THE SHIFT EXCHANGE VERIFICATION
THE SHIFT EXCHANGE SERIES

'We can pull up all of our documentation related to that patient while we are talking to each other,' Pelham says. Lori Pelham, RN, clinical nursing supervisor for the ED at University of Michigan in Ann Arbor, says that staff members give report to each other in front of a computer. Senior ED nurses who helped design the protocol will act as informal peer leaders and assist in the education and implementation processes, adds Flanagan. 'I think that our support will help staff work through what is a new process for shift change while ensuring compliance and identifying any barriers that exist.' 'For the first month as we roll this out, we plan to have leadership presence on the unit during our two biggest shift changes, 7 a.m. need for specialized equipment such as bariatric or padded side rails the patient’s belongings accounted for plan of care and the patient’s understanding of plan of care

THE SHIFT EXCHANGE VERIFICATION

dual verification with two patient identifiers psychosocial needs, family needs, and location of family members or visitors communication including cognitive status and hearing/visual aids critical interventions such as medications administered, vascular access, cardiac monitoring, and oxygen saturation The protocol requires oncoming and off-going nurses to review the following: 'Our goal is to reduce the risk that critical information is overlooked or omitted when patient care is passed from one nurse to the next,' says Flanagan. To improve communication during change of shift, consider these strategies implemented at EDs:Īt Beth Israel Deaconess, the ED nurse manager, clinical educator and ED nurses created a 'safe handoffs' protocol for change of shift. 'Ideally, there should be a good face-to-face communication,' he says. Red flags that an ED isn’t complying with the goal’s requirements include use of tape recorders to give report, illegible handwriting, use of nonstandardized forms, and the inability to contact a nurse for follow-up if needed, says Angood. 'With the combination of communication lapses and not fully trained staff, there is a strong potential for errors to occur during handoffs.'

'The ED is a highly complex environment with a constellation of pressures that create the opportunity for adverse events and errors to occur,' he says. Handoffs are an especially high-risk time in EDs, due to factors including high volumes and the nursing shortage, says Peter Angood, MD, vice president and chief patient safety officer for the Joint Commission’s International Center for Patient Safety. 1, 2006, a newly added National Patient Safety Goal will require a standardized approach be used for handoffs, with an opportunity for staff to ask and respond to questions. 1 root cause of sentinel events reviewed by the Joint Commission on Accreditation of Healthcare Organizations from 1995 to 2004. 'Our nurses give report in the clinical area, where they can be interrupted and distracted by patients, their families, and medical staff.'Ĭommunication lapses were the No.

'This is particularly true in the chaotic environment of the emergency department,' she says. If key pieces of information are missed, this can result in problems ranging from patient dissatisfaction to major adverse events, says Trisha Flanagan, RN, MSN, CEN, ED nurse manager at Beth Israel Deaconess Medical Center in Boston. 'Change of shift is the riskiest time in the ED, as the handoff process is not perfect and information may be lost,' warns Patricia Scott, RN, BSN, CEN, former ED director at Martin Memorial Medical Center in Stuart, FL. Next month, we’ll cover handoffs involving patients being transported from the ED to other areas of the hospital, including diagnostic testing and inpatient units.)Īfter a stressful 12-hour shift in the ED, have you ever forgotten to tell the oncoming nurse about a patient’s pending lab test results, pain medications given but not documented, the fact that a medication is hung on an intravenous pole but not yet infused, or the need for contact precautions? This month’s story focuses on change of shift.

THE SHIFT EXCHANGE SERIES

(Editor’s note: This is the first of a two-part series on improving 'handoff' communication in EDs.

Are dangerous errors occurring during change of shift? Use these strategies

The shift exchange