HUP DEPARTMENT DATE Handoff Safety Curriculum

“Handoffs and Sign-Out” Verbal and Written  Review the importance of handoffs  Watch and critique videos of handoffs  Teach the components of safe written and verbal handoffs  Formal post-didactic observed handoffs

This is why…  Poor communication is the most common cause of medical errors nationally  JCAHO: 2006 National Patient Safety Goal requiring hospitals to implement standardized approach to patient handoffs  HUP Provider Survey: 70 Surgery, 35 Medicine, 25 Emergency, 23 NP/PAs  HUP GME 2012: Mandatory handoff curriculum and assessment for all new resident hires

Video HANDOFF EXAMPLE: GOOD OR BAD?

Case Scenario  Department specific

Keys to Good Verbal Handoffs  Location, location, location oAs quiet as possible oMinimize interruptions  If you are worried about the patient…say it!  Give receiving provider an opportunity to ask questions and repeat back important facts  Review every patient  Follow the same format/order for all patients

SHOUT… it Out! S – Sick or Not Sick (include DNR, diagnosis) H – History and Hospital Course O – Objective Data (exam, vitals, results) U – Upcoming Plan, Dispo T – To Do (include rationale) Acronym modeled after Arora, V., et. al.

Covering Provider  As a reminder, it is the responsibility of the incoming provider to sign in as the new covering provider after verbal handoff

Keys to a Good Written Signout  Standardize  Exclude irrelevant or outdated information  Update sign-out before every handoff!!!  Avoid non-standard abbreviations  Summarize findings. Do not cut and paste every result.

The “Checklist” Procedures Diet and NPO orders Acuity level Code status, allergies, and contact Recent VS, Labs, Exam Antibiotic information Infectious history Updated problem list, correctly prioritized Brief summary of hospital course Important medication information care plan Recap of recent/same day events Med changes, procedures, clinical changes Better anticipatory guidance Q11: How much information does the written/printed sign-out have? N = 124 respondents % of Total Too much (10) Not enough (8) Right amount (40) Variable (66)

Keys to a Good Written Sign-out Pt InfoHPIProb ListMEDSTo DoX Cover Smith, John Bob F A MR: DOB: 11/3/38 DOA: 11/2/06 Allergies: NKDA Code: FULL Access: RIJ 3L (11/4) Cx: >101.4 Precautions: MRSA Contact: Wife Mary Age, Gender, CC (on DOA): short of breath CC (after dx): aspiration pna Race, pertinent PMH, presentation to ED, HPI. -relevant ROS -relevant ED issues (vitals, meds given) -relevant things done o/n -important events during hospitalizaton 11/20 – desat last night, improved after diuresis DATA: 11/3 CXR: LLL pna 11/5 Chest CT: LLL consolidation w/ air bronchograms, some LAD MICRO: 11/2 UA neg, Ur cx neg-final 11/2,3,4,5 bld cx x2 neg-final 11/6 UA neg, cx neg-final 11/6,7,8,9 bld cx x2 ngtd 11/9 sputum cx – normal OP flora **Asp Pna – on cefepime, still borderline **ARF on CKD: Cr 0.8  2.5, likely 2/2 dehydration. Getting volume **CAD – EF 10%, on coumadin for low EF **DM – on insulin **HTN **Hyponatremia – likely 2/2 dehydration **Diarrhea – possibly CDIff, cx pending -Prostate ca – resected, cured -hyperlipidemia -PTSD -chronic anemia Cefepime 1gm IV q12 Colace 100mg po bid Docusate 5mg po daily Furosemide 20mg po daily Metoprolol 50mg po bid Metronidazole 500mg po bid Warfarin 5mg po qHS Diet: Cardiac, mech grnd, Other Med Info--- Flagyl 500mg q12 11/ D/C Info--- PMD Dr. Jones [] needs gi appt ---To Do --- [] f/u xxx test [] daily pulm note [] f/u 7pm Na – increae IVF if Na <130 -if looks bad, consider fungal coverage

Summary of “Best Practices” in Handoffs  Quiet Location  Minimize Interruptions  Standardize both written and verbal format as much as possible  Use anticipatory guidance and avoid anchoring bias  Make time for questions and clarifications