Patient handoffs are those critical times when you communicate essential patient information and transfer responsibility of care. They're also opportunity for errors when nurses are distracted, hurried or interrupted. Listen in during handoffs at your facility to ensure they're concise, accurate and valuable. If they're not, reinforce the importance of incorporating these elements in every patient handoff.
- Interaction. It's not the communication of the handoff-giver to the handoff-receiver that matters most; it's the communication between them their interaction. There must be two-way communication. Both caregivers must be actively involved in the exchange and confirm that the needed information has been received and understood, and that potential issues will be addressed during the next stage of care.
- The most recent information. The patient's information must be up to date and clearly presented. Always report the latest updates about the patient's care, treatment, condition, and any recent or anticipated changes.
- Limited interruptions. Researchers in one study found that as many as 40% of handoffs were associated with communication distractions. By limiting interruptions and distractions, you minimize the possibility that any information will be either forgotten or not conveyed. The key here is limiting interruptions eliminating them altogether is impractical in the perioperative environment. However, if your staff members can agree for the sake of patient safety to do their best to avoid being the person doing the interrupting, you'll be much closer to reaching the goal of limited interruptions.
- Verification. To ensure the handoff-receiver hears and fully understands the patient's information, each handoff should have a read-back (or repeat-back) step. This simply involves repeating back either exactly or paraphrasing what the handoff-receiver just heard to confirm that she got it right. It's a simple, but effective communication improvement tool.
- Opportunity to review. Build in an opportunity for the handoff-receiver to review relevant patient history. This is the final step of an effective handoff. It's also an essential aspect of both patient safety and best patient care. The 30 to 60 seconds that this step takes helps avoid critical mistakes from being made at subsequent stops along the perioperative pathway. Don't skip it.
Review and reinforce
Your staff can have every good intention of making every effort to perform concise, accurate and valuable handoffs, but in the day-to-day busyness and complexity of the perioperative setting, it's too easy to lose track of the patient at the center of all of the activity. Inattention, distractions and interruptions can easily derail the handoff (see "Avoid These Communication Pitfalls").
Poor handoffs are vulnerable junctures where errors can occur. When mistakes do happen, they start a cascade of unwanted events, ranging from minor incidents to serious safety events. For example, the failure to anticipate the need for particular supplies due to an inadequate handoff may seem like a minor hiccup, but if you look more closely at the unintended consequences of the mistake, you'll notice that it can extend anesthesia time, cause cases to last longer than they should and, subsequently, frustrate surgeons and negatively impact the surgical team's performance.
We recently faced handoff issues at our hospital. There wasn't a standard protocol across perioperative services, and recent staff changes mixed nurses with various experiences, which caused confusion about communication expectations during patient exchanges. We were performing handoffs, but not very well. We also heard these comments from the nurses and anesthesia providers involved in handoffs:
- "Don't worry, we have all the info written down in the chart."
- "I don't have time for this."
- "Please hurry, I have other lunch reliefs to do."
If you sense your staff's focus on handoffs is slipping, take a few minutes to reinforce the importance of clean exchanges. Role-play proper interactions at your next staff meeting, so staff see and hear what you expect to occur when patients move from one clinical area to another. Good handoffs lead to a nearly seamless transition of care that dramatically improves patient safety.
We had to address a few communication issues that occurred during patient handoffs at our hospital. Perhaps you've seen them occur in your facility, too.
- Distractions. They significantly increase the amount of time it takes to exchange information. They can also lead to more errors occurring during the exchange. Examples of distractions include noisy monitors and equipment, other staff members conversing nearby and interactions with the patient. Try to limit those influences, and tell staff to focus solely on the exchange of information during the handoff.
- Interruptions. Staff members who ask questions unrelated to the handoff, chart clinical information as the exchange is taking place and communicate with members of the patient's family divert attention away from what matters most and can result in incorrect or incomplete information being passed along to the next level caregiver.
- Inattention. Human behavior can play a significant part in limiting the effectiveness of handoffs. A fast-talking handoff-giver who doesn't provide opportunity for the handoff-receiver to ask questions can be as bad as the distracted handoff-receiver who gives the impression of being too good to need a report about the patient's condition.