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ISHAPED: Together, We're Building a Better Bedside Report

Through the imagination of front-line nurses, new system launches to reduce errors, improve communication for better patient care.


Values in Action: Imagination, Safety and Collaboration.

By Malinda Mason Miller

ISHAPED InsideWhat if you could imagine enhancements to improve communication during shift change? How might you create a better handoff report for patient care? What if that communication could help prevent errors in care and enhance quality and safety?  Better yet, what if that communication helped support our Promise?

This is exactly the mission Sandy Manoushagian, BSN, RN, CPN and Jordan Staggs, MSN, RN set out to accomplish. Three years ago, both were working as bedside nurses. They became aware of facts that inspired them to improve patient-care handoff. For example, they read professional nursing literature that emphasized mistakes being more likely to occur around 6:30 a.m. and 6:30 p.m., during shift changes, and when patient care is transferred from one care team to another. They knew The Joint Commission on Accreditation of Health Care Organizations required a standardized shift report. Sandy and Jordan engaged a team to help find solutions.

It took almost three years to design, pilot, and fully implement a new process aimed at reducing errors during the crucial shift-change time frame. The report process is likened to onboarding a new pilot of a plane each time a new team takes over the cockpit. Its name, ISHAPED, is an acronym standing for key elements in a standardized handoff process. The format guides a collaborative conversation aimed to ensure comprehensive sharing of information between the care team including nurses, the patients and families/caregivers.

Introduction – The team meets at the start of a new shift.

Story – The team reviews what brought the patient to Cook Children’s.

ISHAPED History – The team reviews the patient’s past medical history.

Assessment – The outgoing nurse reviews the patient’s current assessment findings with the oncoming nurse.

Plan – The team discusses the plan of care.

Error Prevention – The team discusses measures to ensure patient safety such as high risk for falls.

Dialogue– Patients and families have an opportunity to ask questions about their care.

ISHAPED was piloted on two medical-surgical units. It was then implemented at Cook Children’s Prosper in January 2023, followed by expansion to 10 acute care units at the Fort Worth campus.

The heart behind this project was to elevate the voice of the bedside nurses, enhance our safety culture, and foster a family-centered approach to care. Sandy and Jordan value the contributions of a very imaginative team that led the project to success. Collaborative partners included EPIC, Marketing, Family Advisory Council, Patient Experience, Media Services, Magnet Champions, Quality, Risk Management, clinical educators, physicians and many more. Sandy and Jordan are confident ISHAPED will improve care transitions because it was designed with input from front line staff who strive to do everything for the child.