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Patient Handoffs

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CE1019 | Contact Hours: 2

COURSE OBJECTIVES

The purpose of this course is to inform health care professionals about handoff techniques that can be used at shift change to improve patient safety. After studying the information presented here, you will be able to:

1. Recognize ineffective vs. effective handoff techniques.
2. Define the processes of various handoff techniques to be used at shift change.
3. Describe the importance of effective and safe handoffs.
4. Identify examples of how a poor handoff can lead to medical errors.
5. Acknowledge strategies for effective handoffs.

RELEASE DATE

07/05/2022

EXPIRATION DATE

07/05/2024

AUTHOR

Natalie Dycus, MSN, BSN, RN

CRITERIA FOR SUCCESSFUL COMPLETION

All learners must complete the entire activity and complete the evaluation to receive contact hours.

APPROVAL STATEMENT (ACCREDITATION INFORMATION)

This nursing continuing professional development activity was approved by the Ohio Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. (OBN-001-91).

In addition to states that accept American Nurses Credentialing Center (ANCC) courses, CE Leaders is an approved provider by the Florida Board of Nursing, and a registered provider with the Arkansas State Board of Nursing, District of Columbia Board of Nursing, Georgia Board of Nursing, Kentucky Board of Nursing, New Mexico Board of Nursing, South Carolina Board of Nursing and West Virginia Board of Registered Nurses (Provider # 50-33450).

RELEVANT FINANCIAL RELATIONSHIP

No one with the ability to control content of this activity has a relevant financial relationship with an ineligible company.

INTRODUCTION

The importance of patient handoff during shift change is more important than ever. However, nurses receive minimal information on how to effectively execute a handoff report. The Joint Commission defines a handoff as a transfer and acceptance of patient care responsibility. It is a real-time process of passing patient-specific information from one caregiver to another or from one team of caregivers to another for the purpose of ensuring the continuity and safety of the patient’s care (5). Hospitals are seeing a greater number of patient complexity, along with many providers involved in patient care. There is an increase in the chance of medical errors because of these vulnerabilities. The Joint Commission found that communication is the root cause of most errors because hospitals lack a systematic, universal method to accurately transfer important information (7). Therefore, there needs to be an emphasis on effective hand-off communication between nurses at shift change.

When hospitals use communication strategies, such as I-PASS or SBAR, there is a reduction in preventable adverse events and decrease in medical errors. Ineffective patient handoffs, and other communication failures, play a part in 80% of all serious preventable adverse events each year (8). Handoff reports should include diagnosis, age, pertinent medical history, code status, pending or completed procedures, care plan, home and hospital medications and other important information that is relevant to the patient’s stay. The situation and background are important because they prepare nurses to implement the nursing process (ADPIE: assess, diagnose, plan, implement and evaluate). The handoff reports are helpful, even if the head-to-toe assessment hasn’t been completed yet. It helps to gather ideas of what the patient’s assessment may involve, what their nursing diagnosis might be, what the plan of care entails and what interventions might have to be completed.

There are several barriers in the handoff process. The most common barriers were explanatory variables, relationship between incoming and outgoing nurses, privacy of report and interruptions. It was also found that handoff improvements included implementing an electronic handoff tool, anticipating patient problems in the upcoming shift, and having standardized handoff methods (11).

Nurses are also facing more stress due to being short-staffed, which causes a heavy workload. Nurses have less time to complete tasks, which causes some to skip safety protocols and provide rush through reports that can cause gaps in information. This in turn causes breaks in the continuity of care. Nurses also compensate by paying less attention to details, which can cause risk of harm to patients. Nurses are also more stressed, which reduces job performance and causes a greater risk for errors. Finally, nurses are more inclined to make shortcuts that compromise the quality of patient care. It can be stressful to take time out of an already demanding shift, but it is more important than ever to ensure proper handoff is performed.

REFERENCES

1. Arora, Vineet MD, MAPP, Farnan, Jeanne, MD, MHPE. Patient Handoffs. Wolters-Kluwer May 2022. Available at https://www.uptodate.com/contents/patient-handoffs?search=patient%20handoffs&source=search_result&selectedTitle=1~12&usage_type=default&display_rank=1#H376248940. Last accessed on June 13, 2022.

2. Blazin, Lindsay MD, Sitthi-Amorn, Jitsuda MD, Hoffman, James PharmD and Burlison, Jonathan PhD for the I-PASS Working Group.Improving Patient Handoffs and Transitions through Adaptation and Implementation of I-PASS Across Multiple Handoff Settings. Pediatric quality & safety, 5(4), e323. Available at https://doi.org/10.1097/pq9.0000000000000323. Last accessed on June 13, 2022.

3. Freel, Jo, MSN, RN, and Fleharty, Brandon, MHA, MSN, RN_BC, PMP, CPHIMS_Standardizing Handoff Communication: A Electronic Tool Helps Ensure Care Continuity and Reduces Miscommunication, American Nurse Journal: March 2021-Volume 16-Number 3.

4. Friesen MA, White SV, Byers JF. Handoffs: Implications for Nurses. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2018 Apr. Chapter 34. Available at https://www.ncbi.nlm.nih.gov/books/NBK2649/. Last accessed on June 13, 2022.

5. Humphrey, Kate E. MD, MPH∗; Sundberg, Melissa MD, MPH†; Milliren, Carly E. MPH‡; Graham, Dionne A. PhD∗; Landrigan, Christopher P. MD, MPH§. Frequency and Nature of Communication and Handoff Failures in Medical Malpractice Claims, Journal of Patient Safety: March 2022 - Volume 18 - Issue 2 - p 130-137 doi: 10.1097/PTS.0000000000000937.

6. Joint Commission. Sentinel Event Alert, The Joint Commission Issue 58, September 2017 p.1-6. Available at https://www.jointcommission.org/. Last accessed on June 13, 2022.

7. Kim, Jung Hee, Lee, Jung Lim and Kim, Eun Man. Patient Safety Culture and Handoff Evaluation of Nurses in Small and Medium-Sized Hospitals, International Journal of Nursing Sciences: January 2021-Volume 8-Issue 1-p 58-64 doi: 10.1016/j.ijnss.2020.12.007.

8. O'Rourke J, Lopez KD, Riesenberg LA, Abraham J. Comparison of a Nurse-Nurse Handoff Mnemonic With Real-World Handoffs. J Nurs Care Qual. 2020 Oct/Dec;35(4):336-340. doi: 10.1097/NCQ.0000000000000465. PMID: 31972782.

9. Patient Safety Movement Foundation. (2022). Hand-Off Communication Actionable Patient Safety Solutions. Available at https://patientsafetymovement.org/community/apss/. Last accessed on June 13, 2022.

10. Patient Safety Network. Handoffs and Sign-outs. Agency for Healthcare Research and Quality: September 2019. Available at https://psnet.ahrq.gov/primer/handoffs-and-signouts. Last accessed on June 13, 2022.

11. Raeisi A, Rarani MA, Soltani F. Challenges of patient handover process in healthcare services: A systematic review. J Educ Health Promot. 2019 Sep 30;8:173. doi: 10.4103/jehp.jehp_460_18. PMID: 31867358; PMCID: PMC6796291.

12. Sharma Umesh, MD, MBA and Ghosh, Amit, MD, FACP, FRCP. Culture of Safety, Journal of Clinical and Health Affairs Minnesota Medicine July/August 2020. Available at https://www.mnmed.org/. Last accessed on June 13, 2022.

13. Wells, Jack MD, MHA, Higbee, Dena EdS, MS, CHSE, Doty, Jen, BSN, Louder, Elaine, BS. Avoiding Fumbles: Online Patient Handoff Training. Peer-Reviewed Reports in Medical Education Research: October 2020 DOI: 10.22454/PriMER.2020.984649.

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