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What is a hand-off?

According to the Joint Commission (JC) (2017), A hand-off is a transfer and acceptance of patient care responsibility achieved through effective communication. It is a real time process of passing patient specific information from one caregiver to another or from one team of caregivers to another for the purpose of ensuring the continuity and safety of the patient’s care. A breakdown of this communication can lead to preventable errors, a decline in patient safety, decreased patient satisfaction, and hinder continuity of care. As healthcare becomes more evolved and specialized, there are greater numbers of clinicians involved in care, and therefore the hand-offs are more frequent and complex than in the past (Friesen, White, & Byers, 2008). This poses challenges for effective communication and can put the patient at risk.

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What is the problem?

-Ineffective hand-offs.

Each time a person moves from one environment to another, there is a risk of essential information not being communicated. As a result of this breakdown in communication, it has been reported that such errors in care have caused an estimated 98,000 deaths each year (Shendell-Falik, Feinson, & Mohr, 2007, p. 95).

Who is affected?

Ineffective hand-offs affect nurses, patients, families, doctors, and everyone in between. Entire hospital systems can also be affected.

How?

Ineffective hand-offs can contribute to gaps in care and patient safety, including medication errors, wrong site surgery, and even patient death (Friesen, White, & Byers, 2008).

Where and when?

Ineffective hand-offs can happen anywhere, at anytime there is a transfer in caretaker or environment. Some examples include shift to shift hand-off, unit to unit hand-off, facility transfer, discharge, and unit to diagnostic area hand-offs.

Why?

There are many reasons a hand-off can become ineffective. Such reasons include failed communications, distractions, incomplete medical records, lack of or illegible documentation, and lack of education on effective hand-offs (Friesen, White, & Byers, 2008).

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Inadequate hand-off communication is a contributing factor to adverse events, including many types of sentinel events. The Joint Commission’s sentinel event database includes reports of inadequate hand-off communication causing adverse events, including wrong-site surgery, delay in treatment, falls, and medication errors. A study released in 2016 estimated that communication failures in U.S. hospitals and medical practices were responsible at least in part for 30 percent of all malpractice claims, resulting in 1,744 deaths and $1.7 billion in malpractice costs over five years (Joint Commission, 2017).

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Importance/role of the nurse

Currently, nurses are more involved in patient hand-offs than any other caregiver. It is vital that all information pertaining to patient care be included in every handoff. It is up to the nurse to use critical thinking and asking the right questions to understand the big picture. Nurses are well known to use “cheat sheets” or “scraps” of information to ensure pertinent information is shared (Friesen, White, & Byers, 2008).

Challenges/barriers?

Clinical environments are dynamic and complex, presenting many challenges for effective communication among health care providers, patients, and families. Some nursing units may “transfer or discharge 40 percent to 70 percent of their patients every day”, thereby illustrating the frequency of handoffs encountered daily and the number of possible breaches at each transition point (Friesen, White, & Byers, 2008).

The ever expanding knowledge base and technological advances in health care spawn additional categories of health care providers and specialized units designed for specific diseases, procedures, and phases of illness and/or rehabilitation. This dynamic, ever-increasing specialization, while undertaken to improve patient outcomes and enhance health care delivery, can contribute to serious risks in health care delivery and promote fragmentation of care and problems with handoffs (Friesen, White, & Byers, 2008).

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Education for a successful hand-off

-          Emphasize teamwork, trust, situational awareness, roles and responsibilities, conflict resolution, and safety culture in training exercises.

-          Encourage supervisors and staff to dedicate ample time and opportunities to ask questions.

-          Engage staff in training using methods such as real-time observation and performance feedback, role-playing and simulation, and independent learning.

Use standardized process to transfer critical information

-          Use a mnemonic such as SBAR (situation, background, assessment, recommendations) to structure and increase consistency in hand-offs.

-          Avoid making hand-offs using solely electronic or paper communications. If face-to-face communication is not possible, communicate in real time via telephone or video conference. Provide ample time and opportunities to ask questions.

-          Communicate and receive hand-off content in a timely way to ensure delivery of appropriate care and services.

Make effective handoffs a best practice

-          Hand-offs should be highly reliable, conducted in a high-quality manner for every patient, every day, with every transition of care.

-          Achieving this level of performance requires strong leadership, resources, and effective implementation of a program for longitudinal monitoring, reinforcement, and improvement of hand-off practices, with the ultimate goal of having best practices integrated into the organization’s cultural norms and expectations.

(Joint Commission, 2017)

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2 Curricular concepts and Leadership role transition

Patient Advocacy

It is up to the nurse to effectively communicate and provide an effective hand-off. In this way, we advocate for our patient. When we discussed this topic in school, we talked about the nurse being the voice of the patient to make sure that everything being done is to the benefit/health of the patient and that they understand what is happening to maintain their autonomy in their healthcare. This has prepared me to take a leadership role once I transition to professional practice because I will take the role of patient advocate very seriously and ensure all critical information pertaining to patients in my care is effectively communicated every time.

The Pursuit of New Evidence-Based Practice and Continued Learning

As nurses, we are continually learning and adopting new best practices as healthcare evolves.  Our curriculum at SCOHS taught us that in order to continue providing the best care is to be actively involved in continuing our education and researching new evidence-based practice guidelines to direct our care. Using best practices when handing off patients creates better outcomes for everyone involved. Setting the example is a large part of leadership. This has prepared me to take a leadership role once I transition to professional practice because I also take evidence-based practice and continued learning very seriously when delivering patient care and I will do my best to model that behavior for my peers.