Essay Example on Shift Changes: Impact on Nursing Teams & Patient Safety

Introduction

Several quantitative and descriptive exploratory studies have been conducted to determine how communication on the changes made during shifts of nurses affects the patients. Also, factors related to patient safety concerning abrupt change on communication resulting from shift changes affect the nursing teams. The research was conducted by a team made up of three Neonatal Intensive Care Units. The implementation requires a validated tool concerning shift changes to be used. From the research, the data analyzed through chi-square analysis revealed several conclusions concerning factors endangering a patient's safety and how they are to be implemented for change. The factors to be addressed were early departures, delays in conducting the shifts, side talks, among nursing care offered during the shifts. The paper focuses on the implementation of safe communication on the shift changes of nurses in Neonatal Intensive Care Units

Is your time best spent reading someone else’s essay? Get a 100% original essay FROM A CERTIFIED WRITER!

Save 25%

Literature Review

Communication is among the vital components in healthcare systems. It is a tool used to ensure that patients get to trust the nursing procedures and care offered to them. It plays a fundamental role since it helps individuals involved to have the ability to relate to whether they are satisfied (Webster et al., 2019).

According to several cases conducted, ineffective communication cause approximately 70% of health care errors committed. World Health Organization (WHO) created a Global Patient Safety Alliance due to problems related to their safety (Ball et al., 2016). The Alliance emphasizes communication in health care settings. By stressing on this, the Alliance targets how communication is made during shift changes; when patients' cases are being passed.

During the shift changes, a patient's information becomes vulnerable since confusions may be raised. At the moment, the patient's case is transferred from one nurse to another professional while on the shift changes. It thus presents a critical moment to check on the communication made by the teams. It is because it gives focus to the new nurse who would start acting on a patient's case in the work shift. The nurses are required to be extra careful while ensuring that the quality and continuity of care is offered to the patients (Ball et al., 2016). Shift changes done among the health teams are a fundamental tool to ensure the prevention of errors while ensuring the continuity of care.

During the shift changes, information sharing is the only attribute that leads to continuity of health care and a great sense of the acceptance of responsibility factors. Other transfer aspects of ensuring that the patients or group of patients are cared for and handled to the optimum are needed. Above all the mentioned aspects, the absence of integrated communication processes among the health care officers results in high chances of lousy choice and errors made after the shifts are made. Adverse events occur because of the lack of structured information transfers between the health systems during shift changes (Parkinson et al., 2018). Communication becomes and should be considered a vital aspect of the shift changes.

There are a significant number of factors that hinder shift changes. Some of the elements are availing excess or minute amount of information on how to ensure continuity of care; the nurses having a limited period to ask questions about unclear information given by nurses from previous shifts. Also, the availability of inconsistent data, being provided with inaccurate information, presence of unrecorded information, interruption during the shift changes, and nonuse of required and standard processes while conducting the shift changes.

SBAR

SBAR is an abbreviation of Situation- background-assessment-recommendation. The Situation stands for the current Situation experienced by the patient getting care from health care officers. Background stands for the illness history of patients, their medical history, and patient medication offered. The assessment represents how a health care officer evaluates the patient's disease, experience, and condition. Recommendation refers to the plan needed to be established for the anticipated changes in the treatment of the patients (Loew et al., 2018).

The electronic SBAR documentation template is the functionality that has been implemented to address shift change errors arising from the communication of health teams. Its purpose is to give a clear and concise format of medical records electronically. Using the PDSA tool, it has been evaluated as a useful program by looking at the frequency and the completeness of the attending physician and bedside nurse report and notification (Loew et al., 2018).

By observing the stated patient's safety within the NICU, health professionals are likely to experience life-threatening adverse situations in their every-day life within healthcare. In relation to the growing concern with the increasing mobility in low weight and anticipated birth, there are other possible issues existing in newborn care. The research is based on patient safety measures in relation to communication improvements during nursing shifts; the study examines the importance of good communication strategies for both nursing or caregivers within a healthcare environment. The research tries to address hypothetical questions such as: what are the main communication-related issues currently affect patient safety, especially during shifts within NICUs?

Results

Over 70% of the overall errors resulting in NICUs are preventable and occur due to poor communication strategies during nursing shifts (Lewin et al. 2020). In most cases, nurses are expected to operate for at-least 12-hours before a change occurs. However, the process for conducting the shifts is not always successful as intended, most nurses within the NICU are forced to delay further or are likely to be involved within an emergency patient-care activity hence causing communication issues during shifts. At least 1% of the total nurses engaged in a shift process are likely to administer the wrong medication to the patients within healthcare (Lewin et al., 2020). Consequently, as a result of poor communication issues, the mortality rates of patients within the healthcare center tend to rise. In contrast, instances of intensive care unit cases tend to increase even for patients who had not shown critical signs earlier.

Change Model

To address the existing communication problems during nurses' shifts, it is essential to form the organization to adopt a relevant change model to improve their general performance (Silver et al., 2020). Therefore, to address the problem stated earlier, choosing Lewin's step model is important since it forms a basic framework for transforming nursing care. In order to improve efficiency in resource use, it essential for the leaders to adopt measures promoting safety and quality improvement within a healthcare environment. One major shift towards quality improvement is the cycle approach which aims at the sustainable and quality improvement to patients. Combining Lewin's change model and the lean system can significantly help eliminate resulting resource waste while improving patient satisfaction (Murray et al. 2020). Leans system focuses on transparency, employee management, communication, and accountability. By adopting the lean model, aspects related to delays within the healthcare are eliminated and replaced within activities that aim at improving patient satisfaction. The organization will be able to cut any unnecessary costs experienced due to delays.

Benchmark theory

Healthcare organizations use a vast number of national benchmarks to better the overall performance. One of the most common benchmarks used within the hospital is Case-Mix Index. Case Mix Index (CMI) refers to the relative average Diagnosis-related group (DRG) hospital's inpatient discharge (Fronczek et al., 2019). Case Mix Index is obtained by adding the individual discharge weight of Medical Severity-Diagnosis Related Group (MS-DRG) and then dividing by overall discharge count. Case Mix diversity is essential in reflecting aspects such as resource, clinical complexity, and diversity needs of the patients within a hospital. Instances of higher CMI shows resource-intensive and complex caseload (Silver et al. 2019). The weight applied using MS-DRG applies to overall discharges disregarding the payer. The weights are, however, designed for the Medicare population. This paper aims to establish how the healthcare organization currently evaluates its operations to determine whether they have met or exceeded the requirements.

The current healthcare systems handle the Diagnosis-Related Group (DRG) coding system and evaluate the Case Mix Index (CMI) to be the most dominant inpatient billing and reimbursement standard. It is used as an indicator of all healthcare systems disease severity during instances when patient-level data are unavailable. Patients are assigned to a DRG only after they are discharged. It is also awarded based on the diagnosis and procedure codes (DaCosta, 2020). The application of the Case Mix Index relies on the presence of complications, gender, age, and discharge status of a patient. CMS payments are made concerning the weight, which is related to each DRG.

The importance of CMI is to assist in calculating all the clinical complexities and total resource consumption of the patient population in a hospital. It is because it represents the average DRG weight for a hospital (Johnson et al., 2020). The DRG weight is thus calculated as the sum of the weights of an entire hospital's DRG divided by the total number of patients admitted during a fixed period. Our facility acknowledges that the target is achieved if the average DRG weight is met during the time frame of interest.

Interventions Using the PDSA tool

Communication quality outcome was observed to be the critical aspect measure reflecting a score of over (36.4%, 4/11) (Archer et al. 2019). Another action observed was on the intention to leave, impact on job-stress, self-efficacy, staff satisfaction, and communication skills. There were relative findings on leaders' satisfaction, usefulness experienced by the staff, and the planned period. Therefore, implementing the Electronic SBAR documentation template within healthcare is should consider as the first alternative towards communication improvement.

References

Silver, S. A., Alaryni, A., Alghamdi, A., Digby, G., Wald, R., & Iliescu, E. (2019). Routine laboratory testing every four versus every six weeks for patients on maintenance hemodialysis: a quality improvement project. American Journal of Kidney Diseases, 73(4), 496-503. https://www.sciencedirect.com/science/article/pii/S0272638618310898

Johnson, C. E., Peralta, J., Lawrence, L., Issai, A., Weaver, F. A., & Ham, S. W. (2019). Focused resident education and engagement in quality improvement enhances documentation, shortens hospital length of stay, and creates a culture of continuous improvement. Journal of surgical training, 76(3), 771-778. https://www.sciencedirect.com/science/article/pii/S1931720418301909

Archer, M., Fuller, M., Cox, K., & Swearingen, N. (2019). Regional Stroke Program Coordinator Nurses Standardize EMS Feedback Utilizing Kurt Lewin's Change Model. https://digitalcommons.psjhealth.org/cgi/viewcontent.cgi?article=1054&context=other_pubs

DaCosta, J. (2020). Insights for implementing change in healthcare. British Journal of Healthcare Management, 26(1), 20-26. https://www.magonlinelibrary.com/d...