Improving Shift Handoff Reports
By Kathryn Carpenter, BSN, RN, and Lori Tebrinke, BSN, RN
When people meet us, they assume we've been nursing for years. We actually graduated from the UW-Madison School of Nursing in May 2013 and recently completed the Nurse Residency Program. Needless to say, nursing is not our first career. Together, we have more than 40 years of prior work experience—Lori with more than 24 years in education, banking, and volunteer leadership positions—Kathryn with 18 working as an environmental consultant and spending more than two years in Afghanistan working on water development projects.
In our previous careers, collecting and analyzing data was a routine part of our work. So we were both surprised to observe that nurses were using handwritten notes during shift-to-shift handoffs and felt the process could be improved through the use of technology. As part of our Nurse Residency Program, we were asked to complete an evidence-based practice project to implement on our unit that would meet unit priorities (as well as the UW Health Strategic Plan), so we thought improving shift handoffs would be perfect.
Based on an extensive literature review, we found that very few hospitals use an electronically-driven handoff tool through existing electronic health records (EHR) systems. Research also validated that using EHR systems to drive handoff reports benefits the communication process by allowing for fewer errors and increasing nursing and patient satisfaction with the quality of the bedside handoff report.
With support from our informatics colleagues, we designed a patient report (developed in Health Link, UW Health's EHR), to streamline shift-to-shift handoff. The report included the most current patient data from Health Link and downloaded it to a standardized one-page report per patient. This process minimized transcription and reporting errors, thereby improving the quality of the bedside report. These patient reports have been trialed, evaluated, revised, and implemented on several units within UW Hospital and Clinics. Current unit culture consists of printing off the patient reports at the beginning of every shift, making them available to all nurses. Nurses can pick up their patients' reports and go directly to the bedside.
While this innovative tool addresses Magnet and national priorities, it also addresses the unit's goals of using technology to improve staff communication for patients' plan of care, patient outcomes and safety, as well as staff efficiency. Hospital-driven goals were also achieved as UW Hospital and Clinics strives to be superior in quality and safety by using existing technology to incorporate most recent patient data during handoff reporting. Evidence-based implementation of this new clinical practice has been successfully piloted. Fiscally responsible use of existing technology has reduced time spent at the computer and improved efficiency. The Joint Commission on Accreditation of Healthcare Organizations has also established as National Patient Safety Goals: to improve communication between caregivers; and for nurses to use a combination of written and face-to-face format during bed-side handoffs to prevent sentinel events.
Optimizing the power and potential of technology and informatics to support innovative patient care and enhancing the effectiveness of professional practice, utilizes our available data to its fullest potential. Quality care for patients and standardized EHR-based shift change bedside reports will ensure that the most up-to-date patient information is available to all parties involved in the handoff. Most significantly, the desired clinical outcome of more quality time spent at the bedside and inviting patients and families to actively participate in developing their individualized care plan improves overall safety, communication and patient and nursing satisfaction.