Effective Nurse Handoff ReportJulie Tamoney, Casey Stevens, Samantha Noriega, and Kristen Lawhorne

Purpose

Improvement Tools/Methods

Limitations / Lessons Learned

Results

Process Improvement

Effective Nurse Handoff ReportSamantha Noriega, Casey Stevens, Julianne Tamoney, and Kristen Lawhorne

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.

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).

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 (

 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.

Tampa General Hospital

Plan-Do-Study-Act improvement method

Create a Handoff Process flow chart

Cause and effect analysis (fishbone diagram)

References Vandenberg, A. K. (2013). Patient hand offs: Facilitating

safe and effective transitions 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

Background

Team Members

Unit nurses

Nurse Managers

Clinical Educators

Unit Clerks

Measures

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.

End of Shift Nursing Check List Review your patient list and address the following if noted:

Review any unacknowledged ordersAddress any overdue medicationsReview any new results and report any concernsReview any new notesComplete pain reassessment Complete required shift documentationComplete required admission documentationOverdue 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

PurposeThe 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.

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).

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.

References Vandenberg, A. K. (2013). Patient hand offs: Facilitating safe and effective transitions 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