Four tips to meet JCAHO hand-off goal

Nurse Leader Insider, October 7, 2005

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A Joint Commission on Accreditation of Healthcare Organizations (JCAHO) National Patient Safety Goal for 2006 will require hospitals to look beyond the obvious to find areas of noncompliance.

"Hand-offs are one of the most vulnerable periods for communication failures," said Della Lin, MD, the chief executive director of continuing medical education at Queen's Medical Center in Honolulu, during the recent HCPro audioconference "JCAHO's Patient Safety Goals for 2006: Tips and recommendations for compliance."

National Patient Safety Goal # 2E requires hospitals to implement a standardized approach to hand-off communications and provide an opportunity for staff to ask and respond to questions about a patient's care. The goal takes effect January 1.

Hand-offs occur at every level of care, Lin said, including

  • during nursing shift changes and relief breaks
  • at the transfer of care from one physician to another
  • when occupational, respiratory, or physical therapy take over care
  • during technician shift changes
  • at a transfer between units (e.g., within the hospital, to another facility, or at discharge)

Avoid an information black hole

Problems can occur when information about a patient gets lost during a shift change or a transfer, Lin said. For example, one nurse could be ending a shift and another one starting a shift, and both could miss a patient's scheduled time to receive a medication.

The following are four ways to meet the hand-off goal and ensure the continuity of care:

1. Use verbal communication

Hand-offs should include verbal communication and allow for face-to-face interaction, Lin said. Staff should be able to ask questions about a patient's care.

Tip: Limit the use of faxed or e-mailed reports during hand-offs. Staff could miss a faxed report until after the hand-off occurs, or the fax could go to a machine without paper.

2. Read back information

Using read-back techniques will aid in verbal hand-off communication, Lin said.

National Patient Safety Goal # 2A requires staff receiving verbal or telephone orders or critical test results to read back the order or result after writing it down. That goal works just as well during hand-offs, Lin said.

3. Write down the basics

Update information in the same order every time, Lin said. This routine will reduce the likelihood that someone will miss vital information.

The situation, background, assessment, and recommendation (SBAR) technique will help you to facilitate hand-offs, Lin said. Staff will be able to give basic information about a patient using the same format every time.

Tip: Using a checklist will help ensure vital steps in care occur during a transfer. For example, there may be ambiguity about who is responsible for hanging antibiotics during a transfer from the emergency room to the ICU. Proper communication and a checklist of duties would ensure staff know which duties to perform.

4. Identify the type of hand-off

Implementing the goal requires knowing where hand-offs occur throughout the organization.

Tip: Identify all areas where hand-offs occur. Categorize the nature of the hand-off (e.g., physician to physician or unit to unit).

Source: This article is adapted from Briefings on JCAHO, October 2005, HCPro, Inc.

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