Author: Sue Mahley, MN, RN, WHNP-BC, CNE
Title: Assistant Professor of Nursing
Institution: Research College of Nursing
Following implementation of these strategies, the student nurse will:
1. Describe examples of the impact of team functioning during patient care hand-offs on safety and quality of care.
2. Utilize the SBAR/Assessment tool as a safe, effective communication practice that minimizes risks associated with hand-offs among providers and across transitions in care.
3. Appreciate the risks associated with the timing of hand-offs among providers and across transitions of care.
A hand-off is a transfer and acceptance of patient care responsibility achieved through effective communication. It is a real-time process of passing patient specific information from one caregiver to another or from one team of caregivers to another for the purpose of ensuring the continuity and safety of the patient’s care. Student nurses are involved in some manner of hand-off communication prior to initiating care and at the conclusion of their clinical day. Observations of our students during hand-offs in the clinical setting revealed a process replete with potential for error. For example, when students listened to hand-offs between staff nurses, they were often unable to get close enough to clearly hear the report or to understand the medical jargon nurses used. Hand-offs were frequently interrupted by occurrences happening at shift change and nurses were sometimes unable to review patient data with students due to the responsibilities of shift change.
Implementation of the Strategy: The Joint Commission Hand-off Communication Failures includes several strategies that might be helpful to student nurses. These strategies involve the development and use of standardized forms, including SBAR tools, establishing a workspace or setting that is conducive for sharing information about patients, and examining the work flow of health care workers to ensure a successful hand-off, focusing on the system, not just the people.
Similar adaptations were made for our students, including the timing of hand-offs to a less stressful time for staff nurses. Nursing staff were surveyed regarding when hand-off communication to students would work best in their schedule. Staff agreed that a clinical start time approximately one hour after usual shift change would be the least stressful time. A later clinical start time was implemented with our students. An SBAR/Assessment tool was also developed specifically for students to use during hand-off communication with staff nurses. This SBAR/Assessment tool (one page front and back) served multiple purposes, as it included space for continuing data collection, nursing diagnoses, interventions and evaluation of outcomes.
To evaluate the effectiveness of these strategies, students and staff nurses were surveyed about their experience at the end of the clinical rotation (survey forms attached). All students and nurses reported more privacy, fewer interruptions and adequate time for hand-off communication. Students indicated that use of the SBAR/Assessment tool increased organization of patient information in a more clear and complete manner at hand-off and for continuing assessments throughout the day.
Students felt more confident in the provision of safe care to their patients. Nurses agreed that patient safety was enhanced. Both students and staff nurses noted that the change to a later timing of hand-offs did not negatively impact their patient care. In fact, nurses commented that they felt less hassled by students, were able to provide more thorough hand-off communication and had more time to answer questions. The age old practice of having student nurses present at change of shift time for hand-offs may not be the best and safest teaching strategy.
Faculty reported that the SBAR/Assessment tool (one page front and back) format was a time saving strategy in reviewing clinical paperwork.