| Primary Author: | Lynn E. Johnson, CNM, OGNP, MS, RN |
| Co-Principal Investigators/Collaborators: | Secondary Investigators: Cathy Galla, Denise Mazzapica, Jayne O’Leary, Myrta Rabinowitz |
| Organization: | North Shore-LIJ Health System |
Abstract
Background
Communication breakdowns during transitions of care have been documented as a leading contributing factor in sentinel events (Joint Commission, 2010). Evidence in patient safety supports the standardization of communication processes, use of electronic medical records (EMR), and the inclusion of patients and family in their care. The North Shore-LIJ Health System (NSLIJHS) has effectively implemented an enterprise-wide EMR. However, corporate managers of initiatives identified variation and gaps in handoff practice throughout the 15-site system.
Purpose
To standardize the handoff communication process at the bedside, supported by scripts incorporating all elements of IPASStheBATON, in alignment with the EMR.
Materials & Methods
A multi-site work group of leadership and clinical information specialists was created from our system Practice of Optimization Group. Collaboration with focus groups representative of staff nurses from medicine and specialty units, described current practice and concluded with a needs assessment and the stratification of handoff communication information from generic to specialty specific. Utilizing this information, a standardized, multi-specialty handoff communication script, inclusive of the elements of IPASStheBATON, was developed and designed in tandem, to mirror a re-designed Clinical Summary Screen (CSS). Rapid-cycle testing methodology was implemented for 7-days resulting in 50 observations. Materials utilized in the study were: (1) re-designed CSS in EMR, (2) handoff script to guide staff through the new screens, (3) validated pre and post visual analogue scale to survey staff, (4) post-implementation observation tool, (5) qualitative data from staff debriefings.
Results
Improvement in all 14 variables studied is appreciated. Importantly, observers report the occurrence of bedside handoffs increased to 100%. Surveys demonstrating the use of the EMR to support standardized communication, increased 186.6% and the identification of high-risk patients increased over 75%. Time variance for handoffs remained stable at -0.5 minutes. Patients and staff verbalized satisfaction.
Conclusion
Collaborative processes resulted in the development and adoption of an evidence-based practice model for standardized handoff communication using EMR at the bedside including the patient and family.
Bibliography
Joint Commission Center for Transforming Healthcare. (n.d.). Retrieved from http://www.centerfortransforminghealthcare.org/projects/display.aspx?pro…
Standardizing the Handoff Communication Process Using EMR at the Bedside
© Improvement Science Research Network, 2011