Shifts Change, But Focus Doesn’t

Chest pains awoke James Alvarez, 82, in the middle of the night, but the Rio Vista resident tried to brush them off. His wife, Jeri, knew this was nothing to mess around with, as he had had a heart attack 20 years before. She called 9-1-1, even though he insisted he was fine.

The Bedside Shift Report is also known as the patient hand-off.

Paramedics didn’t agree, and James was rushed to NorthBay Medical Center where, in the wee hours of the morning, he underwent an angiogram in the catheterization lab. Results revealed major blockages in three arteries and within an hour he was being visited by the cardiovascular team. Vein mapping was conducted in Radiology, consent forms were filled out, and James was put on the schedule to have open heart, bypass surgery the next day.

“This is healthcare at its finest,” says Peter Dhaliwal, R.N. “Imagine the teamwork! From chest pain to angiogram, and then assembling a surgical team, ready to possibly do open heart surgery in the middle of the night? It’s an extraordinary effort.”

The emergency surgery was delayed, how-ever, due to James’ elevated enzyme levels, and he was transferred to Peter’s Acute Care Unit, where he was monitored for a couple of days before a successful open-heart surgery.

Patients and their families love it when we hand off at the bedside. It gives them a chance to ask questions.

—Jennifer Ha, R.N.

In addition to monitoring his vital signs, reassuring James and his family was an important part of the care Peter focused on during his 12-hour shift. He had received all of James’ medical history during the “Bedside Shift Report” when he came on duty at 7 a.m. Outgoing nurse Remy Casiano, R.N., had filled Peter in on the fact that James experienced a heart attack earlier that morning, and that he and his family were nervous about the surgical delay.

“The Bedside Shift Report is also known as the ‘patient hand-off,’ and this important step in patient care is handled at the bedside at every shift change,” explains Jennifer Ha, R.N., lead nurse for the Acute Care Unit’s day shift. As nurses work both eight- and 12-hour shifts, these hand-offs happen at every shift change. They are also conducted between nurses any time a patient is transferred between departments, whether it is the Emergency Department, the ICU or Acute Care Unit.

Patient hand-off used to be handled by nurses huddled over computers at the nurses’ station, far away from the patient and their families, Jennifer explains, but procedures were changed in 2014 in an effort to improve the patient experience.

“We’ve discovered that patients and their families love it when we hand off at the bedside. It gives them a chance to chime in and ask questions.”

During the hand-off, the outgoing nurse introduces the patient and the family to the incoming nurse and then, for privacy considerations, asks if the patient is comfortable with the nurses sharing medical information in the presence of people in the room. The nurses then open the patient’s medical record on the computer, review pertinent history and what occurred during the previous shift, check current vital signs, upcoming lab work or tests, what medications have been administered, and if any forms need to be completed.

“It’s our chance for the two of us to put our eyes on the patient,” Jennifer says. Together, the nurses inspect all wounds, incisions, drains, IVs, and catheters, and visually sweep the room for any physical safety issues.

“We also ask the patient and family if they have any needs or concerns, if the patient is in pain or what might have gone better for them in the past 12 hours, and what they hope for during the next 12 hours,” Jennifer adds. “We’ve found that doing this at the bedside helps reduce anxiety and helps the patients and families feel like they are really involved in their care and that their voices are being heard.”