Patient Hand Offs : An Integral Part Of Patient Care

Within a health care setting communication is a necessity. This communication not only includes the need for professional communication but also the way in which information is shared to the patient and to other healthcare workers. Another important aspect of health care worker such as a nurse is the effectiveness off a handover. Within the video, Effective Communication in nursing these three aspects of communication (Professional communication, provision of information and handover) were seen and will be analysed further, within this essay. These will be analysed through the three aspects, the care of the patient, the image of the individual nurse and the health outcomes of the patient. All of these three aspects of communication are vitally important to the overall patient needs.

Standard 1.1 outlines that the registered nurse should access and analyse the best available evidence which includes research to ensure they provides safe and quality practice (Nursing and Midwifery Board of Australia, 2016). This was absent in scenario one as a result of a fast verbal medical handover Mary to Nicole. There was no guidance as to which patient was being discussed, and no time to write down all the important medical information required about her patients (Edith Cowan University, 2016). In scenario two Mary provides more guidance to Nicole about which patient she is talking about ensuring all the necessary information is received by Nicole (Edith Cowan University, 2016). Research has proven that handover is often difficult in the health care process, and often results in information being lost, distorted or misinterpreted. Verbal handover has also been described as an incomplete process when compared to information available in patient notes and records (Drach-Zahavy & Hadid, 2015). This is demonstrated in both scenarios with Nicole being given a fast handover with no guidance about where the information she is being given is relevant to. Whilst in scenario two Mary provides prompts and gives Nicole time to write down all the necessary information she requires (Edith Cowan University, 2016).

A.Nightingale Community Hospital is attempting to be in complete compliance with Joint Commission’s “communications” standards. Prior to the Joint Commission survey, Nightingale Community Hospital wanted to focus on items UP.01.01.01 through UP.01.03.01 of the Joint Commission handbook. According to the handbook, these items focus on the universal protocols for preventing wrong site, wrong procedure, wrong person surgery (2015). In response to these universal protocols, the hospital implemented a pre-procedure hand-off tool, which is completed and signed off by both the nurse handing off the patient as well as the nurse accepting the patient. The hospital also began

The complexity and type of information, method of communication and caregivers of this program impact the effectiveness of the handoff and patient safety. Healthcare has evolved with time thereby becoming more specialized

A significant amount of communication is done between nurses at handoff report, and the patient’s safety can also be compromised at this time (Sand-Jecklin & Sherman, 2014). In a study conducted regarding near miss incidents, nurses reported that handoff report is a contributing factor (Sand-Jecklin & Sherman, 2014). Communication errors are the leading cause of patient harm and are the root cause of 65% of sentinel events (Tobiano, Chaboyer, & Mcmurray, 2013). If the bedside report is

Investigating problems on both the doctors and patients side during the interaction at any medical appointment is key when interpreting statistics that relate to this matter. These aspects will be further explored later in this paper. The general consensus from many articles and studies indicate that miscommunication is a massive problem that impacts many individuals who die each year from miscommunication. Furthermore, each article shows a different perspective on where this error comes from and where, both doctor and patient, go wrong and what they can both do to improve the communication between them. Another aspect that must also be incorporated into this argument is that communication is not all verbal and that non-verbal communication can be just as effective or ineffective when it comes to dealing with other medical personnel or patients. The 7% rule coined by Albert Mehrabian in his book “Silent Messages” states that “93% of communication is non-verbal, with 55% being body language and 38% being tone of voice; leaving only 7% of communication being verbal.” (“Silent Messages” Albert Mehrabian), and that ineffective or bad non-verbal communication can be just as detrimental during an interaction as verbal communication. Unfortunately, for doctors, the precision of the execution in this small 7% of communication is crucial when explaining challenging

Effective communication during a patient handoff is critical in ensuring patient-care quality and safety and bedside shift reports have been found to increase patient involvement and satisfaction (Wakefield, Ragan, Brandt, and Tregnago, 2012). Bedside shift report is viewed as an opportunity to reduce errors and ensure improved communication between nurses (Gregory, Tan, Tilrico, Edwardson, and Gamm, 2014). Improved communication between nurses can be beneficial for all involved. In response to the Joint Commission’s National Patient Safety Goals, bedside report has been supported as improving patient safety, patient-centered care, and nurse communication as well as reducing medical errors (Gregory, et al., 2014). Ofori-Atta, Biniend, and Chalupka’s (2015) article examines statistics regarding hospital care and shows that according to the Inspector General Office, Health and Human Services

It has been proven that bedside handover with ISBAR has provided a safety transition and met patient’s satisfaction that gives more opportunity to clarify information (ACSQHC 2012). Although, bedside handover with ISBAR is strictly implemented, there are difficulties in the application due to ‘changes in complex social practices’ of nurses that somehow limits its uptake (ACSQHC 2012, cited in Jeffcott, Evans & Cameron 2009). This literature review sought to study the rationale as to the effectiveness of bedside handover with ISBAR framework in clinical settings; and to identify the common barriers to effective communication in bedside handover.

The National Patient Safety Goal 13 was to encourage patients to actively involve in their own care as a patient safety strategy. As per the Joint Commission (2007), the teach-back method is the preferred method to address that goal. According to Fenwick ( n.d.), “Teach-back can help providers communicate with people with low health literacy, but it can also help with communicating overall—even with people with proficient health literacy”. Both the National Quality Forum and The Joint Commission endorse the teach-back method for use in teaching and proper administration of discharge instructions for both the patients and caregivers (Fenwick, n.d.). The American Medical Association also provides the tool kit to educate health care professionals in the use of the teach-back method (Fenwick, n.d.).

The RN who is the gateway to patient care looks at the patient’s situation (current status, code status, level of uncertainty, recent changes and response to treatment…), background (comorbidities, previous episodes, current medication, family history…), assess the patient’s overall health condition and communicates vital information to all team members that are directly involved in the patient’s care during an emergency (Hood, 2014). During the course of my learning experience as a nurse, I realized that the main components in nursing profession is prioritizing information before initiating it. The use of SBAR when communicating patient’s condition to physicians, specialists, dentists, nurses and other healthcare team has improved my communication skills and has also helps physicians to determine the order of treatment for the patient thereby improving the overall patient’s

Currently, at Rutland Regional Medical Center (RRMC) there is no structured process for case management to provide handoff to the primary care offices when patients are discharged from the hospital. The transition of care from hospital to home is a critical time, during which the risk of adverse event occurrence is high. According to Shivji, Ramoutar, Bailey, & Hunter (2015), 19%-23% of patients experience an adverse event following discharge to home. Elderly patients are at greater risk due to functional and cognitive limitations; this is compounded by the presence of co-morbidities and multiple providers (Nelson, & Carrington, 2011). According to the Rutland County Health Assessment (2012-2015), by 2017 it is estimated that the elderly (age > 65) will comprise approximately 21.1% of the county’s population. Clear, concise, and timely communication with cooperative care providers at discharge is critical for the elderly population (Morris & Hoke, 2015). Furthermore, according to Lattimer (2011), the lack of cooperation between providers at discharge can endanger patients ' lives and waste fiscal and human resources. The purpose of this paper is to examine the problem of handoff communication to primary care offices and to plan a recommendation for change to provide a consistent and structured process; thereby ensuring the safety of the community during transitions of care.

In this article, the authors investigated the vulnerabilities in emergency department to internal medicine patient transfers through self-administered surveys of all emergency medicine house staff. More specifically, the survey investigated adverse events due to faulty communications during handoffs. According to this survey, 29% of the emergency staff reported either an adverse or near-miss event due to errors during handoffs. Furthermore, the survey respondents identified inaccurate or incomplete information, cultural and professional conflict, crowding, and many other factors as the contributors to handoff errors. By identifying specific contributors to handoff errors, this article serves as guidance for handoff intervention.

The benefit of standardized handoff reporting. Research shows the implementation of any standardized reporting format will improve communication between health care providers by reducing the risk of transferring inaccurate and incomplete patient information (Barry, 2014). In a study by Guilbeault et al. (2015), both verbal and non-verbal handoffs have been shown to reduce communication errors. While there is little information regarding an electronic handoff, it is expected to reduce the loss of information (Guilbeault, Momtahan, & Hudson, 2015). According to Braun (2012), allowing the electronic medical record to gather the information from multiple sources will reduce the time the nurse will spend gathering information and standardize the process (Braun, 2012). Despite the need for a standardized tool, a common format has yet to be accepted (Matney, Maddox, & Staggers, 2014).

It has been proven that bedside handover with ISBAR has provided a safety transition and met patient’s satisfaction that gives more opportunity to clarify information (ACSQHC 2012). Although, bedside handover with ISBAR is strictly implemented, there are difficulties in the application due to ‘changes in complex social practices’ of the nurses that somehow limits its uptake (ACSQHC 2012, cited in Jeffcott, Evans & Cameron 2009). This literature review will provide a background and rationale as to the effectiveness of bedside handover with ISBAR framework in clinical settings; and to identify the common barriers to effective communication in bedside handover.

The qualitative methodology helped connect the issue of bedside handover. The method included six focus groups of 30 registered lasting 60 minutes each, and enrolled nurses to focus on bedside handover and interview the nurses to understand if the bedside handover developed their communication skills. The numbers of hospitals and nurses involved were record, and the results for the study determining the bedside handover satisfaction were included, as well. Also, the references included in the article ranged within the five-year limit, and all of which range within the early 2000’s. An Australian study that had been done stated that the weakness of their study included of the following: missing information and lack of patent involvement (Johnson