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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 - PowerPoint PPT Presentation
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Nursing Leadership: Mastering the HandoffStephen Forte, RN, BSNc Sarah Parker, RN, BSNc Melinda Winans, RN, BSNc
SITUATION- WHAT’S GOING ON?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)
BACKGROUND- WHAT IS A HANDOFF?
- 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
ASSESSMENT- IDENTIFY THE ISSUES• 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
RESULTS- SUPPORTING DATA
RECOMMENDATIONS- WHAT TO DO
REFERENCES• 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
TYPES AND METHODS OF HANDOFF:
Information of patient needs, planning patient care, establishing goals, and prioritizing and managing care
The National Committee for Vital and Health Statistics
3 primary dimensions of health care information and how it overlaps
Compressing of information
leads to funneling
Abbreviations, similar sounding medications &
dialects/accents
Distractions and noise can affect interpretation
Handoffs vary depending on
experience and knowledge of
nurses
Illegible written
Short-term memory and
large amounts of information
Fatigue increases
errors
Interruptions are common (11-15 per
hours)
Barriers to Handoff
A TYPICAL NETWORK OF COMMUNICATION BETWEEN PROVIDERS TRANSFERRING PATIENTS FROM AN ED TO AN ADMITTING UNIT
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
PERFORMANCE IMPROVEMENT STUDY: Goal to standardize handoff, improve patient safety, involve families and decrease end of shift overtime.