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Ensure safe handoffs between nursing staff with these three tips

Nurse Leader Weekly, February 11, 2005

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Researchers at the Veterans Health Administration Getting at Patient Safety (GAPS) Center analyzed how space shuttle mission control conducts shift changes. They then used this data to identify strategies that can be used in healthcare. The resulting paper, "Handoff strategies in settings with high consequences for failure: Lessons for health care operations," was published in the International Journal for Quality in Health Care, Volume 16, 2004.

The paper recommends the following strategies for conducting safe shift changes, although Emily Patterson, PhD, a research scientist at GAPS notes that they may need modification depending on the facility:

1. Institute a "face-to-face checkout" process. Many acute care hospitals have nurses hand off by audiotaping an update on patients, but this approach leads to several problems, Patterson says. First, the incoming nurse does not have an opportunity to ask questions to clarify his or her understanding of the update. Second, the tape can become garbled or muffled with background noise, making it difficult to understand.

In order to maximize efficiency, have nurses continue to audiotape updates and then meet face-to-face with the incoming nurse for 15-30 seconds to answer questions.

2. Upgrade your technology. If face-to-face updates are out of the question, implement new technology to facilitate the shift change. Often, nurses will tape their updates before the end of their shifts so they do not have to wait in line for a machine at the end. But doing so might mean that the incoming nurse does not have the most accurate information when reviewing the tape.

Therefore, make multiple tape recorders available so that nurses know they will have access to one immediately before the shift ends. In addition, digital markers on tapes allow the incoming nurses to skip over the old patient updates and find the appropriate information right away.

3. Overhear updates. One of the major benefits of recording updates is that nurses gather to hear all of them, taking notes only on the ones relevant to their own patients. Listening to other nurses' updates is a worthwhile practice however, because it alerts them to watch for patients at risk of falling or choking, for example. Also, if a patient has an urgent need, nurses other than the primary caregiver are aware, for example, that a patient is HIV-positive or has a "do-not-resuscitate" status.

The charge nurse also benefits from overhearing the updates. It allows him or her to better schedule which nurses accept incoming patients and when nurses can leave the floor for breaks and patient transfers.

Source: Adapted from Briefings on Patient Safety (February 2005), published by HCPro, Inc.

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