1. ID OR07 Reinforcement for Implementation of Hands-off Communication among Nursing Staff Presenter: Hunaina Hadi Student BScN Year IV Aga Khan University School of Nursing and Midwifery Karachi, Pakistan

2. OBJECTIVES By the end of the presentation learners will be able to : Define Hands-off Communication. Elaborate the purpose of the project. Explain the significance with the literature support. Describe the methods used for conducting the project. Analyze the results of the project with the help of Fish-bone diagram. Discuss the plan of action. Explain the evaluation and sustainability of the project.

3. Definition Hands-off communication is the process of transferring patients’ pertinent information from one caregiver to another. The Joint Commission’s NPSG states: “The primary objective of ‘hands-off’ is to provide accurate information about a patient’s/client’s care, treatment and services, current condition, and any recent or anticipated changes. The information communicated during hands-off must be accurate in order to meet patient safety goals.” (Joint Commission International Patient Safety Goal 2) (Hughes, 2008) (Patton, 2007)

4. Purpose We selected Reinforcement for the implementation of hands- off communication as major issue among nursing staff because: It was noted that copying documentation from previous shifts was the major issue for mishap that was reported by the management. It was observed that despite of having hands-off communication sheet, nursing staff still prefer transferring patients’ information (including only current condition, ongoing treatment, recent changes and complications) verbally during shift over. There was no education material/ pamphlets that could sensitize the nursing staff to comply with hands-off communication on ongoing basis.

5. Significance Ineffective hands-off communication is recognized as a critical patient safety problem in health care; in fact, an estimated 80% of serious medical errors involve miscommunication between caregivers during the transfer of patients. Ineffective hands-off communication is a leading cause of hospital sentinel events (unexpected death, serious physical or psychological injury, or the risk thereof. Bedside hands-off promotes patient safety and allows an opportunity for patients to correct misconceptions enhancing the accountability of staff. (Mahon & Nicotera, 2011)

6. Types of hands-off communication Extra hospital hands-off AdmissionsDischarge Inter- hospital transfer Intra hospital hands-off Shift change Service change Service transfer (Patton, 2007)

7. Method Observation of nursing practices was conducted in Coronary Care Unit, AKUH in March and April 2015. Unstructured interviews were also conducted in the month of March and April 2015. The interviewees were 30 participants (nursing staff, interns and students working in morning, evening and night shifts in Coronary Care Unit, AKUH)

8. Results For root-cause analysis, fish bone diagram was used to find the possible causes of the problem. The identified causes were categorized under the headings of managerial, nursing staff, patients, methods, equipment and environmental causes as presented in the next slide.

9. Fish Bone Diagram

10. Discussion After analyzing the results, we formulated an action plan. The action plan was based on multimodal- interventional strategy that included educational sessions for reinforcement of the implementation of the hands-off communication, verbal reminders and visual reminders by displaying flyers on notice boards along with providing pocket-sized reminder cards to each staff.

12. Evidences of the Project

17. Evaluation Ongoing monitoring was conducted to identify the need for modification of the plan. A summative evaluation based on unstructured questionnaire was done to identify the effectiveness of the project. The evaluation revealed that the hands-off communication sheet was timely filled by the nursing staff, interns and students.

18. Sustainability Following measures were carried out for the sustainability of the project: Pamphlets were stuck on the soft boards of CCU. Reminder cards were distributed. Copy of the session conducted along with the reference material was shared with the preceptor.

19. Challenges Disapproval for conducting survey due to ethical consideration. Limited human and material resources. Availability of nursing staff, interns and students for the session due to work overload. Time constrain Unavailability of the venue

20. References AKUH. (2014). Communication Guidelines. Retrieved from ​ https://vpn.aku.edu/jcia/pdfs/,DanaInfo=portal.aku.edu+FAQsGoal2- Communication.pdf Hughes, R. (2008). Patient safety and quality. Rockville, MD: Agency for Healthcare Research and Quality, U.S. Dept. of Health and Human Services. Mahon, M., & Nicotera, A. (2011). Nursing and Conflict Communication. Nursing Administration Quarterly, 35(2), 152-163. doi:10.1097/naq.0b013e31820f47d5 Patton, K. (2007). Handoff communication. Marblehead, MA: HCPro. PM, M., KM, D., DM, W., & DM, F. (2012). Bedside nurse-to-nurse handoff promotes patient safety. - PubMed - NCBI. Ncbi.nlm.nih.gov. Retrieved 15 August 2015, from http://www.ncbi.nlm.nih.gov/pubmed/22866433

21. Contact Details of Presenter Hunaina Hadi Student BScN Year IV Aga Khan University School of Nursing and Midwifery Karachi, Pakistan Email Address hunaina.hadi.g11@student.aku.edu hunaina.hadi@gmail.com

22. Acknowledgement Ms. Layla Rahim (Former CNI CCU, AKUH)