legal issues due to compromised patient safety.