Transcript Handover for national presentation

Handover Report: Tossing Out the
Tape
Lynnette McCarthy Woodrow BN RN
Maureen March RN
Maud Crowley RN
Who We Are
St. Clare’s Mercy Hospital
City Hospitals, Eastern Health
St. John’s, Newfoundland
Objectives
• Review of our issues with taped end of shift
report
• How we changed our model of report
• Challenges
• Solutions
• Evaluation of the change
Enhancing Communication….
Previous: Taped end of shift report
• Content
• Limited Guidelines
• Delay of care
• Dissatisfaction
Our Improvement Aim / Goals
Improve Communication
Improve patient safety
Increase Nursing time at
bedside
Increase Patient
Satisfaction
Our Guiding Principals
ROP from Accreditation Canada
Patient Safety Area 2: Communication
Goal: Improve the effectiveness and coordination of communication among care/service providers
and with the recipients of care/service across the continuum.
ROP: The team transfers information effectively among providers at transition points.
Tests for Compliance:
1.
The team uses mechanisms for timely transfer of
information at transition points that result in proper
information transfer.
2.
Staff is aware of the organizational mechanisms
used to transfer information.
3.
There is documented evidence that timely
transfer of information has occurred.
Our Guiding Principals Cont’d
Canadian Patient Safety Institute
“Communication is at the core of healthcare. Because
communication can be driven by circumstance or dependent
on individual personalities, standardized tools to facilitate
effective communication and behaviors represent cogent
strategies to support patient.”
(CPSI)
Handover Report
• Combination of verbal and written
communication that occurs at various patient
transfer points (end of shift; transfers from units,
etc.)
Meeting the “Tests for Compliance”
Transfer mechanisms
Staff is aware
Documented evidence
Transfer Mechanisms
Face to Face Verbal Communication
•On-coming/Off-going Staff
•Within Unit – Regrouping
Transfer Forms
Transfer Forms Continued…
Transfer Forms Continued…
Nursing Census
• Computer generated (Meditech)
• Nurse enters data on admission
Transfer Forms Continued…
Unit census includes:
•Basic Patient Demographics
•Admitting Physician
•Admission date and Length of Stay
•Admission Diagnoses
•Past medical History
•Surgery/Procedure(s) since admission
Meeting the “Tests for Compliance” …
Staff Education
• Education Binders
• Emails
• Posters in staff lounges
• Formal and Informal Education Sessions
Meeting the “Tests for Compliance”
Documentation
• Entered in the Document Intervention
menu under the
Consultation/Collaboration screen of
Meditech
Safety Round
First round that staff complete on assigned patient, before
obtaining the written component of handover report and
includes:
•
•
•
•
Check armbands
Call bell placement
Proper IV rate and Solution
Address risk concerns
(side rails, restraints,
brakes)
• De-clutter area
Putting it Together
Unit Specific “Handover Report” Guidelines
developed.
Guidelines for Unit Nurses:
• Safety Round
• Patient Care Plans Parts I & II (PACE/DAR)
• Demographics in Meditech
• Verbalization
• Regrouping
• Patient Care Summaries (optional)
• Document Report Given/Received
Putting it Together Continued…
Guidelines for Patient Care Coordinator (PCC)
• Review Patient Care Plan Parts I & II
• Update PCC Kardex (if uses)
• Verbal Handover
• Highlight Patient Assignment
• Nurse Assigned In-Charge Duties on Night
Shifts
Putting it Together Continued…
Guidelines for Transfer of Patient
• To areas using Handover
• To areas not using Handover
How It Works…
• Off going staff gives a verbal report to the
oncoming staff regarding any urgent or
emergent information
• On coming staff completes safety round on
assigned patients
• Staff converge and make their individual work
lists and read the written component of their
patient’s report
How it Works Continued…
• Staff complete a regrouping to share patient
information that is necessary for all unit staff
to know to ensure safe care of all patients.
• Staff then begin shift
• Update Patient Care Plans (Parts I and II) and
nursing census as shift progresses
How it Works Continued…
Verbal
Report
Safety
Round
Written
Report
Written
Report
Regroup
Work
Challenges
Challenges Continued…
• Nursing Census not completed properly,
leaving staff feeling that they did not have
sufficient information on all patients
• Staff felt that there was not sufficient inservicing
• Patient Care Coordinator(s) report
• Verbal Report between Off-Going Staff and OnComing Staff, within unit, break relief,
questions regarding confidentiality
Challenges Continued…
• Updating Kardex (Nursing Care Plan Part I)
• Written Report Contents (and readability)
•
Safety Round Compliance
•
Tardiness
•
Narcotic Count
•
Extra Reports
Solutions
• Nursing Census: Clarification of how to enter
data; census data compiled so just need to
maintain
• In-Servicing: Information Sessions provided
for each side of the shift
• Verbal Report: Reinforce Guidelines for verbal
report between off-going and on-coming staff,
and within the unit. Some units use patient
care summary, or what is important to each
specific unit to guide the regroup report within
the unit.
Solutions Continued…
• PCC Report: Varies Unit by Unit
• Care Plan Updating: Reinforce this
• Written Report Contents (and readability):
Reinforce Guidelines
• Safety Round Compliance
•
Tardiness: PCC/DM
•
Narcotic Count: Assign Nurse to do counts
Solutions Continued…
• Extra Reports: One unit keeps x 2weeks,
most erase
Evaluation
Our Performance Measures
100
90
86
80
70
60
50
40
30
20
10
10
4
Level of Satisfaction
Dissatisified/Very
Dissatisfied
Handover Report
Neutral
0
Satisfied/Very
Satisfied
Percentage of Staff Surveyed
Staff Satisfaction 2009 (Percentages)
Our Performance Measures Cont’d
100
99
100
64
2
1
0
OGS +OCS
document TOA in
appropriate area
0
Errors/Orrurances
Identified
1
Safety Round
Completed
36
OCS uses witten
TOA tool
Yes
No
99
98
OGS uses written
TOA tool
100
90
80
70
60
50
40
30
20
10
0
OCS + OGS report
verbally
Percentage of Reports Audited
Surgery Program Handover Report Audits 2009
(Percentages)
Criteria
(OCS On- Coming Staff
OGS Off-Going Staff
TOA Transfer of Accountability)
Our Performance Measures Cont’d
Benefits identified by staff:
• Decreased delay in getting to the bedside
•
Increased time at the bedside
•
Decreased call bells at the beginning of the shift
•
Patients are being received in transfer from ER and
Our Performance Measures Cont’d
•
Recovery Room with less delay
•
Post operative patients are mobilized earlier
•
Have more time to spend speaking with the patients
•
Increased staff and patient satisfaction
•
Early identification of errors/occurrences
Our Performance Measures Cont’d
Disadvantages noted by staff…..
• No time to drink coffee at the beginning of their
shift
Next Steps
• Information Sharing
• Providing assistance to initiate handover in other
areas
Strutting Our Stuff
•
Handover has been initiated successfully throughout 8
surgical units and 6 medical units of Eastern Health
•
Safer Healthcare Now! Recognition
•
ARNNL Recognition
•
Article to be published in The Current in January 2010
Questions?
Thank You!
References
Accreditation Canada www.cchsa.ca accessed on January 20, 2009
Arora V., & Johnson, J. (2006). A model for building a standardized hand-off protocol.
The joint Commission Journal on Quality and Patient Safety, 32 (11), 646655.
Canadian Patient Safety Institute. Effective teamwork and communication to enhance
patient safety. Retrieved October 1, 2009, from
http://www.patientsafetyinstitute.ca/English/toolsResources/teamworkCom
munication/Pages/default.aspx
Penney, J. (2008). Literature review of nursing handover. Unpublished.
Schroeder, S.J. (2006). Picking up the PACE: A new template for shift report.
Nursing 2006, 36(10), 22-23.
Schroeder, S.J. (2006). Improving intershift handoff and patient safety. LPN 2007,
3(2), 22-23.
Contact Information
Lynnette McCarthy Woodrow
Division Manager Head and Neck Surgery,
Vascular Surgery, and Vascular Lab (Acting)
St. Clare’s Mercy Hospital
(709) 777-5716
[email protected]