Microsystem assessment project : change of shift report at a Montana critical access hospital

Abstract

Change of shift report that is poorly executed can result in missed information and poor communication between nurses, directly affecting a nurse's ability to deliver safe, efficient, and appropriate patient care. The purpose of this project was to assess the quality of communication during change of shift report on the acute care unit of a CAH in central MT and determine if current practice adheres to The Joint Commission recommendations. This project utilized a cross-sectional design to collect baseline data about the structure, process, and outcomes that influence the quality of communication during change of shift report. The Dartmouth Institute's Clinical Microsystems Approach was used to guide the assessment of this microsystem. Data were collected via administrator interviews, patient and nurse questionnaires, and investigator observation of the change of shift report process Administrators (n=3) who were interviewed agreed that inadequate change of shift report can negatively impact patient safety and diminish patient and nurse satisfaction. However, none of the administrators were aware of any policies that were in place to govern the process of communication change of shift report. Nurses (n=27) reported high levels of satisfaction with the current taped method of change of shift report, yet only 1 of 58 possible categories of patient information (patient name) was mentioned in every episode of report for individual patients. Categories that were reported less than 10% of the time included patient allergy status and patient code status. Patients (n=4) reported high levels of satisfaction with nurse-to-patient communication despite the finding of poor nurse-to-nurse communication during change of shift report sessions. Several opportunities for improvement in the quality of communication during change of shift report were identified in this clinical microsystem assessment. The structure of report could be enhanced by creating specific policies and procedures that reflect best practice. Education about these policies and procedures should be included in orientation and annual competency assessments. Methods for monitoring outcomes related to the quality of communication during change of shift report need to be developed.