Strategies for HandOff Communication

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Strategies for Hand-Off Communication

• Trish Hahn, R.N.
• Nursing Coordinator MIS
• Little Company of Mary Hospital
• Evergreen Park, IL

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Little Company of Mary Hospital

• Non-profit Catholic community hospital providing
  the latest surgical, inpatient, and outpatient
  facilities.
• Opened January 19, 1930 as a four-story 150-bed
  hospital. Little Company of Mary Sisters,
  supported by 12 staff physicians, made up the
  entire staff.
• In 1950 three of our staff physicians performed
  the first human organ transplant in the world- a
  successful kidney transplant that allowed the
  patient to enjoy quality of life for the next 4 ½
  years.

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Today

• 325 certified beds
• Over 350 active staff physicians
• Approximately 2,100 employees
• 46,500 Emergency Room visits per year
• Committed to providing Pain Free Health Care

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MEDITECH MAGIC Site

• MEDITECH customer since 1997
• EDM installed February 2006
• ORM installed February 2007

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Objectives

• Define Hand-Off Communication
• Identify the five strategies for effective
  Hand-Off Communication
• Utilization of MEDITECH to facilitate
• Hand-Off Communitcation

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Hand-Off Communication

• The Joint Commission National Patient Safety Goal
  2, requirement E.
• Implement a standardized approach to hand
  off communications, including an opportunity to
  ask and respond to questions.

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What Does This Mean?

• Health care organizations must define,
  communicate to staff, and implement a process in
  which information about patient care is
  communicated consistently.
• Standardization provides a means to educate staff
  about the process and helps support consistent
  implementation throughout the organization.

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Methods of Communication
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Identify the Following

• To which hand-off situation it applies
• Who is, or should be, involved in the
  communication
• What information should be communicated
• Opportunity to ask and respond to questions
• When to use certain communication techniques,
  such as read back or SBAR
• What print or electronic information should be
  available

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Barriers to Effective Hand Offs

• Physical setting lack of privacy, interruptions,
• background noise
• Language Differences between people of varying
  racial and ethnic backgrounds or geographical
  areas
• Communication medium limitations of
  communication via telephone, e-mail, paper, or
  computerized records versus face-to-face

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Recommended Strategies

• Use clear language
• Incorporate effective communication techniques
• Standardize shift-to-shift and unit-to-unit
  reporting
• Smooth hand offs between settings
• Use technology to your advantage

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Clear Language

• Avoid unclear or potentially confusing terms. (ex
  Hes doing fine, shes a little confused.)
• Do not use abbreviations that could be
  misinterpreted.

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Incorporate Effective Communication Techniques

• Focus on the information being exchanged
• Limit interruptions
• Allow sufficient time
• Use read-back techniques to make sure there is
  common understanding
• Encourage questions
• Keep report patient centered, avoid irrelevant
  details

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Standardize Shift-to-Shift, Unit-to-Unit Reports

• Implement a consistent format
• Organize the data
• Provide cues of important information to pass on
• Keep the report concise and accurate

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Smooth Hand Offs Between Settings

• Communicate with the physician when a patient is
  admitted, and update him/her whenever the
  patients status changes significantly.
• Upon discharge, provide the patient with
  information about discharge medications,
  discharge instructions, follow-up visits.
• Follow-up calls to the patient by a health care
  professional can often prevent many
  post-discharge errors.

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Use Technology to Your Advantage

• HIS systems that transmit information across
  settings and care providers bring consistency and
  coordination to care practices.
• Electronic medical records can facilitate
  transitions by providing consistent, accessible
  information about patients and their care.

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How LCMH Could Achieve This Goal

• Formation of a multidisciplinary Hand-Off
  Communication Team
• Team evaluated user/department needs
• Evaluated different report practices
• Shift-to-Shift, Unit-to-Unit, Transfer off
  campus

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LCM Strategies

• Face-to-Face shift report using a nursing
  profile customized for particular units (ICU,
  Med-Surg
• Peds.) Set up using the SBAR format.
• Telephone reports when patient goes from ED,
  PACU, or Special Procedures.
• Worked with the nursing homes and extended care
  facilities in our area to design a nursing
  profile that is faxed to the nursing home prior
  to transfer.

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Strategies continued

• Customized OE requisitions for central transport,
  and numerous ancillary departments
• Designed specific PCI query groups and clinical
  highlights that enable clinicians to view
  pertinent information on one screen

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SBAR

• Situation
• Background
• Assessment
• Recommendation

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Situation

• Information every care provider at any level
• would need to know about the patient.
• Examples Admitting Diagnosis, Room,
  Location, Code Status, Precautions, Allergies,
  Communication Barriers

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Background, Assessment, Recommendation

• Shift change reports
• Information provided when transferred to a
• different level of care (ICU to General Floor,
  Transfer to Extended Care)

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Nursing Profiles

• Customize profiles
• Specific to different caregivers
• RN, Care Partner, Physical Therapist

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Provider to Provider Hand Off

• Group practices
• Coverage for another provider

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PCI QUERY GROUPS/CLINICAL HIGHLIGHTS
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Questions?