Standardizing Handoff Decreases Episodes of Missed Care

Abstract

Background:

Respiratory Care has their own practice for handoff, all include face-to-face communication, but many are not given bedside. No process is in place defining how to deliver handoff. This leads to avoidable errors. Moving to a standardized approach utilizing our EMR can help with consistency increase patient safety. Among hospitalized children who require respiratory therapy does standardizing handoff between respiratory therapists (RTs) compared to non-standardized handoff affect patient safety such as episodes of missed care? .

Methods:

Evidence-based model for evidence-based practice change search strategy. The initial search identified 106 articles, 89 were discarded, as they were duplicates or not related to the question based on title and abstract review. 17 articles were reviewed in full text and appraised. Keywords: handoff, missed care, respiratory therapy, end of shift, beside handoff, shift report, missed orders, handover, medical errors. Databases searched: MedLine, Cochrane Database, CINAHL, PubMed. Filters used: Publication date 2000-present, English language, pediatric/adult critical appraisal 7 studies answered the question: 1 lesser quality systematic review, 2 longitudinal, 3 QI, and 1 cohort.

Results:

The evidence received a moderate grade and showed that a standardization reduced falls, medical errors, pressure ulcers, preventable adverse events, mortality, codes, infection rates, line errors, delay of care, and documentation errors. The 7 studies shared similar mnemonics none were superior to another. It is strongly recommended that health care professionals utilize a standardized handoff for transitions in patient care to reduce missed care.

Conclusions:

Implementation of standardization would need support from administration. Changing the way RTs perform handoff is a culture change that will impact all RTs. Communication of perceived benefits including safety and cost perspectives will be needed. Implementing a standardized bedside handoff across the organization for the RTs needs to involve the EMR. Staff will utilize a standard patient list, handoff tool and safety check. All RTs will need access to a computer. Expectations will be defined on how to perform handoff, prior to implementation support will be needed to develop and provide RTs with education. Evaluation needed post implementation: audits of adherence, measured outcomes (UE, VAE, safety events, and RT satisfaction). Baseline data collected, IRB submitted, begin with one pilot unit.