Calling the Shots: Nursing News and Notes

Prioritizing Patient Handoffs

Prioritizing Patient Handoffs

Friday, October 27, 2017

Few nurses would be OK with settling for substandard care of patients under their charge. Yet when it comes to patient handoffs to another caregiver, clinicians too often do just that: They commonly transfer the responsibility of care with incomplete and hastily thrown together information that fails to protect the patient.

“When a patient is handed off to another health care provider for continuing care, treatment, or services, the type of information the receiving provider needs may not be the information the sender provides. This misalignment is where the problem often occurs during handoff communication,” said Ana Pujols McKee, MD, executive vice president and chief medical officer of The Joint Commission.

“Failures in handoff communication can result in a sequence of misadventures and adverse events, which can include medication errors, medical complications, readmissions, and even loss of life.” 

In fact, The Joint Commission (TJC) reports that communication failures played a role in nearly a third of all malpractice claims over a 5-year period, resulting in a tragic 1,744 deaths and $1.7 billion in costs.

“Facts, figures, or findings got lost between the individuals who had that information and those who needed it — across the spectrum of health care services and settings,” CRICO reported.

8 WAYS TO IMPROVE HANDOFFS

The Joint Commission recently issued a Sentinel Event Alert to call attention to the dangerous problem of inadequate handoff communication.

“Potential for patient harm — from the minor to the severe — is introduced when the receiver gets information that is inaccurate, incomplete, not timely, misinterpreted, or otherwise not what is needed,” the alert explains. “When handoff communication fails, many factors are involved, such as health care provider training and expectations, language barriers, cultural or ethnic considerations, and inadequate, incomplete, or nonexistent  documentation, to name just a few.”

The Joint Commission recommended 8 tips for improving patient handoffs (if you prefer visual aids, an infographic is available here):

  1. Determine and standardize critical information that needs to be communicated both verbally and in written form during the handoff. Include everything needed to safely and efficiently care for the patient.
  2. Standardize tools and methods for communicating information to receivers. Options include templates, checklists, protocols, and mnemonics (such as I-PASS, ISBAR, and I PUT PATIENTS FIRST).
  3. Don’t rely on electronic or paper communications during handoffs. When face-to-face interactions are not possible, use phone or video conference so the receiver has the time and opportunity to ask questions.
  4. Combine and communicate information from multiple sources at one time rather than communicating it piecemeal.
  5. At a minimum, ensure the receiver gets the following information:
  • sender’s contact info,
  •  illness assessment and severity,
  • patient summary (including events leading up to the illness or admission, hospital course, ongoing assessment, and care plan),
  • to-do action list,
  • contingency plans,
  • allergy list,
  • code status,
  • medication list,
  • dated laboratory tests, and
  • dated vital signs.
  1. Conduct handoffs or signouts face-to-face in a designated location that is free of interruptions.
  2. Include multidisciplinary team members, the patient, and family, as appropriate, in handoffs. Do not rely only on patients or their family to communicate vital information to receivers.
  3. Use electronic health record capabilities and other technologies such as apps, patient portals, or telehealth to enhance handoffs. But don’t rely on them exclusively.

LEADERSHIP MUST COMMIT, TOO

Now, a note to nursing leaders: The Joint Commission also advises the necessity of demonstrating leadership’s commitment to successful handoffs and other aspects of a safety culture. That includes providing the support, time, and funding for handoff quality improvement initiatives. The Joint commission also encourages monitoring the success of handoff interventions to improve communication and to use the lessons gained to drive continued improvement.

Finally, sustain as well as spread best practices in patient handoffs to contribute to improved patient care beyond your organization. Making high-quality handoffs a cultural priority and expectation is a huge step forward in preventing avoidable patient harm.

 

 

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