Standardizing Nurse-to-Nurse Patient Handoffs in a Correctional Healthcare setting: a Quality Improvement Project to improve end-of-shift Nurse-to-Nurse Communication using the SBAR I-5 Handoff Bundle

Abstract

Background. Ineffective nurse-to-nurse communication at handoffs can result in patient harm, including death. Effective communication addresses key technical and non-technical components including: the comprehensiveness and veracity of information exchanged, as well as the mutual understanding of the information shared. When either of these features is missing, ineffective communication results. In the jail setting communication is often based on patient information that is fractured, poorly accessible, and non-verifiable. Of the jail nurses in the study setting, 57% are foreign born; 55% speak a non-English native language, and 35% trained and practiced in foreign countries. This “internationalization” of nursing with the potential for variations in how nurses interpret and act on information exchanged can severely undermine patient safety. Purpose. The purpose of this DNP project was to utilize evidence-based practice processes to standardize the content and format of the nurse-to-nurse handoff communication at the jail, and to explore whether these structural and process changes would improve the quality of the handoff communication. Design. This project explored the impact of an evidence-based communication protocol, the SBAR I-5 Handoff Bundle, on the quality of the nurse-to-nurse handoff communication using a convenience sample of nurses at a 22-bed acute medical services unit of a jail. The study employed a mixed methods approach utilizing questionnaires, observations, interviews, and retrospective chart reviews to collect and compare pre/post-test data. Methods. The primary investigator observed morning and evening end-of-shift handoffs. Problems identified were: inconsistent handoff start and ending times; wide variability in report content, format and style; the absence of information verification; and failure to validate the mutual understanding of information shared. Differences in nurses’ pre/post-test survey responses, interviews, and handoff observations were analyzed. Nurses’ interview responses were examined for salient themes. Results. Post-intervention, jail nurses reported improved handoff quality. Although a marginal increase in the patient care error rate occurred, a 10-fold increase in the handoff error capture rate improved patient safety overall. Thematic analysis yielded two themes: Improved communication and improved team dynamics. Discussion/Conclusion. This study identifies deficiencies in the jail nurse handoff structure and process that were addressed by the study intervention. The study results indicate that standardization of jail handoff communication combined with information verification and validation features can improve the quality of jail nurses’ handoffs.