Compared with other members of the healthcare team, we nurses spend the most time with our patients. In line with this, our performance as nurses, as evidenced by studies, have an effect the quality of care rendered to patients. However, it’s not all the time that we are there to care for our patients. Though we are considered as modern day superheroes, we need to rest, too, thus the presence of shift work wherein nurses and other healthcare professionals work in shifts to make sure that patient needs are met 24/7. There are a lot of benefits to this, however, there are also challenges. For another nurse to be able to provide appropriate care to the patient, he/she must first be informed about the patient’s needs, condition and other pertinent information.

What is patient handoff?

Patient handoff is defined as the process of transferring primary information, authority and responsibility for providing clinical care to a patient from one departing caregiver to one oncoming caregiver. 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.

Problems with handoffs

Handoffs are considered vital in patient care and safety, however, if used incorrectly, they may also result to problems. For one, ineffective handoffs can result to gaps in patient care and breaches such as failures in patient safety, including medication errors, wrong-site surgery, and ultimately patient deaths.

For example, 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.

In another study (now involving nurses), focused on near misses and adverse events involving novice nurses, the nurses identified handoffs as a concern, particularly related to incomplete or missing information.

The complexity of hospitals and specializations has also become a problem when it comes to patient handoffs, as it has been said to result to difficulty communicating with the appropriate health care provider. With the increase of specialties and clinicians providing care to a single patient, nurses and doctors have reported difficulty in even contacting the correct health care provider as evidenced by numerous studies. In one study, it has been found out 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.

Tips for unit-unit, shift-shift patient handoffs

Since shifting and transferring patients are very common among nurses, below are some tips and strategies that would help improve patient handoffs:

• Allow units to customize forms to meet the needs of their patient population.
• Provide a checklist for face-to-face handoffs to ensure a consistent format for communication.
• Make forms easy to access by placing them online.
• Include information about Rapid Response Team calls and dates so that this information is conveyed when a patient is transferred to another unit.
• Allow for lengthy tools in cases where much vital information needs to be transferred.
• Keep the format and elements of the shift report as similar as possible to the trip ticket (if applicable). This is helpful for the individuals who use both forms. By making the forms similar, it doesn’t appear to be an entirely new form each time around.
• Information included on the form can include patient identification, vitals, input-output,medications and labs ordered, allergies, co-morbidities, code status, core measures, and past medical and surgical history, among other information.
• Use unit-to-unit transfers as an opportunity to reconcile medications.

Sources:

• https://www.ncbi.nlm.nih.gov/books/NBK2649/
• https://www.marylandpatientsafety.org/html/learning_network/hts/materials/resources/other/HT_Strategies_Report_Final.pdf
• https://www.handover.eu/upload/library/gv2g0z55seiol04iqcvai.pdf