Nursing Leadership: Mastering the Handoff

1. Nursing Leadership: Mastering the Handoff Benham-Hutchins, M. M., & Effken, J. A. (2009). Multi-professional patterns and methods of communication during patient handoffs. International journal of medical informatics, 79, 252-267. doi: 10.1016/j.ijmedinf.2009.12.005 Dufault, M., Duquette, C., Ehmann, J., Hehl, R., Lavin, M., Martin, V., & ... Willey, C. (2010). Translating an evidence-based protocol for nurse-to-nurse shift handoffs. Worldviews On Evidence-Based Nursing, 7(2), 59-75. doi:10.1111/j.1741-6787.2010.00189.x Hughes RG (ed.). Patient safety and quality : An evidence-based handbook for nurses.http://www.ahrq.gov/professionals/clinicians-providers/resources/nursing/nurseshdbk/nurseshdbk.pdf Klee, K., Latta, L., Davis-Kirsch, S., & Pecchia, M. (2012). Using continuous process improvement methodology to standardize nursing handoff communication. Journal of Pediatric Nursing , 27, 168-173. Shendell-Kalik, N., Feinson, M., & Mohr, B. J. (2007). Enhancing patient safety: Improving the patient handoff process through appreciative inquiry. The Journal of Nursing Administration , 37(2), 95-104. Simpson, K., James, D., & Knox, G. (2006). Nurse-physician communication during labor and birth: implications for patient safety. JOGNN: Journal Of Obstetric, Gynecologic & Neonatal Nursing, 35(4), 547-556. doi:10.1111/j.1552-6909.2006.00075.x Stead, W. W., Kelly, B. J., & Kolodner, R. M. (2005). Achievable steps toward building a national health information infrastructure in the united states. Journal of the American Medical Informatics Association, 12(2), 113-120. doi: 10.1197/jamia.M1685. The Joint Commission. (2006). Joint Commission 2006 National patient safety goals. Retrieved from https://www.premierinc.com/safety/safety-share/06-05-downloads/12-npsg-igs.pdf Recommendations- What to do Results- Supporting Data Face-to-face is preferred to allow verbal and nonverbal exchange of info and questions Use electronic sources and standardized forms to decrease illegibility and assure completeness Limit interruption and provide coverage of other duties Provide handoff in location with limited distractions Use standard format such as the five P’s or SBAR Use repeat-back and read-back to decrease errors Use phonetic and numeric clarifications Avoid abbreviations to avoid miscommunication Limit number of hours worked by nurses and all staff to reduce fatigue and handoff error Provide adequate training on handoffs for novice nurses Assessment- Identify the issues References Background- What is a Handoff? The Joint Commission 2006 National Patient Safety Goals GOAL #2: Requires a standardized approach to “handoff” communication (Shendell-Kalik, Feinson & Mohr, 2007) REASONS FOR STANDARDIZATION: Leading cause of preventable patient injuries, deaths and medical malpractice claims (Simpson, K., James, D., & Knox, G. 2006) Communication was the root-cause in 65% of sentinel events (Klee, Latta, Davis-Kirsch & Pecchia, 2012) Institute of Medicine report estimates that up to 98,000 individuals die each year as a result, in part to errors in communication and care (Shendell-Kalik, Feinson & Mohr, 2007) High variability in handoff styles from nurse to nurse (Shendell-Kalik, Feinson & Mohr, 2007) Situation- What’s going on? Stephen Forte, RN, BSNc Sarah Parker, RN, BSNc Melinda Winans, RN, BSNc Shift-to-shift Nursing unit-to-nursing unit Nursing unit to diagnostic area Special settings Discharge and interfaculty transfer Physician-to-physician Verbally Handwritten notes Bedside Telephone Audiotape Electronic records Computer printouts • Distractions and noise can affect interpretation • Handoffs vary depending on experience and knowledge of nurses • Abbreviations, similar sounding medications & dialects/accents • Barriers to Handoff • Short-term memory and large amounts of information • Fatigue increases errors • Compressing of information leads to funneling • Illegible written • Interruptions are common (11-15 per hours) • Information of patient needs, planning patient care, establishing goals, and prioritizing and managing care A typical network of communication between providers transferring patients from an ED to an Admitting Unit Types and Methods of Handoff: • Over all, 67% were satisfied with clinical information received during handoff • 82% of ED providers were satisfied with handoff communication, yet, 52% of admitting unit providers reported satisfaction • Satisfaction was determined most by physical proximity 3 primary dimensions of health care information and how it overlaps Performance Improvement Study: Goal to standardize handoff, improve patient safety, involve families and decrease end of shift overtime. The National Committee for Vital and Health Statistics