Before NKE, nursing shift changes rarely involved patients. In fact, many patients described hospitals as a “ghost town” during shift changes. But even after NKE was established, nurses giving reports at the beside were getting interrupted and getting pulled out of patient rooms to respond to care needs.
"If you really want to help, can you make sure no patients need pain meds at the beginning of my shift?"
NKEplus builds on NKE by incorporating proactive measures to structure and support nurses
during the essential but often chaotic time during shift changes. It involves:
Proactive preparation to prepare of the oncoming shift
Establishes a standardized last hourly round and pre-shift assignments to help the unit prepare for oncoming shifts.
Coordinated roles to minimize disruptions during shift change
The unit works together to minimize interruptions to nurses, allowing them to get off to a strong hand-off and a strong start-of-shift.
In-room patient engagement
Incorporates the use of a careboard, in-room SBAR, and an in-room safety check to engage patients and drive safety.
In 2011, NKEplus was rolled out in all Med-Surge at all of Kaiser Permanente’s hospital-based regions. As of 2013, in regions like Southern California, it has also been adapted locally and spread to ICUs, NICUs, PICUs, L&D, PP, and Peds. Local medical centers are starting to use NKEplus as a platform to explore ways to reduce waste and involve physicians.