Initiating Standardized and Structured Handoff for Nurses in the Outpatient Setting

Background: Handoff is the transfer and acceptance of patient care responsibility achieved through effective communication. Patient-specific information moves from one caregiver to another, to ensure continuity and safety. Ineffective handoffs negatively impact patient safety, patient and staff satisfaction, adverse events, missed care, and treatment delays. Purpose: To decrease adverse events associated with ineffective handoff and improve nurse satisfaction by implementing a structured, electronic handoff process, inclusive of a standardized handoff report in an outpatient setting. Methods: This quality improvement project implemented an evidence-based, electronic, structured, handoff process, utilizing situation-background-assessment-recommendation (SBAR). A pre-implementation survey was created to identify intra-organization patient transitions and assess nurse satisfaction. Reporting to Improve Safety and Quality (RISQ™) data for handoff were also evaluated. Four weeks and eight weeks after implementing the new handoff process a repeat satisfaction survey was sent to the nursing staff, RISQ™ data was analyzed and use reports were initiated. Results: Initiating this structured and standardized handoff process, inclusive of identifying the transitions requiring handoff, led to an increase in nurse satisfaction with statistical significance p\u3c.001 in 87.5% of the satisfaction categories, a 42% decrease in adverse events associated with handoff and an increase in the use of a structured handoff process. Conclusion: Structuring outpatient handoff for defined care transitions, utilizing a report derived from the electronic medical record can improve patient safety and increase nurse satisfaction

Identifying Transfer of Care Gaps: Electronic Health Record Capture of Perioperative Handoff Communications

Transitions in patient care are held together by interdisciplinary handoff communications intended to coordinate the patient\u27s ongoing care requirements. Patients with complexity in care encumber the transfer of care process requiring a higher level of care coordination between the interdisciplinary team (Coleman, 2003; Naylor et al., 2004). While the literature is abundant on the characteristics and quality of handoff communications, it is limited on the requirements of what data is necessary for ongoing care following transfer communications (Galatzan & Carrington, 2018). This dissertation explores the verbal information transferred during Operating Room (OR) to Post Anesthesia Care Unit (PACU) nursing handoff communications and whether the data is captured in the electronic health record (EHR) to represent the information critical to ongoing patient care and care planning. the study builds on the Kennedy Integrated Theoretical Framework (KITF) (Kennedy, 2012) integrating cognition theory, patterns of knowledge theory, and clinical communication space theory to support the human-technology characteristics within perioperative handoffs. Evidence of wisdom was present in the KITF in addition to elements of non-verbal communication patterns emerging from shared common ground contributed to the framework\u27s expansion. to understand the contributions of the perioperative nursing interface terminology, the Perioperative Nursing Data Set (PNDS), makes to postsurgical care transitions, the study examines nursing diagnoses, interventions, interim outcomes and goals relationships to the handoff data communicated between OR and PACU Registered Nurses. Study findings revealed a complex fragmented process of verbal communications and electronic documentation for the handoff process. While the EHR is prominent in data procurement for the handoff process, the design of handoff artifacts (e.g., paper, electronic) significantly impact the value of information received. Incomplete handoff tools or missing EHR data adds to a cycle of information decay while contributing to increase cognitive load and potentiating opportunities for information and knowledge loss. the absence of nursing diagnoses in the automation of the PNDS challenges the integrity of the language within the documentation platform and raises considerations for hierarchical representation within interface terminologies. This study reinforces literature to reconsider user requirements in the design and functionality of healthcare information technology (HIT) to enable data and information flow and preserve knowledge development. the inclusion of mobile technology, cognitive support aids including clinical decision support tools, and other HIT will further enable the effectiveness of transfer communication, knowledge development, and the safety of ongoing patient care

Program Evaluation of a Bundled Educational Intervention to Enhance Implementation of Professional Exchange Report

Communication handover is a source of potential error and risk to patient safety. Electronic-based tools may reduce errors and mitigate risks to patient safety. Electronic tools have been successfully implemented using multiple methods of education and training. Electronic tools vary in functionality and integration with the electronic health record (EHR). A large West Michigan Regional Health System (RHS) implemented a new EHR containing an embedded tool for communication handover called Professional Exchange Report (PER). There was inconsistency in the practice of bedside report by nurses. The RHS planned to use a bundled approach of educational interventions to implement the new tool and report structure including communications, video demonstration, in-seat training and at the elbow support during the go-live. This project systematically evaluated the interventions to implement PER using evidence based methodology. Evaluation was based on collection of data and evidence through interviews, pre- and post-implementation surveys, observations of the report process, and review of documents related to planning, implementing and evaluating the program. Organizational leaders engaged in robust planning. Educational interventions were evidence-based. Implementation was carried out effectively. The organization did not have a detailed, specific plan for evaluation of educational interventions or PER outcomes. Change in length of report could not be attributed to the process change, and nurse perceptions of the process and consistency of practice at bedside did not change. Observed opening of the EHR during report increased by 68%. There were statistically significant increases in yes responses to awareness of, understanding why, knowledge of specific, and ability to make practice changes

Implementation Of A Standardized Electronic Handoff Tool For Advance Practice Provider Pass-Off

Objective: To increase the rate of documentation and satisfaction by APPs using a standardized handoff tool to and from a neurology intensive care unit. Background: A comprehensive literature review showed that there was minimal literature on handoff tools for advance practice providers (APPs), and presently at the implementation site, there was no formal handoff process for patients transferring from a neurology intensive care unit. Methods: This project was implemented between December 1, 2019 - January 31, 2020. The first step was to have APPs complete a pre-assessment. Based on the results of the pre-assessment, an electronic handoff tool was created. APPs were educated on the use of an EPIC smartphrase to easily access the handoff tool. At the end of the implementation period, APPs were asked to complete a post-assessment to evaluate their satisfaction with the effectiveness of the electronic handoff tool. Results: During the implementation period, there was documentation using the electronic handoff tool for 66 of the 105 neurosurgery transfers, accounting for 63% percent of patients with a completed electronic handoff. Results from the post- assessment showed that 89% felt satisfied with the handoff tool because they perceived improvements in care processes. Conclusion: The implementation of an electronic handoff process resulted improvements in APP satisfaction (with the transfer process and in perceived improvements in patient care. This practice change has the potential to enhance communication between APP groups through standardization of processes and informatio

CORE CONTENT ITEMS AND CONSTRUCTS TO INFORM STUDENT NURSE HANDOFF COMMUNICATION

This study describes nurse educators’ perceptions of content items for a high-risk, high frequency process essential for entry as a nurse generalist into clinical practice. The process of interest is student nurse handoff communication. Research Questions: What do nurse educators identify as core content for successful student nurse handoff communication? Do nurse educators identify with one handoff communication tool for student use? Are student nurses expected to engage in nurse handoff communication during simulation experiences and/or clinical experiences? What educator characteristics are associated with his/her perceptions of the core content? This was a descriptive study involving the administration of an online survey to nurse educators from across the United States of America. Ninety six core content items for handoff communication were selected, representing content items applicable to a broad range of clinical patient situations. Educators were asked to rank each item using a five-word response system. Considerable agreement was identified by nurse educators on the core content items for student handoff communication. Educators perceived items relating to general patient characteristics, such as patient information and physical condition, to be integral to handoff communication. This research demonstrated the highest ranked items concentrated on a change in patient condition, treatment to mitigate the change and patient response to treatment. This study revealed student nurse handoff communication process has a medical focus. This was illustrated in the high regard for a medical diagnosis over a nursing diagnosis and the use of SBAR for student learning. This study describes clustering the core content into eight constructs. The constructs contribute to student understanding by linking lecture material to the clinical practice of handoff communication. The constructs frame the communication process to support student nurse behaviors necessary for the exchange

Patient Safety and Quality: An Evidence-Based Handbook for Nurses

Compiles peer-reviewed research and literature reviews on issues regarding patient safety and quality of care, ranging from evidence-based practice, patient-centered care, and nurses' working conditions to critical opportunities and tools for improvement

Transactions of 2015 International Conference on Health Information Technology Advancement Vol.3, No. 1

The Third International Conference on Health Information Technology Advancement Kalamazoo, Michigan, October 30-31, 2015 Conference Chair Bernard Han, Ph.D., HIT Pro Department of Business Information Systems Haworth College of Business Western Michigan University Kalamazoo, MI 49008 Transactions Editor Dr. Huei Lee, Professor Department of Computer Information Systems Eastern Michigan University Ypsilanti, MI 48197 Volume 3, No. 1 Hosted by The Center for Health Information Technology Advancement, WM

Clinical handover of patients between nurses in the emergency department and somatic wards – an explorative interview study.

Master's thesis in Health and social sciencesBackground: Leading international health organizations have focused on improving the quality of clinical handovers. Research demonstrates areas for improvement where clinical handovers in healthcare are essential for quality, safety, and continuity of patient care. One hospital had received many incident reports about the quality of interdepartmental handovers between the Emergency Department and somatic wards, and wanted to improve them. Aim: The aim of this study was to explore how clinical handovers are experienced between the ED and ward nurses, and gather suggestions for improvement. Method: This study pursued a qualitative, inductive, explorative approach with 6 focus group interviews of nurses (N=19) on both ends of the ED-Ward handover (2 ED, 1 surgical, 3 medical). The interdepartmental handover is by telephone from ED to ward nurses. Graneheim and Lundman’s (2004) content analysis method was used to analyze interview texts. Rasmussen’s system approach and Dynamic Safety Model formed the theoretical basis for interpretation. Results: Four bodies of data emerged from the interviews: Poor handovers and Successful handovers from ED or Wards’ perspectives. Poor handovers occurred in a busy ED without handover structure where efficiency trumps quality causing consequences for nurses and patients on the wards. Nursing assessments and documentation lacked, and patients’ status upon arrival on wards didn’t always match the handover description. Successful handovers were described as bridging needs of patients and nurses. Conclusion: The results provide evidence for improving the interdepartmental handover but will take organizational buy-in and collaboration over time to develop and implement evidence-based, locally suitable handover routines and protocols

Handoff Communication Among Senior Nursing Students: A Phenomenological Study

Despite discussions in health care regarding poor communication and its link to patient safety, it was revealed in the literature that many student nurses are inadequately prepared to conduct handoff communication. Student nurses have difficulty in this area due to limited or no experience with the handoff process, which jeopardizes patient safety. The purpose of this research study was to understand how senior nursing students make meaning of their lived experiences with handoff communication. The guiding research question for this study is: How do senior nursing students make meaning of their lived experiences with handoff communication during the change-of-shift report in the clinical practicum? Lave’s situated cognition theory and Kolb’s experiential learning theory are the two theories that support the conceptual framework of this study. A qualitative phenomenological inquiry using the hermeneutical approach was used to explore and interpret the student nurses’ experience with handoff communication. Purposeful sampling was used to recruit nine senior nursing students enrolled in their final clinical practicum. Four major themes and nine subthemes were revealed in this study: (a) active participation, (b) understanding handoff communication, (c) insufficient training and practical experience, and (d) confidence with the shift report. The results of this study illuminated the experiences of nine senior nursing students’ learning and practical experience with the change-of-shift handoff report during clinical practicum

Download Entire Issue: Gibbon Surgical Review, Volume 1, Issue 1, 2018

Table of Contents A First Year\u27s Perspective on JeffMD, Somnath Das, MS1 Spotlight on TJUH\u27s Quality and Safety Group, Samantha L. Savitch, MS1 Medical Student Involvement in Quality Improvement Research, Tyler M. Bauer, MS3 Global Surgery: A Shift in the Global Health Paradigm, Myles S. Dworkin, MS3 Thomas Jefferson University Design Vault, Victor B. Hsue, MS2 Physician Spotlight: Ernest (Gary) L. Rosato, MD, FACS, Carrie E. Andrews, MS3 The SCALPELS Program, Emily Papai, MS