A PROTOCOL TO ENHANCE NURSE-TO-NURSE COMMUNICATION …
Transcript of A PROTOCOL TO ENHANCE NURSE-TO-NURSE COMMUNICATION …
The importance of how well nurses communicate with each other,
physicians, nursing assistants, pharmacy staff, and janitorial staff makes the
difference in patient care and safety and the patient’s attitude toward
healthcare and compliance with their plan of care
Baggs et al. (1992) have observed improved communication and
collaboration results in more positive patient outcomes, higher satisfaction,
and lower readmission rates. If nurses are at the heart of the communication
process, and are carrying out this process efficiently, then it’s safe to say that
the client is more likely to have increased positive patient outcomes and
higher satisfaction with the care being provided.
Evidence suggests that communication improves when nursing handoff
involves the patient and is carried out using a structured reporting format
(Mascioli et al 2009, Tucker et al 2009).
The World Health Organization (2007) recommends the use of the SBAR
(Situation, Background, Assessment, and Recommendation) tool to
standardize handoff communications. The hospital where our research was
conducted has a policy in place that states using the SBAR tool when giving
hand off information combined with bedside report.
Bedside Reporting, which is what our study facility participates in, is only
effective when done properly and even then has its drawbacks. A simple
drawback is the “inclusion-exclusion” of patient’s from their care. The RN’s
may be in the patient’s room, but the focus is on discussing the case to the
next RN on duty in terminology that the patient does not understand. This
creates a “parallel” perception of RN care from the patient, which is better
than no perception, but can still be improved upon for better patient
outcomes.
Hannah Chitkara; Kiristan Dials; Kati Schuh; Nick Thompson; Celena Wagner; Mrs. White, MSN, RN
NURB 361 Introduction to Nursing Research, Baccalaureate Nursing Program
Introduction Literature Review
A PROTOCOL TO ENHANCE NURSE-TO-NURSE
COMMUNICATION DURING PATIENT HANDOFF
Policy Alterations
The objective of this project is to observe, analyze, and
ascertain nurse to nurse communication methods within a
moderate sized, urban, teaching hospital within Kentucky
and propose recommendations to increase the effectiveness of
nurse to nurse hand-off and nurse telecommunications for
better patient outcomes. Improved communication techniques
will ultimately lead to higher quality, holistic nursing care
and therefore increase rates of patient safety and satisfaction.
This will be completed by conducting nurse discussions,
observing nurse implementation, and analyzing hospital
policy to uncover barriers to efficient communication. Further
research and analysis upon the hospital’s current policy
revealed obstacles to efficient patient handoff. Discussion
with nurses on the unit revealed negativity regarding the
current practice of bedside reporting. Observation of 13
weeks within the hospital revealed variance from the policy
by staff members. Delving into current evidence based
practice techniques, a modification was proposed. Nurse shift
reports and nurse handovers are two of the most critical
processes in patient care that can support patient safety and
reduce medical errors in the United States (Gregory, 2014). A
timely, efficient patient handoff is of vital importance to the
beginning of a shift adhering to patient-care, and the focus of
this project was conducted upon this premise.
Clinical Implications
Adherence to the hospital’s handoff
communication policy regarding the use of
Situation Background Assessment
Recommendation (SBAR) when passing on
specific relevant information from one team
member to another for the purpose of ensuring
the continuity and safety of the patient.
Proposed model creates a more meaningful, time
saving method of patient handoff therefore
increasing both nurse and patient participation.
Patient Satisfaction Survey results will improve
thereby increasing hospital reimbursement.
More meaningful time spent with patient- rather
than discussing case in parallel to patient
speaking in medical jargon, Nurse would be
speaking directly to them in understandable
terms.
Less HIPAA violations.
Having an effective patient handoff would lead
to more holistic nursing care, leading to less
morbidity and mortality.
Patient Satisfaction Survey
Proposed Patient Hand-Off
Modification
IncreasedHand-Off
Report Efficiency
LessMorbidity and
Mortality
Less HIPAA Violations
Higher Patient Satisfaction
More Hospital Reimbursement
80%
52%
72%75%
49%
65%
NURSES "ALWAYS"
COMMUNICATED
WELL
PATIENT'S WHO
"STRONGLY AGREE"
THAT THEY
UNDERSTOOD CARE
WHEN LEAVING
HOSPITAL
PATIENT'S WHO GAVE
THEIR HOSPITAL A
RATING OF 9 OR 10
National Average Urban Teaching Hospital
Current Policy
30 minute
complete bedside report
SBAR
Proposed Modification
15 minute RN to RN patient handoff in designated area
15 minute patient rounding
Patient
Centered
CareIncreased
Nurse
Participation
Positive
Patient
Satisfaction
Surveys
References
Agency for Healthcare Research and Quality (2013). Nurse bedside shift report and implementation handbook. Retrieved
from http://www.ahrq.gov/profressionals/systems/hospital/engagingfamilies/stragegy3/index.html
Baggs, J., Ryan, S., Phelps, C., Richeson, J., & Johnson, J. (1992). The association between interdisciplinary collaboration and
patient outcomes in medical intensive care. Heart Lung, 21, 18–24
Casey, A., & Wallis, A. (2011). Effective communication: Principle of nursing practice E. Nursing standard, Vol. 25, pp. 35-37
Christie, P., & Robinson, H. (2009) Using a communication framework at handover to boost patient outcomes. Nursing Times.
105, 47, 13-15.
Holzmueller, C., Timmel, J., Kent, P., Schulick, R., & Pronovost, P. (2009). Implementing a team based daily goals sheet in a
non-ICU setting. Joint Commission Journal of Quality Patient Safety, 35, 384–388.
Mascioli S, Laskowski-Jones L, Urban S, & Moran S (2009) Improving handoff communication. Nursing 2009. 39, 2, 52-55.
World Health Organization (2007) Communication During Patient Hand-Overs. http://bit.ly/ecCnXg (Last accessed: March 22
2011.)
Benefits of Modification