Handoff In Nursing

Handoff and transitions are an integral component of nurse to nurse communications during a shift. The information gathered within the scope of a handoff is incorporated into the patient’s plan of care for that day, and helps to facilitate multi-level team collaboration which also utilizes this information. Currently there is an estimated, “80 percent of medical errors are due to communication failure during the handoff process”(Robins & Dai, 2015, p. 264). The purpose of this quality improvement project is to increase the education of nursing staff in the critical care setting, to streamline the delivery of handoffs, as well as the implementation of a standardized checklist-based handoff tool that will narrow the gap in communication breaches.
Thereby, decreasing the influence of variables in the information exchange from the sender to the receiver. The proposed handoff tool will have a 90 day trial period in which a duplicate form will be collected for analysis in order to identify discrepancies in documentation and reporting. The anticipated benefits include a decrease in handoff communication related errors, improved communication among nurses and patients, improved continuity of care, and a decrease in time to complete handoff reporting. The potential barriers would include lack of staff involvement, low adherence in the usage of the handoff tool, and the cost of implementation and training.
Keywords: patient safety, standardized handoffs, transitions, communication, implementation, critical care units

Transition and Handoff Errors in the Critical Care Setting
Introduction
According to Robins and Dai (2015), handoff is defined as a transfer of information, authority, and responsibility from one provider to another to ensure the safety and continuity of care amongst patients. For the purpose of this project we will use the terms handoff and transitions of care interchangeably and will be defined as the transfer of information, authority, and responsibility at any given time. In a highly volatile world of healthcare, the providers rely on the accurate delivery of data. Nurses and physicians alike use a specialized type of report that encompasses all pertinent information, this is used to inform members of the interdisciplinary team, during transitions of care, and shift changes (Riesenberg, 2012). However, it is important to remember that the handoff technique is not uniform or standardized, and the style of handoff, along with the amount, type, and the importance of information that is being passed along from one individual to another varies greatly (Eaton, 2010). These inconsistencies can result in a gap in patient care and thereby outlines the need for further research to improve handoff communications .
Project Charter
Data reveals that approximately 1.6 million handoffs are given annually in hospital settings (Abraham, Kannampallil, Patel, Almoosa, & Patel, 2012).
Therefore, handoff is an integral part of professional communication throughout patient care. Some of the most common mistakes in the transition of patient care occur in the fields of communication, information sharing practices, and human factors (Abraham et al., 2012). Patients that are in the intensive care unit are at even more risk of being impacted due to the vulnerability and complexity of care that is required along with the critical nature of their condition (Colvin, Eisen, & Gong, 2016). according to the Joint Commission miscommunication among healthcare providers has lead to an approximate 80 percent of serious medical errors compromising patient safety (Joint Commission Perspectives, 2012). These mistakes, depending on the degree and the condition of a patient, may lead to dreadful consequences for the patients such as “delays in treatment and ordering of tests, incongruence in patient data, and increased patient length of stay (Abraham et al., 2011, p.28). Given these facts, it becomes evident that the need for an intervention is
undisputable.
Purpose
The purpose of the quality improvement project will be to integrate a standardized handoff tool that will allow nurses to conduct a handoff in a more uniform and accurate manner. The project will implement a checklist-based handoff tool that will narrow the gap in the breakdown of communication from one healthcare provider to another. According to Cohen and Hilligoss (2010) we are lacking a clear definition of what is to be standardized in the handoff process, therefore the integration of this tool will allow for a more standardized approach that will be less influenced by the healthcare provider’s personal bias regarding what information is pertinent. This will in turn reduce the frequency of errors due to omissions, as well as eliminate the subjectivity of handoff information provided throughout the critical care setting (Abraham et. al, 2012).
Goal
The goal of this project is to develop an intervention that will aid in improving the handoff process to promote the continuity of patient care and, thereby, reducing the risk of transition and handoff errors in critical care settings.
Benefits
One of the advantages of implementing a uniform checklist-based protocol for handoff and transitions is that it allows for a more organized approach in the delivery of information. The handoff checklist will take a straightforward approach to each body system that includes sections designated to diagnosis, physical examination, labs, medications, and plan of care. This type of structured format will allow for a clear, direct, and concise form of information sharing that is not subjected to person-to-person variations (Abraham et al., 2011).
Risk Factors The quality and impact of this handoff tool will be dependent on staff education and training in how to utilize it, as well as the adherence of the staff in using the above stated tool during handoff reporting. Other barriers that have been identified in previous handoffs include difficulty of implementation due to “unit protocols and models of care” (Abraham et al., 2011, p. 35) these variations can affect the tool’s ability to meet the unit needs. Other possible risk factors include handoff communications, distractions, interruptions, fatigue, memory, knowledge, experiences in handoffs, written communications, variations in information pass-down processes, time constraints, and staffing limitations (Friesen, White, & Byers, 2008). These risks affect the quality and type of information that is recorded and received, thereby having a direct impact on the quality of handoff report given.
Project Plan The plan for the project will make use of the handoff tool in duplicate form for implementation into all critical units, where hospital staff will undergo in-depth training for two consecutive days on how to properly use and incorporate this type of handoff into their standard of care.
Healthcare professionals will be informed that the use of this protocol is mandatory and that no other form of handoff or transition report is permitted for a ninety-day period. All healthcare professionals will be required to submit the carbon copy of the handoff tool at the end of each shift. A qualitative analysis will be conducted from the collected copies to aid in identifying information gaps, frequencies of missed and incorrect information, and missed problem diagnoses (Abraham et al. 2012). The handoff documentation will be analyzed and categorized according to type, such as information breakdowns, decision-making breakdowns, and/or expertise differences (Abraham et al.,
2011).