Perspectives on Handoffs: Challenges in Care Transitions. Yvonne Ford PhD RN Bronson School of Nursing

Transcription

1 Perspectives on Handoffs: Challenges in Care Transitions Yvonne Ford PhD RN Bronson School of Nursing

2 Objectives Review the Relationship Between Handoffs and Patient Safety Identify the Components and Outcomes of Successful Handoffs Evaluate the Effectiveness of a Simulated Handoff

3 Handoffs Defined The exchange between health professionals of information about a patient accompanying either a transfer of control over, or responsibility for, the patient. (Cohen & Hilligoss, 2010) Transfer of information, accountability and responsibility for a patient from one healthcare provider to another during transitions across the continuum of care. (Berger, Sten & Stockwell, 2012)

4 Handoffs Defined The transfer of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another person or professional group on a temporary or permanent basis. (BMA 2004) Transfer and acceptance of patient care responsibility achieved through effective communication. (TJC, 2017)

5 Other Purposes of Handoffs Often Criticized Ritualistic Include: Education Enculturation Social/Psychological Support

6 Patient Safety Freedom from accidental or preventable injuries produced by medical care. (AHRQ) The prevention of health care errors and elimination or mitigation of patient injury caused by health care errors. (NPSF) Actions undertaken by individuals and organizations to protect health care recipients from being harmed by the effects of health care services. (Plath, 2000)

7 Patient Safety Freedom from accidental injury (Kohn, Corrigan & Donaldson, 1999) The avoidance, prevention, and amelioration of adverse outcomes or injuries stemming from the processes of health care. (Cooper et al., 2000) The prevention of harm to patients. Patient safety efforts aim to reduce errors of commission or omission (DMAA, 2005)

8 Patient Safety Metadefinition Patient safety is the prevention and amelioration of adverse outcomes or injuries stemming from the process of health care, as well as initiatives aimed towards improving patient safety processes and outcomes. (2005)

9 Handoffs and Patient Safety Communication Failures Clearly Linked to Errors and Adverse Events Links Between Handoffs and Errors are Less Clearly Identified Much of Reporting is Based on Clinician Perception Resident Physicians Report Errors Related to Handoffs Nurses Also Relate Errors Due to Handoffs

10 Handoffs and Patient Safety AHRQ National Survey on Hospital Released in 2004 Patient Safety Culture Hundreds of Hospitals Have Administered and Re-administered Comparative Database Published Starting in 2007

11 Handoffs and Patient Safety AHRQ National Survey on Hospital Safety Culture 44 Items 12 Composites 4 Items Asking About Handoffs and Transitions Scale: Strongly Disagree to Strongly Agree

12 Handoffs and Patient Safety Things "fall between the cracks" when transferring patients from one unit to another. Important patient care information is often lost during shift changes. Problems often occur in the exchange of information across hospital units. Shift changes are problematic for patients in this hospital.

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17 Research on Handoffs Descriptions Clinician Perception Interventions Standardized Handoff Format Bedside Handoffs Clinician Education Outcome Indicators Clinician Satisfaction Patient Satisfaction Handoff Related Care Failures Shared Mental Model Actual Errors/Patient Outcomes Not So Much!

18 Handoff Research Descriptions Actual Structure of Handoffs Clinician Perceptions of Handoff Errors Language Use in Handoffs What Do We Say? How Often Do We Say It? What Does it Imply?

19 Handoff Structure Many Suggestions! SBAR, I-SBAR, IPASSTHEBATON, SHARQ Inconsistent in Purpose Actual Structure Differs From These

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21 Frequently Used Phrases

22 1 en they can do it (xx) <OCN>: Mm-hmm. <OGN>: So I don't know And then, she has some allergies, she's 2 offee (xx) <OGN>: um. Patricia Jones is um uh - I don't know how old she is. She's a fifty five year 3 age. Um he baseline he's mentally challenged. So I don't know how far off he really is from his baseline 4 kind of just, thick. You know what I mean? Like I don't know how to describe it but she's not 5 rs are q six. <OCN>: (xx) <OGN>: I think so. I don't know, I'll check. I want to say one eighty. 6 s a lot better but. She's still a full code. Um, I don't know I think she (xx) a lot. She's, um, (xx) 7 nts the pneumonia vaccine so I put it on the MAR. I don't know if they'll okay it but. But she's had 8 last night. And we had her on a versed drip but I don't know if she needs it now that's why I'm 9 starts with an E' so I have to give that today. I don't know if she is getting it (xx) I can't 10 d salt diet. He also has his walker in there too. I don't know if he uses it all the time. I think 11 <OCN>: Okay <OGN>: so um they want to (xx) and I don't know if her baseline is incontinence or 12 >: So, but yeah, she has edema on her (xx). (xx) I don't know if somebody didn't (xx), (xx) the only 13 ually one time her tube actually came fully apart I don't know if she pulled it <OCN>: (xx) 14 I guess, she had a emesis with few melana stools. I don't know if that was at home or that was on 15 ll putting out pseudomonas and um like bile. (xx) I don't know <OCN>: (xx) <OGN>: Yeah I think 16 m every time. I <OCN>: (xx) <OGN>: Just water, I don't know <OCN>: (xx) <OGN>: I've never had a 17 x-ray.to verify that (xx)? <OGN>: <OVERLAP> Oh, I don't know. <OCN>: Or just pull it back and hook 18 She's supposed to have a lumbar puncture today. I don't know of the time for that yet but the consent 19 ous, supposed take this like every hour so I mean I don't know. She was she was better last night 20 rvical spine. (xx) showed myalepathy, myloapathy, I don't know. She had an abdominal x-ray as well on 21 night. <OGN>: This is Donna Vinton, or Vintner, I don't know. She's sixty-three years old. I guess, 22 he went down for her ultrasound. <ADDRESSED TO SU>I don't know that she needs to know right now but 23 rtive. <OCN>: Okay <OGN>: Um, so the ultrasound I don't know the results of that. Um, her ECHO 24 when she was not intubated and she could talk and I don't know what (xx) that means (xx) for 25 said they wouldn't be able to for five more days. I don't know what the deal is on that, it's kind of 26 N>: (xx) <OGN>: Yeah I just I've been looking oh I don't know what's up with lab (xx). However, I 27 itis, afib uh stasis ulcers, hyperhomocysteine. I don't know what that is. Hyperlipidemia. Anxiety 28 ble. Her blood sugar was a hundred and ninety and I don't know what's up with that. I think she's 29 set of C-I-Cs eight hours after the first set but I don't know when the first set was done. Her K was 30 w, like, where are you sick at? And she was like I don't know' (xx) She writes really well (xx) and 31 st a (xx) she's had. <OCN>: Urocit? <OGN>: yeah I don't know. (xx), I didn't look it up, but (xx)

23 I don t know in Handoffs Context of Use of I don't know General knowledge of patient Tests and Results Medication Issues Fall Risk/Prevention Occurrences

24 What We Still Don t Know Specific Types of Errors Associated with Handoff Practices Effectiveness of Standardized Handoff Formats Does Effectiveness Differ by Care Setting? Impact of Patient/Family Participation on Error Rates, Severity, Outcomes

25 Successful Handoff Barriers to Successful Handoffs More Prevalent in the Literature Varied Communication Styles Lack of Attention Social Communication Lack of Knowledge Time Too Long, Too Short Background Noise

26 So What Makes an Effective Handoff? Illness Assessment (Severity) Patient Summary Events Leading to Admission Hospital Course Ongoing Assessment Plan of Care To-Do Action List Contingency Plans Allergy List Code Status Medication List Dated Lab Tests Dated Vital Signs

27 Bedside Handoffs Are They Effective? Bedside Handoffs Have Been Shown to Increase Patients Satisfaction with Care Understanding of Care Feelings of Safety Why or Why Not?

28 Other Suggestions for Effective Handoffs Consistent Location, Time Free of Interruptions Include Team Members and Family As Appropriate Don t Rely on Patient or Family Member to Communicate Information to Other Providers Standardize Training for Senders and Receivers Use EHR/Technologies

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