Patient Handoffs

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.