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According to a 2001 report by the Institute of Medicine (IOM), “Crossing the Quality Chasm”, a safe system preserves information, fosters ease of access of information and acts as a platform for reference in the event that some information is forgotten (Committee on Patient Safety and Quality Improvement, 2013; Smeulers, Lucas and Vermeulen, 2014, p. 2). Implementation of principles that enhance the effective interdisciplinary provision of healthcare is imperative. However, there are some areas that interfere with the quality of the interdisciplinary approach. One area is patient handoffs, which have received little attention. During my practice as a nurse, I have realized that handoffs are a source of preventable medical errors and malpractice claims. In order to facilitate continuity of quality healthcare, I aim to improve communication between me and the next nurse when changing a shift in my institution. A majority of the medical errors that result from handoffs can be prevented using effective communication systems because the true clinical picture is usually unintentionally modified. Nurses experience stress, burnout and fatigue by the end of a shift; hence, there is a possibility of making unintentional verbal errors when giving handoff reports. In order to enhance communication, I have formulated a SMART goal and discussed ways to achieve it in this paper.
The SMART goal for review focuses on improving communication between me and the next shift nurse during handoff. I need to determine an effective communication system for use during this process through a review of the literature. Mobile technologies, for example, mobile phones are effective in sending text messages between me and the next nurse during the change of shift. As their name indicates, they are carried wherever a person goes; hence, one can readily access information as it is transmitted. Despite the fact that there is a need to adopt effective communication strategies during a handoff, it is equally important to organize one’s schedule in a manner that allows the preparation of an accurate handoff report. Virtually all adults have a mobile phone because ownership of mobile phones has exponentially increased over time alongside the exchange of text messages and emails, and all this at an affordable cost. The use of mobile phones is reliable because it allows synchronization in real-time and within a feasible context. Time has led to the development of sophisticated mobile phones through which information can be transferred from a computer and to another mobile phone. Taking this level of sophistication into account, conveying accurate information is enhanced. Despite the fact that it takes some time to write a text message, it minimizes information gaps experienced when verbally transferring a patient’s personal information and associated medical information to another health care provider (Committee on Patient Safety and Quality Improvement, 2013).
It is necessary that the nurse handing over organizes his/her thoughts prior to the handing over process; thus he/she should prepare a summary of the patient and clinical information in a soft copy form using Ms Office word. The nurse taking over can easily refer to this copy that is readily accessible online when saved as an email copy. Saving the documents as an email attachment prevents issues of information loss, misunderstood verbal reports and forgetfulness. In addition, due to time constraints, sending the Ms document takes less than a minute. The word document can be sent as an email attachment using the mobile phone, and the next nurse taking over a shift can access it before meeting the outgoing nurse. The document, when saved as an email attachment, can be downloaded at one’s convenience, and its accessibility is attainable using mobile devices. In addition, the nurse can design small summary notes for each client and place them at each patient’s bedside (Agency for Healthcare Research and Quality, 2015). Such summary notes to aid in eliminating any confusion that can arise when patients share similar clinical histories and diagnoses. Since the use of either one method highlighted is not effective, an integrated communication system for the exchange of handoffs reports is beneficial because information not clearly indicated through one communication mode can be verified through another form.
Audiotaping is another style of communication that can be integrated to transfer patient and clinical information to the incoming nurse. There is the likelihood that the recorded audio is more detailed than a written report because there are no time constraints. Recording the audio and accessing it can be done at the convenience of the nurses. It is important to note that a comprehensive report of each patient from the time of admission is very paramount, and omission of any clinical detail can have adverse outcomes (Smeulers et al., 2014). The audiotape, therefore, should have comprehensive coverage of the patient information since it is prepared at one’s convenience. However, audibility is paramount. The audiotape should be recorded at a moderate pace so that the nurse taking over the shift can comprehend the content objectively.
The use of a simplified tool that can help compress all the required information into a simplified format can be effective as an improved communication strategy during handoffs. This tool can be designed in a way that indicates all the shifts on particular days. Easier access can be achieved through a search icon that allows one to search the name of nurses handing over their shifts. This tool can be designed in such a way that it can be easily transferred using mobile phones, and a nurse taking over a shift can go through the tool prior to the shift; hence, get the chance to ask critical and relevant questions. Scientific literature indicates that different models and tools are adopted by different hospitals to enhance effective communication during a change of shift for nurse practitioners. Based on all the models I reviewed, I recommend the integration of the situation-background-assessment-recommendation (SBAR) model to facilitate this process between me and the next shift nurse (Vardaman et al., 2012). Integration of the SBAR during the handing over process of a shift change will enable healthcare workers to develop a common language, enhance rapid decision making, enable less-tenured nurses to gain social capital and legitimacy, and standardize the nursing profession to prevent malpractice. This tool helps to bridge the gap between newly hired nurses and highly experienced nurses due to standardization, which is encouraged by the Committee on Patient Safety and Quality Improvement (2013).
The SBAR can be integrated with bedside reporting during a change of shifts. This kind of communication strategy is adequately holistic to the extent of involving the patient. Also, this kind of reporting helps the incoming nurses to make an informed decision about prioritizing patient care because they are able to analyze all the information based on the assessment of each individual patient. Different communication styles act as barriers to shift handoffs. The incoming and outgoing nurses have different years of experience, objectives, and levels of comprehension. These three factors affect the manner in which a nurse will communicate information and how the other one perceives it. Therefore, the change of shift handoffs should adopt a social exchange approach that allows the outgoing nurse to give a rationale for actions laid down and the incoming nurse to query these actions. In addition, the outgoing nurse should not abbreviate information unless she/he intends to explain the abbreviations used. Whereas an outgoing nurse is in a hurry to give the handoff without interruption, the incoming nurse may miss out on some utterances.
Variation in levels of expertise between the outgoing and incoming nurses prompts the use of an agreed-upon standardized protocol, for example, written handoffs should have no abbreviation unless accompanied by a section defining the abbreviations. In addition, there is a need for the shift nurse to seek clarity, and this can be made possible if he/she is able to preview a written copy of the written information. Subsequently, obtaining a verbal handoff report helps to augment the written report. The importance of mobile phones at this juncture is handy.
An analysis of all the different forms and styles of communication leads to the conclusion that the change of shift requires a comprehensive approach that will accommodate socialization between the healthcare workers. Different literature states that outgoing nurses after a shift perceive the process of asking questions as an insult to their practice, but the SBAR provides a section that allows the nurses to socialize and ask questions. This kind of standardization enables the nurses to realize that asking questions is part of enhancing quality during the delivery of healthcare. In my endeavor to implement an effective communication system, I will formulate three questions that aim to seek the opinion of my fellow nurses on the best communication approach to adopt.
The questions will be collected at baseline before introducing any new communication system. The questions to be answered will be:
- Highlight the procedures currently used during a change of shift.
- What are the advantages of the system you are currently using during a change of shift?
- a. Are you satisfied with this system?
Highlight the elements of this system that support your answer above
I will promote the implementation of a newly improved communication system by preparing a presentation of the current communication system during a change of shift and how it can be improved. While liaising with the administrative unit of the hospital, I will develop brochures for disseminating to all the nurses and avail necessary resources to facilitate the change. One brochure will contain details about an integrated communication approach and how to embrace it while the other one will contain details about the SBAR. The hospital wards will be divided into three segments based on the current communication system and two intervention strategies. After 4 weeks of using the different intervention strategies, I will evaluate the efficacy of these methods using the questions used at baseline. A statistical comparison of the results before the intervention and after the intervention will enable me to my measure and achieve my SMART goal. I will determine the most effective communication strategy for implementation into the hospital communication system when exchanging patient and clinical information from one healthcare worker to another.
Effective communication during a shift of responsibilities is crucial because it controls the occurrence of medical errors. Despite the need for effective communication during a handoff, most institutions are still trying to adopt an effective communication transition strategy. The results obtained after an analysis of the different intervention approaches will determine the communication system to be integrated into the institution during handoffs.
References
Agency for Healthcare Research and Quality. (2015). Nurse Bedside Shift Report: Implementation Handbook. Web.
Committee on Patient Safety and Quality Improvement. (2013). Communication Strategies for Patient Handoffs. Web.
Smeulers, M., Lucas, C., Vermeulen, H. (2014). Effectiveness of Different Nursing Handover Styles for Ensuring Continuity of Information in Hospitalised Patients (Review). Cochrane Database of Systematic Reviews. Issue 6.
Vardaman, J., Cornell, P., Gondo, M., Amis, J., Townsend-Gervis, M., & Thetford, C. (2012). Beyond Communication: the Role of Standardized Protocols in a Changing Health Care Environment. Health Care Management Review, 37(1), p. 88-97.
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