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Effective Nurse Handoff Report

Effective Nurse Handoff Report. Julie Tamoney , Casey Stevens, Samantha Noriega, and Kristen Lawhorne. Effective Nurse Handoff Report. Samantha Noriega, Casey Stevens, Julianne Tamoney , and Kristen Lawhorne. Purpose. Results. Measures.

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Effective Nurse Handoff Report

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  1. Effective Nurse Handoff Report Julie Tamoney, Casey Stevens, Samantha Noriega, and Kristen Lawhorne

  2. Effective Nurse Handoff Report Samantha Noriega, Casey Stevens, Julianne Tamoney, and Kristen Lawhorne Purpose Results Measures • The goal of this project is to improve change of shift handoff report to decrease the amount of time spent in report and increase time for direct patient care. • Tracking time spent on handoff utilizing the proposed flowsheet. • The nursing staff will be given a short questionnaire on satisfaction with the flowsheet. • Utilize time study method. Process Improvement • Create a standardized handoff flowsheet in Epic that incorporates: pertinent assessment information for the shift, consults, attending physician, labs, tests for the shift, diet, to do lists, medical history, and medications. Example on the left. • See Change Theory • Utilize the End of Shift Nursing Checklist ( Background • Nurse to nurse report is essential to obtaining pertinent patient care information and can be a time consuming process. • Nurse to Nurse handoff is becoming increasingly time consuming and impeding time that can be spent providing direct patient care. The increase in time that is spent giving handoff can be better spent on valuable one on one time with these increasing critical patients to better provide care, perform more thorough assessment, and/or answer patient questions and provide patient teaching. • There is increasing room for error because of the variable methods of patient handoff and there is not continuity in information from shift to shift. As patient acuity is increasing, patients that might have been ICU status a few years ago are now on medical surgical floors, it is important that information is consistent in order to prevent medical errors and sentinel events (Vandenberg, 2013). • According to a study of incidences reported by surgeons indicated that communication issues contributed to 43% of incidents, and 2/3 of the communication issues were related to hand off issues (Friesen, White, & Byers,2008). • End of Shift Nursing Check List • Review your patient list and address the following if noted: • Review any unacknowledged orders • Address any overdue medications • Review any new results and report any concerns • Review any new notes • Complete pain reassessment • Complete required shift documentation • Complete required admission documentation • Overdue work list responsibilities reviewed and addressed? • All specimens collected? • Vital signs documented? • I&Os documented? • Patient Care Summary assessments and interventions (SCDs, etc) documented based on patient needs? • Added or removed lines, drains, airways or dressings/splints. • Plan of care outcome statement documented? • Patient education updated? • SBAR hand off signed • Remove self from the patient’s treatment team. • Change batteries on Rover Limitations / Lessons Learned •  Nurse attitude: Nurses may be opposed to the idea of change therefore making the implementation of the tool difficult. • Time consuming: Ideally we would like to make handoff a more time efficient process, however learning a new method of handoff may initially take some time. • Standardized Sheets: Different units serve different populations therefore information that may be pertinent on one may not as pertinent on another. Ideally as the project is implemented they can be re-worked and tailored to the nurses needs on each unit. References • Vandenberg, A. K. (2013). Patient hand offs: Facilitating safe and effectivetransitions of care. Grand Valley State University. • Friesen, M. A., White, S.V., & Byers J. F. (2008). Handoffs: Implications for Nurses. Patient safety and quality: An evidenced-based handbook for nurses. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2649/ • Halm, M. A. (2013). Nursing handoffs: Ensuring safe passage for patients. American Journal of Critical Care, 22, 158-162. doi: 10.4037/ajcc2013454 • LaValley, D. (2007). Reducing risk during handoffs. Forum, 25(1), 1-24. Retrieved from https://www.rmf.harvard.edu/~/media/Files/_Global/KC/Forums/2007/forumMar2007.pdf • Goldsmith, D., Boomhower, M., Lancaster, D. R., Antonelli, M., Kenyon, M. A., Beonit, A., … Dykes, P. C. (2010). Development of a nursing handoff tool: A web-based application to enhance patient safety. Annual Symposium Proceedings Archive, 2010, 256-260. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041387/ • Caro, D. (2013). TGH Trauma Handoff Protocol. Retrieved from https://portal.tgh.org/SearchCenter/Pages/Results.aspx?k=handoff%20protocol%20badge&s=All%20Sites • Davis, J. & Karczewska, M. (2013). End of Shift Nursing Checklist. Retrieved from https://portal.tgh.org/SearchCenter/Pages/results.aspx?k=End%20of%20Shift%20Nursing%20Check%20list&s=All%20Sites Improvement Tools/Methods Team Members • Plan-Do-Study-Act improvement method • Create a Handoff Process flow chart • Cause and effect analysis (fishbone diagram) • Unit nurses • Nurse Managers • Clinical Educators • Unit Clerks Tampa General Hospital

  3. Purpose • The goal of this project is to improve change of shift handoff report to decrease the amount of time spent in report and increase time for direct patient care.

  4. Background • Nurse to nurse report is essential to obtaining pertinent patient care information and can be a time consuming process. • Nurse to Nurse handoff is becoming increasingly time consuming and impeding time that can be spent providing direct patient care. The increase in time that is spent giving handoff can be better spent on valuable one on one time with these increasing critical patients to better provide care, perform more thorough assessment, and/or answer patient questions and provide patient teaching. • There is increasing room for error because of the variable methods of patient handoff and there is not continuity in information from shift to shift. As patient acuity is increasing, patients that might have been ICU status a few years ago are now on medical surgical floors, it is important that information is consistent in order to prevent medical errors and sentinel events (Vandenberg, 2013). • According to a study of incidences reported by surgeons indicated that communication issues contributed to 43% of incidents, and 2/3 of the communication issues were related to hand off issues (Friesen, White, & Byers,2008).

  5. Limitations •  Nurse attitude: Nurses may be opposed to the idea of change therefore making the implementation of the tool difficult. • Time consuming: Ideally we would like to make handoff a more time efficient process, however learning a new method of handoff may initially take some time. • Standardized Sheets: Different units serve different populations therefore information that may be pertinent on one may not as pertinent on another. Ideally as the project is implemented they can be re-worked and tailored to the nurses needs on each unit.

  6. References • Vandenberg, A. K. (2013). Patient hand offs: Facilitating safe and effectivetransitions of care. Grand Valley State University. • Friesen, M. A., White, S.V., & Byers J. F. (2008). Handoffs: Implications for Nurses. Patient safety and quality: An evidenced-based handbook for nurses. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2649/ • Halm, M. A. (2013). Nursing handoffs: Ensuring safe passage for patients. American Journal of Critical Care, 22, 158-162. doi: 10.4037/ajcc2013454 • LaValley, D. (2007). Reducing risk during handoffs. Forum, 25(1), 1-24. Retrieved from https://www.rmf.harvard.edu/~/media/Files/_Global/KC/Forums/2007/forumMar2007.pdf • Goldsmith, D., Boomhower, M., Lancaster, D. R., Antonelli, M., Kenyon, M. A., Beonit, A., … Dykes, P. C. (2010). Development of a nursing handoff tool: A web-based application to enhance patient safety. Annual Symposium Proceedings Archive, 2010, 256-260. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041387/ • Caro, D. (2013). TGH Trauma Handoff Protocol. Retrieved from https://portal.tgh.org/SearchCenter/Pages/Results.aspx?k=handoff%20protocol%20badge&s=All%20Sites • Davis, J. & Karczewska, M. (2013). End of Shift Nursing Checklist. Retrieved from https://portal.tgh.org/SearchCenter/Pages/results.aspx?k=End%20of%20Shift%20Nursing%20Check%20list&s=All%20Sites • Joint Commision for Transforming Healthcare. (2013). Improving transitions of care: Hand-off communications. Retrieved from http://www.centerfortransforminghealthcare.org/assets/4/6/CTH_Hand-off_commun_set_final_2010.pdf

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