Successful Unit Handoffs

Leah Gawin, Kelly Mellody, Allison Meaux, Larissa Gorman, & Gabby Harrington
 Our Objective

Our objective is to improve the effectiveness of unit to unit handoffs within

SAVHACS to reduce medical errors and provide continuity of patient care
and safety.
 Nursing Hand Off

“A nursing handover occurs when one nurse hands over the responsibility of care
for a patient to another nurse, for example, at the end of a nursing shift. On
average, nursing handovers occur three times a day for each patient”

(Smeulers, Lucas & Vermeulen, 2014)

Description of the Problem
- Successful nursing handoffs provide continuity of nursing care and safety for patients
- Problems with unit to unit handoffs
- Lack of communication
- Missing information
- Inappropriate times
- Improper hand offs can lead to
- Adverse events
- Delays in treatment
- Inappropriate treatment
- Omission of care

(Smeulers et al., 2014)

 Significance in Health Care
Poor communication during nursing hand off results in:
- 22% of all medical errors
- Twice as many adverse events
- Inappropriate treatment
- Redundant testing
- Dissatisfied patients
- Increased costs
- Patients transferred from the operating room are “most susceptible to medical errors and
omissions”
- Handoff errors are more common in teaching hospitals d/t inexperienced residents and
students

(Maree, 2013), (Moon, Gonzales, Woods, Fox, 2016), (Riley, Merritt, Mize, Schuette, & Berger, 2017), (Shahian, McEachern, Rossi, Chisari,
& Mort, 2017)
 Current State on Wards
- No standardization
- Teams involved in transferring patients from the OR to the floor/ICU are responsible
for:
- Handoff report
- Managing the patient’s hemodynamic and ventilatory status
- Medication delivery
- Invasive monitoring
- Pertinent medical events regarding the surgery
- Multitasking increases the risk of adverse medical outcomes for the patient and
decreases handoff report effectiveness.

(Moon, Gonzales, Woods, Fox, 2016).

What the Literature Says

Standardized handoff produce:

- Consistent and thorough information exchange

- Increased presence of the caregiver involvement
- Important for continuity of care and patient safety
- Standardized handoff does not increase working time
- Improves healthcare team satisfaction and morale
- Decreases medical mistakes that lead to lawsuits
I-PASS System

I - Illness Severity

P - Patient Summary

A - Action List

S - Situational Awareness / Contingency Planning

S - Synthesis by Receiver

(Shahian, McEachern, Rossi, Chisari, & Mort, 2017).

Solutions and Outcomes

Solutions:
- Encourage in-person handoff with standardized report sheet
- Mandate distraction-free zones for individuals involved in report handoff

Outcomes:
- Less patient adverse events
- Better patient outcomes / satisfaction
- Improved healthcare team collaboration and communication
How to Measure the Impact
- Handoff CEX scale - based on Mini-CEX
- Six main domains
- Setting
- Organisation
- Communication
- Content
- Judgment
- Professionalism
- Addition → Overall competency
- Open-ended comment space

CLINICAL PRACTICE APPLICATION: educators, supervisors, and practicing nurses → providing

training, ongoing assessment, and feedback → improving quality of handoff

(Horwitz, Dombroski, Murphy, Farnan, Johnson, & Vineet, 2012).

Recommendations
- Standardized Handoff
- I-PASS
- In person, bedside report
- No unnecessary handoffs 30 mins before and after shift change (except
emergencies)
- Written handoff report to complement verbal report
- Distraction free zone
- Individuals involved in handoff report cannot participate in patient care at that time
- Multidisciplinary handover committee
- Educational staff will create material required for proper handoff
- Based on e-b practice
References
Horwitz, L. I., Dombroski, J., Murphy, T. E., Farnan, J. M., Johnson, J. K., & Arora, V. M. (2012). Validation of a handoff assessment tool: the Handoff CEX.
Journal of Clinical Nursing, 22, 1477-1486. doi:10.1111/j.1365-2702.2012.04131.x

Johnson, M (2013). Nurses discuss bedside handover and using written handover sheets. Journal of Nursing Management, 21(1), 121-129,
doi:10.1111/j.1365-2834.2012.01438.

Moon, T. S., Gonzales, M. X., Woods, A. P., & Fox, P. E. (2016). Improving the quality of the operating room to intensive care unit handover at an urban
teaching hospital through a bundled intervention. Journal of Clinical Anesthesia, 31, 5-12. doi:10.1016/j.jclinane.2016.01.001

Paolo, F., Terzoni, S., Davi, S., Biesti, A., & Destrebecq, A. (2017). A tool for assessing the quality of nursing handovers: a validation study. British Journal
of Nursing, 26(15), 882-888. doi:10.12968/bjon.2017.26.15.882

Riley, C. M., Merritt, A. D., Mize, J. M., Schuette, J J., & Berger, J. T. (2017). Assuring sustainable gains in interdisciplinary performance improvement:
creating a shared mental model during operating room to cardiac ICU handoff, Pediatric Critical Care Medicine, 18(9), 863-868,
doi:10.1097/PCC.0000000000001231

Shanian, D. M., McEachern, K., Rossi, L., Chisari, R. G., & Mort, E. (2017). Large-scale implementation of I-PASS handover system at an academic medical
centre. British Medical Journal, 26, 760-770, doi:10.1136/bmjqs-2016-006195.

Smeulers, M., Lucas, C., & Vermeulen, H. (2014). Effectiveness of different nursing handover styles for ensuring continuity of information in
hospitalised patients. Cochrane Library, 6, 1-30, doi:10.1002/14651858.CD009979.pub2.