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A nutty idea for handling patient handoffs

Nurse Leader Weekly, October 2, 2006

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At Blount Memorial Hospital in Maryville, TN, staff are encouraged to "Just Go NUTS" during patient handoffs.

Just Go NUTS is the name of the hospital's handoff program. NUTS is shorthand for the following four steps that the hospital expects staff to take when transferring the care of a patient:

• N is for Name. Staff should give a patient's name, other identifying information, and current diagnosis.
• U for the Unique. This is where staff would relate information that's specific to a patient's care (e.g., pain management and any critical lab values).
• T is for Tubes. Staff should recount any IVs, catheters, or other tubing used with a patient.
• S is for Safety. Concerns such as fall risks and medication reconciliation should be expressed in this last step.

The program was recommended to the hospital by a JCAHO surveyor as a way to comply with the commission's patient handoff National Patient Safety Goal (NPSG), according to Patient Safety Officer Susan Wood, RN.

Rolling out to the floor

Wood started by introducing the program to the various working committees in the hospital, where she received consensus support. She then introduced it to the board of directors, which embraced it as a smart way to address the needs of the JCAHO's NPSGs on handoffs.

Once the program was approved by the hospital's various committees and board, Just Go NUTS posters were put up in the hospital. The signs were also placed at every chart box in patient rooms.

Train everyone with a broad tool

After the posters were introduced around the hospital, staff and executives alike attended inservice training to better understand NUTS and what sort of information was expected to be shared during a handoff.

She says that expectation differs depending on the staff involved and where a patient is being sent. Transporters were sent to inservice training to use the tool along with nurses, physicians, and other clinical staff.

Although transporters don't need some of the more detailed information that nurses would share with each other, they do need to be aware of tubing connections, a patient's pain management, whether he or she is on oxygen, and other conditions.

Wood says staff took to the program immediately. It's been so successful, that the hospital plans to include Just Go NUTS in other patient safety programs, such as its patient falls program, she adds.

Editor's note: This excerpt was adapted from Briefings on Patient Safety, October 2006, HCPro, Inc.

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