Question

Develop a comprehensive plan to improve hand off procedures in health care and transitions to reduce risk and errors and improve outcomes.

Note: It's a project so it is supposed to be 5-7 pages long for a word file with references please.

Answer 1

The transfer of essential information and the responsibility for care of the patient from one health care provider to another is an integral component of communication in health care. This critical transfer point is known as a handoff.An effective handoff supports the transition of critical information and continuity of care and treatment. However, the literature continues to highlight the effects of ineffective handoffs: adverse events and patient safety risks.The Institute of Medicine (IOM) reported that “it is in inadequate handoffs that safety often fails first”. This chapter presents an overview of handoffs, a summary of selected literature, gaps in the knowledge, and suggestions for quality improvement initiatives and recommendations for future research.
First one needs to recognize the term “handoff” and synonymous terms that are used in a wide variety of contexts and clinical settings. There are a number of terms used to describe the handoff process, such as handover,sign-out,signover,cross-coverage and shift report.For the purpose of this discussion, the term “handoff” will be used and defined as, “The transfer of information (along with authority and responsibility) during transitions in care across the continuum; to include an opportunity to ask questions, clarify and confirm”. The concept of a handoff is complex and “includes communication between the change of shift, communication between care providers about patient care, handoff, records, and information tools to assist in communication between care providers about patient care". The handoff is also “a mechanism for transferring information, primary responsibility, and authority from one or a set of caregivers, to oncoming staff”. So, conceptually, the handoff must provide critical information about the patient, include communication methods between sender and receiver, transfer responsibility for care, and be performed within complex organizational systems and cultures that impact patient safety. The complexity and nuance of the type of information, communication methods, and various caregivers for each of these factors impact the effectiveness and efficiency of the handoff as well as patient safety.

As health care has evolved and become more specialized, with greater numbers of clinicians involved in patient care, patients are likely to encounter more handoffs than in the simpler and less complex health care delivery system of a few generations ago.Ineffective handoffs can contribute to gaps in patient care and breaches (i.e., failures) in patient safety, including medication errors,wrong-site surgery,and patient deaths.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” there by illustrating the frequency of handoffs encountered daily and the number of possible breaches at each transition point.

Our 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.It is ironic that as health care has become more sophisticated due to advances in medical technology focused on saving lives and enhancing the quality of life, the risks associated with the handoffs have garnered attention in the popular press and reports from health care organizations and providers.The hazard that “fumbled handoffs”pose to patient safety and the delivery of quality health care cannot be ignored. Ineffective handoffs can lead to a host of patient safety problems; research and development of strategies to reduce these problems are required.

What contributes to fumbled handoffs? An examination of how communication breakdown occurs among other disciplines may have implications for nurses. A study of incidents reported by surgeons found communication breakdowns were a contributing factor in 43 percent of incidents, and two-thirds of these communication issues were related to handoff issues.The use of sign-out sheets for communication between physicians is a common practice, yet one study found errors in 67 percent of the sheets.The errors included missing allergy and weight, and incorrect medication information.In another study, focused on near misses and adverse events involving novice nurses, the nurses identified handoffs as a concern, particularly related to incomplete or missing information.

Acute care hospitals have become organizationally complex; this contributes to difficulty communicating with the appropriate health care provider. Due to the proliferation of specialties and clinicians providing care to a single patient, nurses and doctors have reported difficulty in even contacting the correct health care provider.One study found that only 23 percent of physicians could correctly identify the primary nurse responsible for their patient, and only 42 percent of nurses could identify the physician responsible for the patient in their care.This study highlights the potential gaps in communication among health care providers transferring information about care and treatment.

A handoff is largely dependent on the interpersonal communication skills of the caregiver as well as the knowledge and experience level of the caregiver. There is reported variability in quality,lack of structure in how handoffs usually occur,and variances in shift handoffs.Concern has been raised that the transition of care between providers during handoffs will continue to be problematic as research indicates that “only 8 percent of medical schools teach how to hand off patients in formal didactic session”creating a large educational gap in new professionals and persistence of traditional models. Physicians and nurses communicate differently. Nurses are focused on the “big picture” with “broad and narrative”descriptions of the situation, whereas physicians are focused on bullets of critical information.A technique that seeks to bridge the gap between the different communication styles of nurses and physician is the situation, background, assessment, recommendation (SBAR) briefing model that is being used successfully to enhance handoff communication.

The issue of handoffs has become so prominent that the Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations, JCAHO) introduced a national patient safety goal on handoffs that became effective in January 2006.The national safety goals, developed by the Joint Commission with input from the Sentinel Event Advisory Group, identify new actions with the potential to protect patient safety.The patient safety goal requires health care organizations to “implement a standardized approach to “handoff” communications, including an opportunity to ask and respond to questions.”While the goal is simply stated, it is challenging to develop and implement effective strategies for handoffs across various health care settings, given the complexity of health care delivery.

Handoffs occur across the entire health care continuum in all types of settings. There are different types of handoffs from one health care provider to another, such as in the transfer of a patient from one location to another within the hospital or the transition of information and responsibility during the handoff between shifts on the same unit.Interdisciplinary handoffs occur between nurses and physicians, and nurses and diagnostic personnel, while intradisciplinary handoffs occur between physicians or between nurses.Interfacility handoffs occur between hospitals and among multiple organizations,including home health agencies,hospices,and extended-care facilities.

Handoffs may involve use of specialized technology (e.g., audio recorders, pagers, hand-held devices, and computerized records),fax,written documents,and oral communication.Each type and location of handoff presents similar as well as unique challenges. Given the variety of handoffs, the following discussion will focus on:

Shift-to-shift handoff
Nursing unit-to-nursing unit handoff
Nursing unit to diagnostic area.
Special settings (operating room, emergency department).
Discharge and interfacility transfer handoff
Handoffs and medications
Physician-to-physician handoffs.
There are paradoxes in communication and handoffs, especially at shift changes.Many human factors play a role. Human factors (ergonomics) focus on behavior and interaction between human beings and their environment. Human factors engineering focuses on “how humans interact with the world around them and the application of that knowledge to the design of systems that are safe, efficient, and comfortable”.The handoff poses numerous human factors engineering implications. From the perspective of patient safety, the primary purpose of the shift report or shift handoff is to convey essential patient care information,promote continuity of care to meet therapeutic goals, and assure the safe transfer of care of the patient to a qualified and competent nurse. However, other reported purposes of shift report include education,debriefing,socialization,planning and organization,enhancement of teamwork,and supportive functions.

The intershift handoff is influenced by various factors, including the organizational culture. An organization that promotes open communication and allows all levels of personnel to ask questions and express concerns in a nonhierarchical fashion is congruent with an environment that promotes a culture of safety.Interestingly, one study reported novice nurses seeking information approached those seen as “less authoritarian.”The importance of facilitating communication is critical in promoting patient safety. The shift-to-shift handoff is a multifaceted activity.A poor shift report may contribute to an adverse outcome for a patient.

A phenomenon well known to nurses is the use of nurse-developed notations, “cheat sheets” or “scraps” of information, while receiving or giving intershift reports. A study of such note taking found scraps are used for a variety of purposes, including creating to-do lists and recording specific information and perceptions about the patient and family.This approach presents some challenges, as no one else has easy access to the information; therefore, continuity of care may be compromised during a meal break, for example, or if the scrap or cheat sheet is misplaced.

Improve Handsoff :-

Identify the Various Types of Handoffs Your Organization Makes, and the Requirements for Each One. ...
Establish Best Practices Around Patient Handoffs. ...
Create and Communicate Handoff Protocols that Meet Patient, Provider, and Employee Needs.
In the fast-paced environment of modern healthcare, good hospital communication is critical to patient outcomes and quality of care. Nowhere is this more evident than when handing over a case to another shift, team, or organization. An effective patient handoff process will help you avoid communication barriers, improve care transitions, create a better patient experience, and ensure excellent continuity of care, throughout the supply chain.There are plenty of ways to enhance the handoff communications process — effective technology, established procedures, staff training, good protocols, and more. This will help you avoid medical errors, improve patient satisfaction, and create greater collaboration throughout your healthcare team.Every type of handoff will be slightly different. Handoffs between nurse shifts on a critical care ward will differ significantly from mental health nursing, or handoffs between surgical and recovery staff. Identify the various types of handoffs your organization makes regularly — between shifts, teams, areas, disciplines, and providers. Speak to your staff to ensure you properly understand the scope of handoffs and who is involved in each one.Before creating handoff protocols, you will want to establish best practice. Look at clinical guidelines, interview staff, and explore successful handoff techniques used elsewhere in your, or other healthcare providers. Establish exactly what types of information that people making and receiving the handoff need, and the best way to provide that information.Create protocols, processes, and guidelines for every type of handoff your organization makes. Get feedback from your employees and refine your handoff processes to balance efficiency and patient care. Make sure that all of your protocols, processes, and guidelines are clearly communicated — make them easily accessible and build them into your hospital communications technology so they are easy to review and use.