Change takes time. Shift change on the 5300 Orthopedic Unit at Royal University Hospital, for example, takes approximately three minutes per patient – the target for staff in the Releasing Time to Care™ (RTC) Shift Handover at the Bedside module.

Shift handover at the bedside includes patients and their families in the information exchange that happens at shift change.

“Three minutes gives a patient enough time to listen, ask questions and communicate with staff but it’s not so much time that it disrupts their rest and recuperation,” says Cheryl McNally, Manager of Nursing, Unit 5300.

Shift handover at the bedside includes patients and their families in the information exchange that happens at shift change. “Patients and their families are introduced to the incoming staff by the outgoing staff,” explains McNally. Nursing staff review the patient’s care plan with the patient and the patient’s family, if present. “Many patients and their families have told us that they feel more involved in this reporting process because they have the opportunity to ask questions, voice concerns and better understand their care plan.”

The shift handover module of RTC is a leading practice in patient centred care. McNally and Clinical
Nurse Educator Linda Gartner first heard about bedside reporting at the Canadian Orthopaedic Nursing Association conference in Halifax and challenged the RTC team in Saskatoon Health Region to implement it.
“Shift handover really is a patient safety initiative,” explains Norma Noesgaard, Releasing Time to Care Facilitator. “Patient identification and IV rates and solutions are double checked with outgoing staff. As well, conducting the report at the bedside gives both outgoing and incoming staff an opportunity to visually inspect the patient which helps to prioritize care.”

Shift handover has been a mentoring and learning opportunity for nursing staff. “As RTC team members gained experience they were able guide the other staff through the report process and offer suggestions on how to address patient concerns. Now all staff are participating and can teach new staff coming onto our ward,” says Gartner. “It also enhances relationship building between nurses and patients and improves listening skills.”

The team began the initial work on the Shift Handover Module in Fall 2010, conducting a lot of research and planning before implementation. “We really wanted to look at what information we were reporting on and why,” says McNally. The team even engaged the staff in role play to test run report delivery. They experimented with the length of the report, how to deal with sensitive issues, and how to protect confidentiality. “We experienced a lot of trial and error to standardize the reporting process but that’s how you learn.”

Noesgaard is very proud of the work done by McNally and her team. “This team is the first in Saskatchewan to adopt shift handover at the bedside and there have been very few stumbling blocks,” she says. Staff have quickly adapted to this care approach because they can see the positive impact on their patients. “The overall number of concerns raised by patients or their families has decreased because of their involvement at bedside,” says Noesgaard.

The module has changed things for the better for staff as well. One of the past problems with shift change was that it was time consuming. “Staff were consistently staying past the end of their shift to update the incoming staff,” explains McNally. “Shift change was making a lot of people late in getting home to their families.”

Implementation of the Releasing Time to Care Shift Handover module has fundamentally changed the way shifts change.

“The nurses are happy to take those six minutes to build a trusting relationship with patients and their families and as a result patients feel safer and better communicated with,” says McNally. “Now the unexpected bonus is that staff get to finish the report and leave for home on time.”

The RTC team and the staff of 5300 have proved that while change takes time, making a difference in patient care can take as little as three minutes.