Improving Inter-shift Communication and Nursing Handoff Workflow

DOI: 10.5176/2315-4330_WNC15.74

Authors: Riel Mart De Guzman, Leonora Collantes, Helen Joy Maruya and Tala Tuazon

Abstract:

Background: The complexity of patient conditions and work environment in the hospital usually make it difficult for nurses to recall and transmit all information accurately during inter-shift handoffs. Ineffective handoffs may result in a progressive loss of information leading to increased risk for treatment errors, patient complaints and decreased nursing productivity. Objective: The study aimed to determine the effectiveness of a standardized handoff worksheet, along with a modified handoff process flow, in decreasing the proportion of handoff-related errors from the total errors reported in a nursing unit. Methods: This action research utilized a pretest-posttest design. Revision of the handoff worksheet and process flow was based from the recommendations of a Handoff Worksheet Committee. Through descriptive statistics, the proportion of handoff-related errors to the total unit errors was compared two months before (January- February 2014) and after (March-April 2014) its pilot implementation in the Digestive and Liver Unit. Handoff-related incidents and errors were recorded from nurse unit managers’ reports, patient complaints related to poor handoff, and nursing audit data. Results: There are 1034 Standardized Handoff Worksheets utilized by the bedside nurses two months after implementation (7190 completed items out of 7200 items= 99.86{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465} compliance rating). Compared to its pre-implementation (11 handoff-related errors/issues out of 34 total errors= 32.3{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465}), the proportion of handoff-related incidents and errors was decreased by the end of the pilot implementation (1 out 36 total errors= 2.7{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465}). Conclusion: The standardized bedside handoff worksheet and modified process flow seemed to provide an effective alternative structure in improving and organizing nurses’ handoff work flow.

Keywords: Handoff, Workflow and Productivity