Handover Report: Tossing Out the Tape
Lynnette McCarthy Woodrow BN RN Maureen March RN Maud Crowley RN
Objectives
• Review of our issues with taped end of shift
report
• How we changed our model of report
• Challenges
• Solutions
• Evaluation of the change
Enhancing Communication….
Previous: Taped end of shift report
• Content
• Limited Guidelines
• Delay of care
• Dissatisfaction
Our Improvement Aim / Goals
Improve Communication
Improve patient safety
Increase Nursing time at
bedside
Increase Patient
Satisfaction
Our Guiding Principals
ROP from Accreditation Canada
Patient Safety Area 2: Communication
Goal: Improve the effectiveness and coordination of communication among care/service providers and with the recipients of care/service across the continuum.
ROP: The team transfers information effectively among providers at transition points.
Tests for Compliance:
1. The team uses mechanisms for timely transfer of
information at transition points that result in proper
information transfer.
2. Staff is aware of the organizational mechanisms
used to transfer information.
3. There is documented evidence that timely
transfer of information has occurred.
Our Guiding Principals Cont’d
Canadian Patient Safety Institute
“Communication is at the core of healthcare. Because communication can be driven by circumstance or dependent on individual personalities, standardized tools to facilitate effective communication and behaviors represent cogent strategies to support patient.”
(CPSI)
Handover Report
• Combination of verbal and written communication that occurs at various patient transfer points (end of shift; transfers from units, etc.)
Transfer Mechanisms
Face to Face Verbal Communication
•On-coming/Off-going Staff
•Within Unit – Regrouping
Transfer Forms Continued…
Nursing Census
• Computer generated (Meditech)
• Nurse enters data on admission
Transfer Forms Continued…
Unit census includes:
•Basic Patient Demographics
•Admitting Physician
•Admission date and Length of Stay
•Admission Diagnoses
•Past medical History
•Surgery/Procedure(s) since admission
Meeting the “Tests for Compliance” …
Staff Education
• Education Binders
• Emails
• Posters in staff lounges
• Formal and Informal Education Sessions
Meeting the “Tests for Compliance”
Documentation
• Entered in the Document Intervention menu under the Consultation/Collaboration screen of Meditech
Safety Round
First round that staff complete on assigned patient, before obtaining the written component of handover report and includes:
• Check armbands
• Call bell placement
• Proper IV rate and Solution
• Address risk concerns
(side rails, restraints,
brakes)
• De-clutter area
Putting it Together
Unit Specific “Handover Report” Guidelines developed.
Guidelines for Unit Nurses:
• Safety Round
• Patient Care Plans Parts I & II (PACE/DAR)
• Demographics in Meditech
• Verbalization
• Regrouping
• Patient Care Summaries (optional)
• Document Report Given/Received
Putting it Together Continued…
Guidelines for Patient Care Coordinator (PCC)
• Review Patient Care Plan Parts I & II
• Update PCC Kardex (if uses)
• Verbal Handover
• Highlight Patient Assignment
• Nurse Assigned In-Charge Duties on Night Shifts
Putting it Together Continued…
Guidelines for Transfer of Patient
• To areas using Handover
• To areas not using Handover
How It Works…
• Off going staff gives a verbal report to the oncoming staff regarding any urgent or emergent information
• On coming staff completes safety round on assigned patients
• Staff converge and make their individual work lists and read the written component of their patient’s report
How it Works Continued…
• Staff complete a regrouping to share patient information that is necessary for all unit staff to know to ensure safe care of all patients.
• Staff then begin shift
• Update Patient Care Plans (Parts I and II) and nursing census as shift progresses
Challenges Continued…
• Nursing Census not completed properly, leaving staff feeling that they did not have sufficient information on all patients
• Staff felt that there was not sufficient in-servicing
• Patient Care Coordinator(s) report
• Verbal Report between Off-Going Staff and On-Coming Staff, within unit, break relief, questions regarding confidentiality
Challenges Continued…
• Updating Kardex (Nursing Care Plan Part I)
• Written Report Contents (and readability)
• Safety Round Compliance
• Tardiness
• Narcotic Count
• Extra Reports
Solutions
• Nursing Census: Clarification of how to enter data; census data compiled so just need to maintain
• In-Servicing: Information Sessions provided for each side of the shift
• Verbal Report: Reinforce Guidelines for verbal report between off-going and on-coming staff, and within the unit. Some units use patient care summary, or what is important to each specific unit to guide the regroup report within the unit.
Solutions Continued…
• PCC Report: Varies Unit by Unit
• Care Plan Updating: Reinforce this • Written Report Contents (and readability):
Reinforce Guidelines
• Safety Round Compliance
• Tardiness: PCC/DM
• Narcotic Count: Assign Nurse to do counts
Our Performance Measures
Staff Satisfaction 2009 (Percentages)
86
104
0
10
20
30
40
50
60
70
80
90
100
Sat
isfi
ed/V
ery
Sat
isfi
ed
Neu
tral
Dis
sati
sifi
ed/V
ery
Dis
sati
sfie
d
Level of Satisfaction
Pe
rce
nta
ge
of
Sta
ff S
urv
ey
ed
Handover Report
Our Performance Measures Cont’d
Surgery Program Handover Report Audits 2009(Percentages)
36
99 100 98
1
100
64
1 0 2
99
00
102030405060708090
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Criteria(OCS On- Coming Staff OGS Off-Going Staff TOA Transfer of Accountability)
Pe
rce
nta
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of
Re
po
rts
Au
dit
ed
YesNo
Our Performance Measures Cont’d
Benefits identified by staff:
• Decreased delay in getting to the bedside
• Increased time at the bedside
• Decreased call bells at the beginning of the shift
• Patients are being received in transfer from ER and
Our Performance Measures Cont’d
• Recovery Room with less delay
• Post operative patients are mobilized earlier
• Have more time to spend speaking with the patients
• Increased staff and patient satisfaction
• Early identification of errors/occurrences
Our Performance Measures Cont’d
Disadvantages noted by staff…..
• No time to drink coffee at the beginning of their shift
Strutting Our Stuff
• Handover has been initiated successfully throughout 8 surgical units and 6 medical units of Eastern Health
• Safer Healthcare Now! Recognition
• ARNNL Recognition
• Article to be published in The Current in January 2010
References
Accreditation Canada www.cchsa.ca accessed on January 20, 2009
Arora V., & Johnson, J. (2006). A model for building a standardized hand-off protocol. The joint Commission Journal on Quality and Patient Safety, 32 (11), 646- 655.
Canadian Patient Safety Institute. Effective teamwork and communication to enhance patient safety. Retrieved October 1, 2009, from http://www.patientsafetyinstitute.ca/English/toolsResources/teamworkCommunication/Pages/default.aspx
Penney, J. (2008). Literature review of nursing handover. Unpublished.
Schroeder, S.J. (2006). Picking up the PACE: A new template for shift report.
Nursing 2006, 36(10), 22-23.
Schroeder, S.J. (2006). Improving intershift handoff and patient safety. LPN 2007, 3(2), 22-23.
Contact Information
Lynnette McCarthy Woodrow
Division Manager Head and Neck Surgery,
Vascular Surgery, and Vascular Lab (Acting)
St. Clare’s Mercy Hospital
(709) 777-5716