HANDOFF REPORTING Using SBAR for exchange of information

Hand off Defined  The transfer of information (along with responsibility) during a transition in care across the continuum for the purpose of ensuring the continuity and safety of the patient’s care.

Types of Hand offs  Transitions of care within the hospital setting (i.e. ER to Med Surg, Med Surg to OR, OR to PACU, PACU to Med Surg/ICU, ICU to Med Surg)  Nursing transfer to ancillary services  Hospital Transfers (Higher level of care, Nursing Home)  Hospital discharge to assisted living center or Home Health Agencies  Critical Reports to physicians  Phone calls or verbal encounters with physicians  Patient Hand off to other nurses at change of shift, breaks, transitions

Procedure for In Hospital Hand off  Should be performed at every transition of care, you should not leave a patient or accept a patient without handoff report  Performance at bedside in presence of patient and family is preferred  Report should be uninterrupted with enough time allotted for adequate communication  An opportunity for questions to be answered should be included in report  Read back verification should be used for critical information  SBAR method should be used

Why allow patient/family presence?  Allows patient and family to feel Informed Empowered Encourages the patient to ask questions Prompts nurses to introduce each other to the patient Allows for questions to be answered by family related to health history and for nurses to attend to patient and family needs and questions Promotes physical assessment to take place at time of hand off. This allows nursing agreement related to information exchange. **Ask permission to give report if family is present, ask visitors to step into the hall until report is complete.

Communication is the Key  The National Institute of Medicine stresses that good communication is critical to ensuring safe and reliable care.  In a recent JACHO Root Cause Analysis survey it was reported that a breakdown in communication was the responsible factor in 65% of Sentinel Event occurrences and 80% of medication errors.  Effective Communication should be a priority across the board and within every hospital department

Sometimes what you say and what you mean are different!

Barriers to Effective Communication  Expectations differ between senders and receivers of patients in transition.  Culture does not promote successful hand-off (e.g., lack of teamwork and respect).  Inadequate amount of time provided for successful hand- off.  Environmental distractions: alarms, visitors, other staff  Lack of standardized procedures in conducting successful hand-off, ex: use of SBAR (Situation, Background, Assessment and Recommendation) techniques.

Solutions to Ineffective Hand off  Use a standardized format such as SBAR  Ask the charge nurse or another nurse to tend to your patients during inter-hospital or transfer hand off  During shift hand off, inform the patients that you are performing a shift change and need a few minutes to ensure exchange of information for their “safety”  Be prepared, Be patient, Be considerate of the nurse following you

Hand off to Another Facility  Use SBAR method, including a thorough assessment  Note the Nurse receiving report and get a call back number  Be prepared when you give report, have chart and results available  Give the receiving Nurse a phone number to reach you if questions arise after report  Give receiving Nurse opportunity to ask questions prior to ending report.

What should a handoff report contain? S ituation B ackground A ssessment R ecommendation

SITUATION  Patient’s name  Age  Gender  What brought the patient to the hospital  Diagnosis/planned procedure  NPO status, diet specifics  Fluid Restrictions  Allergies  Advanced directive  Precautions  Primary Care Physician  Family Contact person/number

BACKGROUND  Reason for hospital visit  Medical History  Past Hospitalization  Primary Language  Legal Status  Special Needs  Religious Needs  Disposition of belongings  Admit Date  Current Medications  Lab Results with trends  Code Status  Fall Risk  Primary Physician  Consults

Assessment (Preferred Nurses perform physical assessment together)  Surgical Procedures  Mental status  Language barriers  Blood Products given  Consents signed  Medication to be given prior to procedures, including anesthesia  Most recent Vital Signs  Observe Drains or Dressings with last changed date and time  Bowel and Bladder status  ADL needs  Observe Wounds or skin issues  Functional status and pt activity tolerance  Last void and bowel movement  IV sites and change times  Most recent vital signs and trends  PRN or presurgical medications given  Pain level and interventions  Amount of oxygen and delivery method  Treatments by ancillary services and effect

Recommendation  Plan of care, including surgery schedule  Discharge Plan  Scheduled procedures and radiology  Questions for the physician at rounds  Nursing care plan needs  Equipment needed  Review of orders and MAR  Follow up related to:  Medication  Documentation  Lab and Radiology results  Interventions