The ideal evening shift begins with the all-important change of shift report or patient handoff. In my dream scenario I’d hear the previous shift nurse say, “Every patient is comfortable, all IVs are flowing well with adequate fluid to be absorbed, all treatments were completed and no one has complaints.”
In reality, I’d frequently experience a far more bumpy handoff. Thirty minutes into the shift, I’d see empty IV fluid bags, infiltrated IV sites, and most of the patients suddenly complained of pain.
So if the dream is so different from reality, what is a handoff in the first place? The Joint Commission states, “a handoff is a transfer and acceptance of patient care responsibility achieved through effective communication. It is a real-time process of passing patient-specific information from one caregiver to another for the purpose of ensuring the continuity and safety of the patient’s care.”
Handoffs Are Hard
A startling 70 percent of all sentinel events in a hospital setting result from ineffective handoffs. Of those, half occur due to poor communication at handoff. The problem is compounded by the high volume of handoffs, especially in hospitals. The Joint Commission recognized the problem, subsequently requiring that all accredited healthcare providers must implement a standardized approach to handoff communication.
In spite of Joint Commision efforts, standardized handoffs have been rare. Recently, the Joint Commission issued a Sentinel Event Alert to address the problem. The Alert identified the core problem to be communication.
Fix the Problem with a Process
The Joint Commission recommended several actions to improve communication at handoff:
- Determine what information is critical to be communicated. At the very least:
- Sender contact information
- Illness assessment
- Patient summary, including events leading up to illness or admission, hospital course, ongoing assessment and care plan
- To-do action list
- Contingency plans
- Allergy list
- Code status
- Medication list
- Use standardized tools and methods to communicate in the form of checklists, forms, protocols, etc.
- Make sure there is sufficient time for questions
- Know that information may come from many sources, so it may be prudent to combine the sources and report them all at the same time.
Face-to-Face is Best
The best handoff is in-person. Choose an area that is free from interruption. Include all team members, and if appropriate, the patient and their family. Electronic health records and other forms of technology may enhance the handoff process, but should not be the sole solution to provide handoff communication.
LAMMICO Recognizes Superior Handoff Communication
LAMMICO has established the annual Patient Safety Award and Grant Program to reward patient safety initiatives optimized via our Risk Management education. The 2017-2018 award and grant program stems from our online education courses entitled "Nursing Hand-off Communication," "ED Handoff Communications," "Hospitalist Handoff" and "Anesthesia Handoff Communication". Visit lammico.com/grant to see the award requirements and to download the award and grant application.
Questions? Contact LAMMICO Hospital Risk Management Specialist Lynne Vega, R.N., BSN at firstname.lastname@example.org or 504.841.2738.