1. Improving hand off communication: New solutions for nurses
Jennifer Newcombe, DNP, MSN, CNS-BC, CPNP-PC/AC
Pediatric Cardiothoracic Surgery
Improving hand off communication: New solutions for nurses

2. Introduction
Hand offs occur in many different forms varying among institutions, specific units and even individual nurses.
Patients in the inpatient care setting have become increasingly more complex requiring higher levels of care, more complex interventions, and coordination of multiple specialties to manage their disease process.
Nurses use written or verbal formats to exchange information. Information can be exchanged at the bedside or a central nursing station

3. Introduction
44,000-98,000 patients die each year due to medical error that effective communication could play a key role in preventing (IOM, 1999).
Nursing hand off occurs 2-3 times per day for each patient.
Hand off styles vary and are often based on nurse’s own personal style (Kerr, 2011).
Ineffective communication is commonly acknowledge as a contributing factor to medical errors

4. Background 14 bed cardiothoracic intensive care unit Staff
48 Full Time
6 Part Time
3 Per diem
Time to complete report was 25 minutes
87% of staff were using LLEAP overview
25% All of the time
21% Most of the time
42% Some of the time
27% Experienced a delay during report
Incremental overtime was between hours a pay period ($6,000-8,000)
Median overtime 74.1 hrs

5. Shared Governance Team
Raeann Sandquest, RN
Sean Cavence, RN
Juan Morales, RN
Amanda Joy, RN
Angelica Bennett, RN
Maureen Hokama, RN
Jennifer Newcombe, NP
Decrease staff overtime in order to fund CNS postion

6. PICO Question
In the CTICU does a structured nurse hand off as compared to the current process decrease staff incremental overtime?

7. Objective and Aims
RNs to initiate hospital course tab upon admission in LLEAP
RN would be responsible for updating hospital course each shift
Hand off would be done in the SBAR format
Decrease interruptions during report
Decrease staff incremental overtime by 3%
RNs were writing down the patients hospital course with each shift report. Very time consuming

8. Project Design
PDSA is a validated process improvement model in healthcare

9. Project Methodology Information technology Consistency of information
LLEAP hospital course section
Consistency of information
SBAR
Limiting interruptions
Report in progress sign
Peer to peer accountability
5 minute wrap up
S- Patient name, age
B-Past Medical History, significant clinical events
A-Significant vital signs, labs, assessment by system
R-Recommendations for next shift

10. Issues of Implementation
Unit census varies with diagnosis and complexity
ICU to discharge
Unit start time changed from 6:30 A.M/P.M to 7:00 A.M./P.M
Report in progress sign not consistently placed by RN circulator
Circulator not present for every shift

11. Issues of Implementation
Hospital course was not always initated on day of admission
Hospital course with unnecessary information
Not updated appropriately (Q shift)
Nov
Some not updated appropriately
Some admissions not started. Update Q 12hrs
Made team question what information is pertinent to include in hospital course?

12. Overcoming barriers Unit shift huddles
Routinely presented data at staff meetings
Education board in report area
In God we trust
Everything else we need to see the data

13. Data Analysis
There was a significant difference between how long it took to complete the report before any changes were made and how long it took after the latest changes were made (p=<.001).

14. More nurses are completing the report on time than not
Data Analysis
More nurses are completing the report on time than not

15. Data Analysis
Those who completed the report on time completed the report in a significantly shorter amount of time than those who did not (p<.001)

16. Data Analysis

17. Data Analysis

18. Data Analysis
Interruptions remains a significant reason for why reports are not completed on time (p<.001). The number of people who were interrupted did not significantly change.

19. Data Analysis
Those who were interrupted took significantly longer to complete their report than those who were not interrupted (p<.001). Those who were interrupted were 4 times more likely to not complete their report on time.

20. Data Analysis

21. Conclusion
RNs who used LLEAP hospital course completed report on time.
RNs who were interrupted took significantly longer to complete their report than those who were not interrupted (p<.001). Those who were interrupted were 4 times more likely to not complete their report on time.

22. Questions

23. References
IOM (1999). To error is human: Building a safer health system. Retrieved April 23, 2018 from Files/1999.
Kerr, D., Lui, S., McKinlay, L., Fuller, C. (2011). Examination of current handover practice: Evidence to support changing the ritual. International Journal of Nursing Practice, 17,