Quality Improvement Process for Hand off Report - Weebly



Quality Improvement Process for Hand off ReportVanessa D. GonzalesFerris State UniversityAbstractAn ineffective handoff report can be detrimental to the safety of a patient. A quality improvement process is used to assess the shift to shift handoff report process and develop a plan to ensure that it is effective. Evidence based research and theory guide the quality improvement team toward the outcomes set in an effort to improve patient safety. Through the implementation of the quality improvement process, the quality of patient care is affected and patient outcomes are improved. Quality Improvement Process for Handoff ReportQuality and safety initiatives are essential to the success of any healthcare organization. Most every healthcare organization and its healthcare providers desire to provide their patients with the safest and highest quality care available. In order to provide exceptional care, the leaders within the organization need to be observant to areas that need improvement. Quality and safety initiatives are designed to set forth a plan for improvement for certain aspects of patient care that are not meeting the standards of the organization. Ineffective Handoff Report When caring for a patient in an acute care setting it is vital that an effective shift to shift handoff report is given to the oncoming nurse. “An effective handoff report supports the transition of critical information and continuity of care and treatment”(Friesen, White & Byers, 2003). When missing or inaccurate patient information is reported to the oncoming nurse it can affect the care the patient receives. “Ineffective handoffs can contribute to gaps in patient care and breaches in patient safety. They can also cause medication errors, wrong site surgery and patient deaths” (Friesen et al., 2003). There are many factors that can contribute to an ineffective handoff report. According to Friesen, White & Byers (2003), the factors that contribute to an ineffective handoff are fatigue, job experience, variations in the report process, staff shortages and the acuity of the patient. Many of these contributing factors can be improved upon. Variations in the report process can be eliminated through staff education. The clinical activity that I will be reviewing is shift to shift handoff report. Quality Improvement Interdisciplinary TeamIn order to develop a solution for the problem of ineffective handoff report, a quality improvement team needs to be assembled. There are several individuals that need to be included in the quality improvement (QI) team such as an experienced registered nurse (RN) and a newer graduate nurse with less experience. There also needs to be a representative from the nursing education department on the QI team. Both of the RN’s can provide different perspectives as to what they believe needs to be changed in order to improve the handoff report process. The handoff report process can seem very intimidating to the less experienced RN. Hearing from the perspective of a new RN can be very valuable. The less experienced RN can also offer ideas on how to better train a new RN the handoff process. The more experienced RN can offer suggestions as to what they believe will improve the process. The more experienced RN has seen which types of handoff processes have been used in the past and which ones were effective. The representative from the nursing education department can offer guidance as to what types of handoff report processes as available. The representative from the nursing education department can guide the QI team, as they discuss ways in which the handoff report process can be improved. Data Collection MethodThe data collection method that is used to analyze and present the causes of an ineffective handoff report is a fishbone diagram. “The fishbone diagram is an effective method of summarizing a brainstorming session” (Yoder-Wise, 2011 p.398). This data collection method will allow the QI team to sort through the factors that may be the cause an ineffective handoff report. According to Friesen, White & Byers (2003), possible causes of an effective handoff report are nursing staff that are inexperienced, staff fatigue, variations in the report process, and a shortage of nursing staff. Other possible causes are limited physical space to give report and the high acuity of the patient (Friesen et al., 2003)Goal for ImprovementAn ineffective handoff report can be detrimental to patient safety. An ineffective handoff report can result in medication errors and even patient death. There can be wide variations in the way a handoff report is performed. According to a study performed by the Australian Council of Safety and Quality in Health Care, it has been found that there is “a lack of knowledge regarding effective handoff processes and education on effective handoff strategies” (Friesen et al., 2003 ). A goal for improvement for handoff report would be that every staff nurse be educated on the effective approach for handoff report and follows the standardized approach per hospital guidelines. Implementation of Strategies“The issue of ineffective handoff reporting is such a problem that the Joint Commission developed a set of guidelines and suggestions for handoff reporting with the goal of maintaining patient safety” (Friesen et al., 2003 ). Preventing the potential effects of a poor handoff report from occurring can be accomplished through staff education. The process for improvement would include the education of nursing staff on effective handoff strategies and the current hospital guidelines for handoff report. The guidelines as presented by the Joint Commission state that there should be “interactive communication allowing for the opportunity for questioning between the giver and the receiver of patient information” (Friesen et al., 2003). The Joint Commission guidelines also state there should be “up to date information regarding the patient’s care, treatment and services” (Friesen et al., 2003) The guidelines also suggest that there should be a “process for verification of received information such as repeating back information and staff should try to minimize the number of interruptions during report handoffs” (Friesen et al., 2003). The Joint Commission compiled a list of strategies for improvement of handoff report. According to Friesen, White & Byers (2003), some of the strategies included a standardized checklist of handoff requirements, to speak in a clear, simple manner and to avoid the use of jargon. Every nursing staff member would be required to view a power point presentation covering the strategies for a more effective handoff report and the hospital guidelines for report. After the nursing staff members had the opportunity to view the power point they would be required to take a quiz over the covered material and pass the quiz with a the minimum of eighty five percent. The implementation of this change would have to occur over a period of time to ensure staff compliance. As humans we can be resistant to change and nurses are no exception to the rule. Introducing the idea of a more standardized handoff report in small steps will give the nursing staff an opportunity to accept the change. First an email would be sent out to inform the nursing staff of the changes that will occur with handoff report. Then the staff would go through the education process regarding the handoff process. The new standardized handoff report process would then “go live” hospital wide. “Kurt Lewin proposed a three stage theory of change referred to as Unfreeze, Change, Refreeze. This theory explains the different stages that individuals go through when faced with change” (Connelly, 2008). The first stage of this theory is called the Unfreeze stage. “This stage is when the individual begins to understand that the change is necessary” (Connelly, 2008). The second stage is called the Change stage. This stage is also known as the transition stage. “This stage occurs as we make the required change” (Connelly, 2008). The last stage of this theory is called Refreezing. “This stage is about establishing stability once the changes have been made. The changes are accepted and become the new norm” (Connelly, 2008). Evaluation“As the strategy for change is implemented, the QI team continues to gather and evaluate data to document that the new outcomes are being met” (Yoder-Wise, 2011 p.104). The method for measuring improvement of the handoff report process will involving the audits of random nursing staff while they are performing a handoff report. The QI team will designate a nursing staff member to perform an audit of four other nursing staff members in their unit for a period of one month. The audits will be done randomly and the other staff members will not be aware of which nursing staff member will be doing the audits. After each audit is completed the designated nursing staff member will be required to fill out a standardized form that will evaluate the effectiveness of the handoff report they received. The completed forms will be returned to the QI team for review. The QI team will review the results of the audits and evaluate if further changes need to be made in order to ensure that the set outcomes are met. Every month a different nursing staff member will be designated as an auditor. After several months of the evaluation process had been completed, a survey would be distributed to all nursing staff members to evaluate what they had learned from the education process. Donald Kirkpatrick developed the evaluation theory that consisted of four levels of evaluation. “The first level is the reaction of participants to the training. The second level is the learning assesses the impact the program has had on the learning process. The third level is the behavior level and it is the ability to apply the newly learned skills. The fourth level of the evaluation theory is the results level. This level determines the success of a training program in operational and strategic terms” (Chiranton, 2012). Portions of this theory are used in the evaluation process for the implementation of a more effective handoff report. ReferencesByers, J. F., Friesen, M. A., & White, S. V. (April, 2006). Handoff: Implications for Nurses. Patient Safety and Quality: An Evidence-Based Handbook for Nurses (34). Retrieved from , Basu., (2012). Kirkpatricks Evaluation Theory. Retrieved from , M., (2008). Kurt Lewin Change Management Model. Retrived from , P.S. (2011). Leading and management in nursing (5th ed.). St. Louis, MO: Elsevier Mosby. ................
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