1. Manager of Nursing Support Services
Nurse-Sitter
Handoff
Claudette Johnson
Manager of Nursing Support Services

2. What is handoff?
transfer of information (along with authority and responsibility) during transition in care for the purpose of ensuring the continuity and safety of the patient care.

3. Research Supporting Handoff
Institute of medicine reports
Cost associated with medical errors is $8-29 billion annually
Joint Commission data on sentinel events from reports
Communication issues as the leading cause of sentinel event

4. 48% of sitters responded Reason for Change SITTERS
Lack of staff satisfaction
Lack of respect for sitters
Not part of Team
No breaks or last choice on breaks
48% of sitters responded

5. Benefits of sitter handoff
Promote safety
Improve communications
Improve staff relationship
Improve staff satisfaction

6. Improve communication
Why do sitter handoff?
Respect
Staff Satisfaction
Improve communication

7. Handoff
Stakeholders
INEFFECTIVE HANDOFFS
Leadership
Patient
Staff
Wrong treatment Delay in Diagnosis Adverse events Patient dissatisfaction Increase hospital cost Increase length of stay

8. Barriers to Handoff Communication
Gaps in communication
Limited training
Confidentiality
Volume of Information
Time constraints
Human factor

9. Common handoff Issues Causes of Failure Causes of Success
Ineffective Methods
Time constraints
Change
Lack of focused research on healthcare and handoff
Lack of Efficiency
Lack of commitment
Open to change Understand purpose of Change. Preparedness and education Commitment to making a difference Management Support

10. Implementation Up-to-date information on the following:
Diagnosis, Care, Condition and Changes
Limited interruptions
Sufficient time allocated
Process for verification- repeat back read back

11. Nurse-Sitter tool Purpose
to improve safety as well as patient and staff satisfaction. 
Purpose
Patient: Room # _____ Date ____Shift______
Hand off information for any sitter will include:
What is wrong with patient? ____________________________
Why do they need a sitter? _____________________________
Diet/ fluid restrictions: _________________________________
Activity- independent or with assist ______________________
Specifics about their care ______________________________
Time for their meal breaks, what time they are expected back - SPECIFIC TIME _______________________________________
Who will relieve them for their break? ____________________
Phone number: Charge: Break Relief: ____________
OA/PCT Signature:________________ Date:____________

12. Sitter Handoff Guidelines
Hand off information for any sitter staff will include:
1) What is wrong with patient?
Why is a sitter needed? (Hip replacement but is sun downing tries to get out of bed after 7 pm)
2) Diet/ fluid restrictions (NPO, 1 cup of water every shift)
3) Activity- independent or not (can get up by himself, can get up safely with walker)
4) Specifics about their care (examples: quick with hands must watch IV or Foley, bolts out of bed, confused, watch for visitors)
5) Time for their meal breaks, what time expected back -MUST be a SPECIFIC TIME (not 1 hour from now but instead 0445)
6) Who will relieve sitter for their break (Julie, PCT and her phone # is____) - OA for suicides have to watch the patient at all times and should not be standing by the door looking for help.

13. OA role
OAs CAN
OAs CANNOT
Ambulate steady gait patients Set up trays Unplug IMEDS only if directed by Nurse Talk and calm patient down
Ambulate unsteady patients Feed patients Touch IMEDS without nurses' direction Hold a patients arm down (staff should use mitts or medicate patient)
Know that PCTs who are sitting can provide PCT care.
The nurse will need to update sitter for any changes.
Sitters will be passing information to each other

14. What is Assertiveness IT IS not… Aggressive Hostile Confrontational
Ambiguous
Ridiculing

15. Pilot Study Begins February 08 to March 08, 2011
Forms available in the Float Pool room
Send completed sheets to
Claudette Johnson
Questions: call Claudette at x.7959

16. Survey to assess the success of the PILOT STUDY
For:
all OAs
random RN/ PCT
Deadline:
October 1, 2011
Return to:
Claudette
Johnson 3W

17. Change
For
Safety
And more importantly,
change for
YOU

18. References
Agency for Healthcare Research and Quality (2005). 30 safe practices for better health care: Fact sheet. Retrieved March 19, 2011, from
Institute of Medicine. Committee on Quality Health Care in America. (2000). Errors in health
care: A leading cause of death and injury. In L. Kohn, J. Corrigan, & M. Donalsdson (Eds.) To Err Is Human: Building a Safer Health System. Washington, D.C: National Academy Press.
Joint Commission on Accreditation of Healthcare Organizations. (2008) national patient
safety goals [electronic version]. Joint Commission Perspectives, 28(7), 12. Retrieved March 19, 2011, from
Northwest Community Hospital (NCH), (2011). Nurse- Sitter handoff tool.
Nothwest Community Hospital. (2011). Pre-assessment of sitter needs survey.