Most Crucial Hour of the Day: Setting Up for Success to Ensure Patient Safety

Purpose: The goal of this project was to increase caregiver satisfaction levels by proactively meeting patients’ needs, thus decreasing potential safety concerns from arising.

Background: Change of shift is a critical time as exchange of information occurs, patient safety checks are done, and patients may end up waiting for caregivers to finish handoff. If any steps in the process are missed, the risk of an error increases and caregivers may experience stress. “The most crucial hour of the day” was initiated as a way to improve caregiver satisfaction levels during the change of shift process, decrease the potential for safety concerns from arising, and promote compliance with bedside report.

Methods: Pre-data was collected through audits utilizing a standardized room audit tool to assess room preparedness. A pre-survey was completed by all staff members to obtain their baseline level of satisfaction with room readiness at the beginning of shift change. We then initiated the project, where RNs and PCNAs completed rounds on their patients strategically, emphasizing completing tasks according to the provided checklist such as replacing low IV bags/tubing, assessing for pain, administering pain medications accordingly, and asking patients if they need to use the restroom. This strategic rounding would occur before change of shift, during the hours of 6am to 7am during night shift, and 6pm to 7pm during day shift. Audits would continue to be completed to measure improvement during change of shift time. After 3 months of initiation, post-surveys were collected.

Outcomes: The pre- and post-survey were completed by 40 respondents, comprised of both RNs and PCNAs. The initial post-survey showed increases in caregiver satisfaction with the room preparedness and overall quality of handoff report given. The survey also found a decrease in the amount of time a patient would make comments about not having needs met from the previous shift. The intervention of " most crucial hour of the day" resulted in an initial 71% caregiver compliance rate through room audits during bedside handoff.

Conclusion: Data collection is ongoing, and further data collection is ongoing to assess compliance and trends. “the most crucial hour of the day” had a positive impact on improving caregiver satisfaction during shift change. This can be applied to all areas of nursing practice across the spectrum, as this project revealed that setting up the next shift for success can greatly improve overall caregiver satisfaction, thus decreasing potential safety concerns from arising. Anecdotal findings revealed that the nursing unit had a significant decrease in fall rates during the intervention period. Future projects should focus on identifying if improvement in bed side report is correlated to reduction in falls. Our long-term goal is to create an environment where patients’ needs are proactively being met and decrease the dissatisfaction levels that can be felt by caregivers during change of shift.