Improving
Hand-off
Report
Student Names
Team Name and First/Last Names of Participants
Problem
Report (timing and hand off errors): The unit manager of a medical surgical unit has observed that change of shift report takes greater than 45 minutes. In addition, staff has complained that their peers do not include vital data (IV sites, dressing sites, DVT prevention measures….) in report leading to errors, leave patients in disarray, and leave tasks incomplete. Our task is to propose a change that will address these issues.
Report (timing and hand off errors: Unit managers observed that there was miscommunication between staff during shift report. Often times leaving out important patient information as well as taking a significant amount of time to relay the information. Our goal it to offer a change that will address these issues.
Now here is our SWOT analysis starting off with Derrick talking about the strengths.
Majka
“Communication failures compromise patient treatment, care quality, and safety. It also leads to medical errors, the third leading cause of deaths in the United States” (Ghosh, et all., 2015)
“The varying parties and large amount of complex information included in patient handoff reports frequently contribute to informational gaps and omissions in the handoff report that can lead to sentinel events and patient hard” (Staggers & Blaz, 2013)
“Research has identifed handovers as a risky time in the care process, when information may be lost, distorted or misinterpreted (Borowitz et al 2008, Owen et al. 2009, Philibert 2009)
Report (timing and hand off errors): The unit manager of a medical surgical unit has observed that change of shift report takes greater than 45 minutes. In addition, staff has complained that their peers do not include vital data (IV sites, dressing sites, DVT prevention measures….) in report leading to errors, leave patients in disarray, and leave tasks incomplete. Your task is to propose a change that will address these issues.
Increase of errors during patient hand-off report leading to missed information and incomplete tasks
Hand-off report time is taking a greater deal of time
Our task is to implement the use of SBAR as the standard hand-off report between shifts in order to reduce errors and decrease the time spent giving report.
2
SWOT
Strengths:
Multidepartment focus addressing handoff report problems(Robins et al., 2017)
Solutions shorten time taken in report while increasing quantity of pertinent information. (Stewart & Hand, 2017)
SBAR is supported by the Joint Commision (Stewart & Hand, 2017)
Proven error reduction due to use of SBAR tool. (Stewart & Hand, 2017)
SBAR is an evidence-based hand-off tool (Eberhardt, 2014)
Weakness
Use of the tool requires education to reduce user error (Stacey Eberhardt 2014)
Medical personnel have personal bias on giving report (Ghosh et al., 2018)
Some staff are unreceptive to change (Robins & Dai, 2017).
Evaluating execution of report can be affected by observer bias (Robins & Dai, 2017)
Opportunities
SBAR is inexpensive as a tool and will earn its cost in education by the reduction of sentinel events (Stewart, 2017)
Improve patient handoff by implementing an evidence-based handoff tool in SBAR format (Eberhardt, 2014)
For continued nursing education in standardizing hand-off report (Ghosh et al., 2018). Threats
Due to the variety of the change-of-shift reporting process, the findings of the study may not be applicable across similar settings (Ghosh et at., 2018).
Some staff are unreceptive to change (Robins et al., 2017).
Evaluating execution of report is subject to observer bias (Drach-Zahavy, 2014)
Small sample sizes from 2 studies: only one randomized control study (Stewart, 2017)
Strengths:
Multidepartment focus on addressing problems with handoff report (Robins et al., 2017)
Solutions manage to shorten time taken to give report while increasing the amount of pertinent information given in that time frame. (Stewart & Hand, 2017)
SBAR is supported by the Joint Commision (Stewart & Hand, 2017)
Error reduction due to use of SBAR tool. (Stewart & Hand, 2017)
SBAR is an evidence-based hand-off tool (Eberhardt, 2014)
Weakness (Wendy)
Use of the tool requires education for all staff to reduce user error (Stacey Eberhardt 2014)
Medical personnel have personal bias on how they want to give report (Ghosh et al., 2018)
Healthcare worker disinterest in changing how they give report. (Robins et al., 2017).
Subjective approach to measuring a handover’s strategies might be subject to bias, as participants may behave differently in the presence of an observer.
Opportunities (ashley)
SBAR is inexpensive as a tool and will earn its cost in education by providers by the reduction of sentinel events (each of which carries a high expense). (Stewart, 2017)
Improve patient handoff by implementing an evidence-based handoff tool in Situation Background Assessment Recommendation (SBAR) format (Eberhardt, 2014)
For continued nursing education in standardizing hand-off report (Ghosh et al., 2018).
Threats (Alma)
Due to the variety of the change-of-shift reporting process, the findings of the study may not be applicable across similar settings (Ghosh et at., 2018).
The acuity of patient injury and medical history can increase the amount of time for patient hand-off (Robins, 2017).
Small sample sizes from 2 studies: only one randomized control study (Stewart, 2017) and sample size of 200 handovers in 5 wards in another study(Drach-Zahavy, 2014)
3
Assessment
Inefficient communication during hand off report is a challenge to patient care. (Ghosh, et al., 2018)
Communication error given during report increases risk of poor patient outcomes. (Stewart, 2017)
Hand off communication between medical personnel leads to an increase in medication errors, incomplete tasks, disorder, and eventually poor patient outcomes (Robins et al., 2015)
According to The Joint Commission, communication errors have been among the top three leading root causes of reported sentinel events every year since 2004. (Stewart, 2017)
The information we had gathered from our assessment on giving report overall was –
1. Poor communication leads to poor patient outcome
2. The Joint Commission has stated communication errors has been the top 3 leading root causes of unanticipated major events in the healthcare setting that results in death or serious physical or psychological injury to a client which require immediate investigation by the health care facility since 2004
3. And now we will be talking about our Diagnosis.
Goal should comes from assessments (SMART (MEASURABLE))
Assessment will be bullet points of why is this a problem
Specific, measurable, attainable, realistic, timely
All RNs and assistive personnel will attend 1 or more in-services on the use of SBAR handoff report within three weeks.
During the same three week period, charge nurses and nursing management will include SBAR teaching in pre-shift meetings, encouraging staff to begin to practice using the SBAR template during report.
Following the three week introduction of SBAR to the staff, SBAR will be implemented on the unit for a trial period of 1 month with the goal of receiving ideas of how we can improve it from the staff at the end of the 1 month period.
At the end of the one month period, staff nurses and assistive personnel will be invited to discuss their experiences with SBAR, as well as any ideas they have to improve it, during pre-shift meetings, down-time during their shift, or via email with the nurse manager.
15 days into the trial month, as well as at the end of the trial month, the nurse manager will personally solicit input regarding SBAR from harvest nurses on the unit.
At the end of the 1 month trial period, metrics on sentinel events, falls, nosocomial infections, and other communication errors will be compared with the month prior to SBAR implementation and to the same month in the previous year.
During the second month, a new SBAR form that includes select suggestions from staff will be used by those staff members while other staff members continue to use the known SBAR report. Communication errors, sentinal events, falls, nosocomial infections, et al will be compared between the two systems.
Majka
4
Diagnosis
Lack of standardization in report
Communication Barriers (Stewart & Hand, 2017)
Communication practices learned by various career stages of nurses (promise, momentum, harvest)
Different individual communication styles
Gaps in knowledge regarding lack of standardized reporting
A lack of standardization in report increases risk of error and poor patient outcomes
5
S.M.A.R.T. Goal
Use an evidence-based standardized hand-off report tool to reduce report times to less than 45 minutes while reducing report-based errors by 20% within 6-month period.
Precontempemplation: Nurse manager goes to charge nurses, harvest nurses, and harvest support staff with the SBAR template and asks them to sit with it for one week. He or she will ask for feedback from these individuals about implementing it on the unit.
Contemplation: Harvest nurses and support staff, and charge nurses spend a week with the SBAR template and consider its strengths, weaknesses, and or simply form an opinion around it.
Preparation: nurse manager introduces in-services on SBAR and charge nurses begin introducing the template during pre-shift meetings.
Action: Nurses and support staff begin using the template during all hand-off reports for a one month period. Nurse manager seeks input from harvest staff on ways to improve the system and attempts to include their input on a trial period, thereby extending the practice of the original SBAR for another month with most staff, and offering a personalization to those interested in improving the system.
Maintenance: Nurse manager compares statistics from the same time period one year ago, to the same length of time prior to using the SBAR report, and the data from the SBAR report compared with the modified SBAR report and presents the data to the staff at a staff meeting. At the meeting the nurse manager encourages public input and opinions on the SBAR report. If there is resistance, the manager asks that SBAR be continued in practice for a 3 month period in which he or she will personally receive report from individuals on their patients – helping those nurses who need it with ways to be more succinct. At this point, the report will have been used in practice for 5 months and will have become habit for many of the staff.
Alma
6
Full-Range Leadership Model/Theory
Definition: Focuses on the behavior of leaders towards the workforce in different work situations. (Marquis & Huston, 2011)
Three sub-types
Transactional
Transactions between leaders and followers
Leaders promote compliance to standard SBAR method through rewards and punishments
Transformational
Identifies needed change, inspires, and executes change
Emphasize the importance of reducing errors in patient hand-off through application of SBAR. Our goal is to enhance quality of care and thorough communication.
Laissez-faire
No standard rules
Used when nursing staff and PCTs are efficient with and advocating use of SBAR
Full Range Leadership: Promise, Momentum, Harvest
Wendy
Transactional: Promoting buy-in from nurses and PCTs through encouragement of ideas and discussion while also increasing of stakeholder support of the SBAR method
Theory should apply to what we are trying to accomplish
“this is how we plan to use this leadership style because….”
Why is this theory important for our outcome?
Using more then one theory, where is it applicable?
7
Plan
Following the three-week introduction of SBAR to the staff, SBAR will be implemented on the unit for a trial period of one-month with the goal of receiving ideas of how we can improve it from the staff at the end of the one-month period.
At the end of the one-month period, staff nurses and assistive personnel will be invited to discuss their experiences with SBAR, as well as any ideas to improve it, during pre-shift meetings, down-time during their shift, or via email with the nurse manager.
15 days into the trial month, as well as at the end of the trial month, the nurse manager will personally solicit input regarding SBAR from harvest nurses on the unit.
At the end of the one-month trial period, metrics on sentinel events, falls, nosocomial infections, and other communication errors will be compared with the month prior to SBAR implementation and to the same month in the previous year.
During the second month, a new SBAR form that includes select suggestions from staff will be used by those staff members while other staff members continue to use the known SBAR report. Communication errors, sentinel events, falls, nosocomial infections, et al will be compared between the two SBAR report templates at the end of a one-month trial.
8
3 Weeks
RNs and assistive personnel to attend 1 or more in-services on SBAR handoff report
Following in-service, SBAR teaching in pre-shift meetings, encouraging staff to begin to practice using the SBAR template during report.
1-month trial
SBAR will be implemented on the unit for a trial period with the goal of receiving ideas of how we can improve it from the staff at the end of the one-month period.
15 days into the trial month/ after the trial month
Nurse manager will personally solicit input regarding SBAR from harvest nurses on the unit.
Post 1-month trail
Staff invited to discuss their experiences with SBAR, to share ideas to improve it
Second trial(1 – 3 months)
New SBAR form that includes select suggestions from staff will be used. Communication errors, sentinel events, falls, nosocomial infections, et al will be compared between the two SBAR report templates at the end of a one-month trial. Then again at the end of three months.
Metrics on sentinel events, falls, nosocomial infections, and other communication errors will be compared with the month prior to SBAR implementation and to the same month in the previous year.
References
Drach-Zahavy A ; Hadid N. Nursing handovers as resilient points of care: linking handover strategies to treatment errors in the patient care in the following shift. J Adv Nurs. 2015; 71: 1135-1145
Ghosh, K., Curl, E., Goodwin, M., Morrell, P., & Guidroz, P. (2018). An Exploratory Study on how to Improve Bedside Change-of-Shift Process: Evidence from One Hospital Using Technology to Support Verbal Reporting. HICSS.
Marquis, B.L., & Huston, C. (2011). Leadership roles and management functions in nursing: Theory and application (9th ed). Lippincott, Williams, Wilkins. ISBN: 978-1-4963-4979-8
Robins, H., & Dai, F. (2015). Handoffs in the Postoperative Anesthesia Care Unit: Use of a Checklist for Transfer of Care. AANA journal, 83 4, 264-8.
Stewart, Kathryn R., “SBAR, communication, and patient safety: an integrated literature review” (2016). Honors Theses. https://scholar.utc.edu/honors-theses/66
Student Name: Nissane Diao
EBP Journal Article in APA format:
Hurtado, D. A., Heinonen, G. A., Dumet, L. M., & Greenspan, S. A. (2018). Early career nurses with fewer supportive peers for safe patient handling are likely to quit. International Nursing Review, 65(4), 596-600. https://doi.org/10.1111/inr.12456
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Is this an Evidence-Based Article? Name of Journal and Year article was written? |
Yes
Name of Journal: Year: 2018 |
.2 points |
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State the problem What was the goal of the project in the article? Does this project correlate with your problem? State how? What are you trying to achieve? Does this article support this goal? |
Problem: Newly graduates and early career nurses especially RNs are likely to quit their jobs in hospital settings leading to turnovers. This in turn leads to the decline in the morale of nurses who choose to stay leading to low job satisfaction both to the health care professions and the patients as well. When they leave their jobs, hospitals are faced with lower staffing ratios leading to further decline in the delivery of quality care due to increased workload. Goal: The researchers of this study aimed at identifying the role of social support in enhancing nursing retention at hospitals thereby leading to low turnovers by ensuring the retention of early-career nurses at hospitals. The goal of this study was to: 1. Test the association between social support and turnover. 2. Identify the impact of peer support in safe patient handling leading to retention and low rate of early career nurses quitting their jobs in hospital settings. 3. Identify safety practices that would facilitate integration thereby prompting retention. State how this article correlates with your group problem and goal: The groups’ problem is that there is a shortage of RNs at a surgical unit following a mass quitting of newly graduated nurses in their early careers. The goal of the group is to come up with a comprehensive plan to ensure the retention of new graduate nurses. This follows the hiring of six new graduate nurses to the surgical unit. This research article identifies the hindrances that these nurses face before their quitting in their first year of hire including heavy workload, lack of proper social support and mentorship from their peers with heavy experience, and job dissatisfaction. For an effective plan, the problems that lead to poor retention need to be identified hence the research article is helpful to our goal. Second, the research article tests the impact of social support in promoting retention of these nurses which would add value to the group’s goal. Finally, the research has further provided retention strategies effective for retaining early career nurses including provisions of programs to integrate, mentorship, and support as well as providing a conducive working environment. This would be very resourceful in crafting a retention plan by the group leading to successive efforts in retention. |
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Strengths (Internal) What’s was good about your article? |
Support from Institutions: The researchers received overwhelming support from various institutions including Oregon Health & Science University that covered the expenses of the research through funding. There was no conflict of interest despite being funded for the research. The International Council of nurses also provided support to the research. Staff Input: Nurses from different units who participated in the study provided self-reported data sources propelling the success of the research study. Their input into the research study helped the researchers maximize the information provided aiding the success of the study. There was also efficient corporation by the administration on which the investigative study was conducted. Did the Implementation take place in an area like yours? Yes. The research study drew nurses from both the medical and surgical units as well as Registered nurses from the Intensive Care units at the environmental setting where the study was conducted. |
.4 points |
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Weakness (Internal)- issues |
Size: Despite the researchers drawing participants from core units at the hospital setting where the study was conducted, it was only limited to two units within the hospital settings. Nurses from some specific departments such as the emergency and pediatric departments were not included in the study hence difficult to know how efficient it would be to the other units. Inefficient Assessments: The researchers noted that it was difficult to assess the role of supportive peers that nurses acted due to the tenure and nature of their work. In addition, there was the absence of key information regarding the causes of what led to the departure of some nurses who had barely served a year at the hospital settings raising concerns of the eligibility of the study. |
.4 points | ||
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Opportunities (External) |
Patient Satisfaction: By providing social support through peer motivation, early-career nurses were able to provide safe patient handling to patients compared to those who had quit hence facilitating the satisfaction of patients. However, there was a lack of diversification with the majority of the nurses being predominantly white. An improvement on equality through diversifying recruitment would help ensure that patient satisfaction is met on cultural differences between patients. Staff Satisfaction: Through social support and safe patient handling, there was a remarkable decrease in the reduction of early-career nurses quitting their jobs thereby facilitating retention. This would help in achieving a supportive staff ratio to patients. However, social support needs to be provided early. This would help in curbing the rate at which nurses quit their jobs within one year of recruitment. Baseline data: The researchers did not find any significant changes among employees who had quit their jobs on safety compliance. |
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Threats – (External) |
Cultural Differences: The researchers acknowledged that a majority of the nurses’ participants were non-hispanic white, hence drawing threats on the validity of social support among culturally diverse nurses and patients. This further raise concerns on satisfaction on both staff and patient from diverse cultures. Validity: While the social support was effective within the surgical and ICU units, it remains unclear whether it would help attain retention among early-career nurses in other hospital units such as emergency departments and pediatric units. |
Total Points = 2 points
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