1. Handover Report: Tossing Out the Tape Lynnette McCarthy Woodrow BN RN Maureen March RN Maud Crowley RN

2. Who We Are St. Clare’s Mercy Hospital City Hospitals, Eastern Health St. John’s, Newfoundland

3. Objectives Review of our issues with taped end of shift report How we changed our model of report Challenges Solutions Evaluation of the change

4. Enhancing Communication…. Previous: Taped end of shift report Content Limited Guidelines Delay of care Dissatisfaction

5. Our Improvement Aim / Goals Improve Communication Improve patient safety Increase Nursing time at bedside Increase Patient Satisfaction

6. Our Guiding Principals ROP from Accreditation Canada Patient Safety Area 2: Communication Goal: Improve the effectiveness and coordination of communication among care/service providers and with the recipients of care/service across the continuum. ROP: The team transfers information effectively among providers at transition points. Tests for Compliance: 1.The team uses mechanisms for timely transfer of information at transition points that result in proper information transfer. 2.Staff is aware of the organizational mechanisms used to transfer information. 3.There is documented evidence that timely transfer of information has occurred.

7. Our Guiding Principals Cont’d Canadian Patient Safety Institute “Communication is at the core of healthcare. Because communication can be driven by circumstance or dependent on individual personalities, standardized tools to facilitate effective communication and behaviors represent cogent strategies to support patient.” (CPSI)

8. Handover Report Combination of verbal and written communication that occurs at various patient transfer points (end of shift; transfers from units, etc.)

9. Meeting the “Tests for Compliance” Transfer mechanisms Staff is aware Documented evidence

10. Transfer Mechanisms Face to Face Verbal Communication On-coming/Off-going Staff Within Unit – Regrouping

11. Transfer Forms

12. Transfer Forms Continued…

13. Nursing Census Computer generated (Meditech) Nurse enters data on admission

14. Transfer Forms Continued… Unit census includes: Basic Patient Demographics Admitting Physician Admission date and Length of Stay Admission Diagnoses Past medical History Surgery/Procedure(s) since admission

15. Meeting the “Tests for Compliance” … Staff Education Education Binders Emails Posters in staff lounges Formal and Informal Education Sessions

16. Meeting the “Tests for Compliance” Documentation Entered in the Document Intervention menu under the Consultation/Collaboration screen of Meditech

17. Safety Round First round that staff complete on assigned patient, before obtaining the written component of handover report and includes: Check armbands Call bell placement Proper IV rate and Solution Address risk concerns (side rails, restraints, brakes) De-clutter area

18. Putting it Together Unit Specific “Handover Report” Guidelines developed. Guidelines for Unit Nurses: Safety Round Patient Care Plans Parts I & II (PACE/DAR) Demographics in Meditech Verbalization Regrouping Patient Care Summaries (optional) Document Report Given/Received

19. Putting it Together Continued… Guidelines for Patient Care Coordinator (PCC) Review Patient Care Plan Parts I & II Update PCC Kardex (if uses) Verbal Handover Highlight Patient Assignment Nurse Assigned In-Charge Duties on Night Shifts

20. Putting it Together Continued… Guidelines for Transfer of Patient To areas using Handover To areas not using Handover

21. How It Works… Off going staff gives a verbal report to the oncoming staff regarding any urgent or emergent information On coming staff completes safety round on assigned patients Staff converge and make their individual work lists and read the written component of their patient’s report

22. How it Works Continued… Staff complete a regrouping to share patient information that is necessary for all unit staff to know to ensure safe care of all patients. Staff then begin shift Update Patient Care Plans (Parts I and II) and nursing census as shift progresses

23. How it Works Continued… Verbal Report Safety Round Written Report Regroup Work Written Report

24. Challenges

25. Challenges Continued… Nursing Census not completed properly, leaving staff feeling that they did not have sufficient information on all patients Staff felt that there was not sufficient in- servicing Patient Care Coordinator(s) report Verbal Report between Off-Going Staff and On- Coming Staff, within unit, break relief, questions regarding confidentiality

26. Challenges Continued… Updating Kardex (Nursing Care Plan Part I) Written Report Contents (and readability) Safety Round Compliance Tardiness Narcotic Count Extra Reports

27. Solutions Nursing Census: Clarification of how to enter data; census data compiled so just need to maintain In-Servicing: Information Sessions provided for each side of the shift Verbal Report: Reinforce Guidelines for verbal report between off-going and on-coming staff, and within the unit. Some units use patient care summary, or what is important to each specific unit to guide the regroup report within the unit.

28. Solutions Continued… PCC Report: Varies Unit by Unit Care Plan Updating: Reinforce this Written Report Contents (and readability): Reinforce Guidelines Safety Round Compliance Tardiness: PCC/DM Narcotic Count: Assign Nurse to do counts

29. Solutions Continued… Extra Reports: One unit keeps x 2weeks, most erase

30. Evaluation

31. Our Performance Measures

32. Our Performance Measures Cont’d

33. Benefits identified by staff: Decreased delay in getting to the bedside Increased time at the bedside Decreased call bells at the beginning of the shift Patients are being received in transfer from ER and

34. Our Performance Measures Cont’d Recovery Room with less delay Post operative patients are mobilized earlier Have more time to spend speaking with the patients Increased staff and patient satisfaction Early identification of errors/occurrences

35. Our Performance Measures Cont’d Disadvantages noted by staff….. No time to drink coffee at the beginning of their shift

36. Next Steps Information Sharing Providing assistance to initiate handover in other areas

37. Strutting Our Stuff Handover has been initiated successfully throughout 8 surgical units and 6 medical units of Eastern Health Safer Healthcare Now! Recognition ARNNL Recognition Article to be published in The Current in January 2010

38. Questions?

39. Thank You!

40. References Accreditation Canada www.cchsa.ca accessed on January 20, 2009www.cchsa.ca Arora V., & Johnson, J. (2006). A model for building a standardized hand-off protocol. The joint Commission Journal on Quality and Patient Safety, 32 (11), 646- 655. Canadian Patient Safety Institute. Effective teamwork and communication to enhance patient safety. Retrieved October 1, 2009, from http://www.patientsafetyinstitute.ca/English/toolsResources/teamworkCom munication/Pages/default.aspx http://www.patientsafetyinstitute.ca/English/toolsResources/teamworkCom munication/Pages/default.aspx Penney, J. (2008). Literature review of nursing handover. Unpublished. Schroeder, S.J. (2006). Picking up the PACE: A new template for shift report. Nursing 2006, 36(10), 22-23. Schroeder, S.J. (2006). Improving intershift handoff and patient safety. LPN 2007, 3(2), 22-23.

41. Contact Information Lynnette McCarthy Woodrow Division Manager Head and Neck Surgery, Vascular Surgery, and Vascular Lab (Acting) St. Clare’s Mercy Hospital (709) 777-5716 Lynnette.MccarthyWood@easternhealth.ca