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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.