1. Lisa Caple Change Reporting From Fax to Phone

2. History  38 bed neurology/ neurosurgery unit that is divided into two sections.  12 beds are dedicated to the intermediate neurology care unit(INCU) and the remaining 26 beds being occupied by neurology medical surgical patients.  This unit constantly receive patients from the intensive care unit(ICU).

3. History Cont’d  The ICU is the only unit that continues to use fax reporting.  Most patients being admitted into the INCU are usually on vents for respiratory reasons, tracheotomy and peg tubes, some have ventrics, or on some sort of drip.  All need continuous monitoring.

4. Current Issue

5. Fax Report  ICU is the only unit that continues to fax report which causes issues such as:  Lack of communication  Disruption of care  Lack of clarity-  Delay in management in care

6. Why Change

7. Improve Transition  Calling report before patient leaves unit, can make the transition of the patient from one unit to the next easier.  There is little to no confusion and more accuracy about the patients plan of care  Patient and family members can feel at ease that there is no interruption of care

8. How to Change

9. Implementation of Lewin’s Change Theory Change occurs in three stages:  Unfreezing  Moving  Refreezing

11. Unfreezing  Involves motivating individuals by getting them ready for change (Lee, 2006)  Implementation: Using in-services and documentation supporting how verbal report is more accurate then fax report to help decrease resistance.

12. Move  Involves encouraging individuals to adopt a new perspective that enables them to perceive that the current situation can be improved (Lee, 2006)  Implementation: Encourage participation and ideas from staff through open communication and support. Feedback, support and clarification will be given.

13. Refreezing  Involves reinforcing new patterns of behavior (Lee, 2006).  Implementation: Maintain change by continuing to support staff, reinforce the change while focusing on the outcome which would be better communication and clarification through verbal reporting.

14. Barriers to Change

15. Predictable Issues  Resistance of nurses to change- there are always nurses who feel if it not broke don’t fix it which causes them to be resistant to the new way of doing things. Overcoming resistance to change is a consistent theme in management literature, and efforts to guide leaders in developing the skills needed to foster change and innovation are well documented(Porter- O’Grady & Malloch, 2011).

16. Predictable Issues Cont’d  Change avoiders or resisters must be identified, challenged, worked with, empowered and placed in the midst of the change process so that they do not impeded the ability of the organization to thrive (Porter-O’Grady & Malloch, 2011).

17. Predictable Issues Cont’d  Lack of support- Managers have to be supportive of change and listen to the concerns of the employee. The leader that is an expert at listening believes that every employee is a source of unique information critical to the organizations success(Porter-O’Grady & Malloch, 2011)

18. Outcomes  Changing from fax report to verbal report will decrease errors due to illegible handwriting or delay of receiving the fax  Will offer nurses a chance to ask questions for clarification during verbal report.

19. Outcomes Cont’d  Knowing that you spoke to the nurse will determine that the patient is ready for transport to the unit and the nurse is prepared to receive the patient.  The most important thing is that the patient care is not delayed or interrupted which improves trust between the patient/patient family, the nurses and the organization.

20. References  Lee, T. (2006). Adopting a personal digital assistant system: application of Lewin's change theory. Journal Of Advanced Nursing, 55(4), 487-496. doi:10.1111/j.1365- 2648.2006.03935.  Porter O'Grady, T., & Malloch, K. (2011). Quantum leadership: Advancing Innovation, transforming health care (3rd ed.). Sudbury, MA: Jones and Bartlett Learning, LLC.