Doctor of Nursing Practice Program

• Committee Chair Name & Credentials:
  Melissa Davis, DNP, CNM, FNP-BC, FACNM, C-EFM
• Committee Member Name & Credentials:
  Jason Jean, DNP, RN, FNP-BC

DNP Project Abstract

VUMC Hospital at Home Nursing Response to Current Shift Change Process

Purpose
This project was aimed at the The Joint Commission recommendation for the development of a written procedure for managing critical test results and diagnostics, transmission of information to appropriate personnel, and providing timely transfer of sensitive information. This recommendation is the epitome of nursing shift change. Therefore, the development of a written protocol, in conjunction with the verbal and zoom platforms currently used, ensure effective shift change turnover of critical information and is warranted by the Joint Commission’s 2022 recommendation of National Public Safety Health Goals (NPSG.02.03.01).

Vanderbilt University Medical Center (VUMC) Hospital at Home was utilizing a form of Epic SBAR (situation, background, assessment and recommendation) for their nursing shift change process. It was unknown whether this process was used consistently, if the nurses were satisfied with the efficiency of the report, or if this method of shift change report was adequate or appropriate for the Hospital at Home scenario. The Hospital at Home project at Vanderbilt University Medical Center was utilizing an untested shift turnover process warranting analysis.

Methods
A Likert style survey was developed to assess the effectiveness of the current nursing shift turnover process used by the VUMC Hospital at Home project. The stepwise method was to develop a 45 item Likert style survey specifically addressing the efficiency of the current shift change process. Categorized questions elicited responses that described the National Public Safety Goals of effective communication: accuracy, efficiency, and completeness, but respnses also offered insight into nursing preferences and the application of information in the field.

The Likert scale survey was disseminated through the REDCap program to nursing staff working with Hospital at Home project, with a successful goal of 100% participation rate with 11/11 respondents. Data was aggregated largely by REDCap and Excel statistical programming, under the direct advisement of Dr. Parish, statistical expert of VUSN. Data was evaluated and correlated from the survey, and a synopsis of the effectiveness of the current shift change process was developed. This project is the results and interpretation of the survey.

Results
The VUMC Hospital at Home nursing response to the current shift change process was positive and endorsed it as accurate, efficient and complete, which satisfied the National Patient Safety Goal.

Hospital at Home nursing preferences were neutral toward the platform of the current shift change process; many continued to reiterate information onto a “nurse brain,” a handwritten paper that describes pertinent information from shift change. The majority of the nurses agreed that the current process was informative and complete. Respondents indicated the process was compatible and useful in the field, and even more agreed that the complexity of the process was appropriate, utilizing a reasonable amount of time. Importantly, they agreed the current shift change process accurately communicated pertinent information. Most nurses agreed the current nursing shift change process provided them a good understanding of patient information including diagnosis, plan of care, upcoming lab work, functional status, code status, recent complications and emergency contact numbers. Most nurses endorsed they were able to discriminate pertinent information to focus on during the shift change process, and most also agreed they were given information on situations or changes they could anticipate for their patient. Fewer nurses felt they had a strong understanding of the medication regimen of their patients.

The REDCap survey also addressed the effective use of the shift change information. Reassuring data showed near total agreement of the importance and prioritization of the shift change process, acknowledged by high participation rates. Nursing response also indicated that the current process allowed for the opportunity of real-time questions and clarification of turnover information. Several studies have indicated that the opportunity for immediate verbal feedback was one of the strongest identify indicators of effective shift change communication.

It is also noted that most nurses were confirming shift change information with the patient and families — another strong behavior that endorsed effective shift change process. Overall, the average positive response was 3.63 out of five points.

Implications for Practice
Moving forward, these survey results hope to inform future iterations of shift change process for the VUMC Hospital at Home Project and are aimed to reduce the risk of harm to patients. This survey tool intentionally restricted free text responses, however qualitative data would be very helpful to improve the next practice change in shift change process.

As expected, there were special challenges to utilizing shift change information in the field, notably unreliable internet access and accessing information on the computer. A concerning secondary finding was the responses that addressed concerns for personal safety while accessing shift change information in the field. This aspect of the finding requires further investigation.

We were very fortunate to utilize the REDCap program and the expertise of Vanderbilt University School of Nursing faculty. We achieved a remarkable 100% response rate from the survey participants (n=11). However, it was such a very small survey group that it could potentiate overestimating the magnitude of the results as each participant’s item score greatly altered each line-item result and may be unreliable. Certainly, a large scale survey would hold greater reliability. Ultimately, the survey results endorsed that the VUMC Hospital at Home shift change process meets the National Public Safety Goal for effective communication between health care providers.