From the 2023 HVPA National Conference
Norsyma Jaffar BS (Johns Hopkins Aramco Healthcare), Rabie Kilan, Master Degree
Continuity of patient care is vital between patient care units transfer post-procedure to ensure that patients receive all necessary care and treatment. According to Joint Commission International Accreditation (2018) (1) , inadequate handover is a significant factor in ineffective communication among healthcare providers contributing to 80% of all adverse events. Communication failure is mainly caused by a deficiency of standardized guidelines or processes to deliver effective transitions within an organization. The use of SBAR (situation, background, assessment, and recommendation) as a structured communication method has been proven to be effective and efficient during handover (2) Comprehensive Unit-based Safety Program (CUSP) is a method that can help improve patient safety, clinical outcomes and safety culture (3).
The aim was to ensure effective and efficient handoff by standardizing the process of communication that follows the SBAR method of communication. Our goal was to achieve a 100% compliance to the handover process by December 31, 2022. To evaluate effectiveness of interventions, we will monitor number of phone calls related to post-procedure handover and incidents related to handover communication failure.
Through the implementation of CUSP in the Cardiac Catheterization Laboratory (Cath-lab), staff in the unit voiced out concerns that post-procedure handover between Cath-lab staff and receiving unit staff may not be effective and efficient. A few incidents and reports received from unit floor staff regarding miscommunication between Cath Lab nurses and receiving unit nurses regarding post-procedure handoff. Issues included missing information on medications, incomplete and non-standardized documentation in the procedure log, failure to communicate post-procedure plan and failure to acknowledge and carry out physician orders. The multidisciplinary CUSP core team conducted process mapping and root cause analysis to identify system factors that contribute to the challenges. What we found was that there was no standardized tool that includes all relevant information critical to ensure continuity of care post-procedure that provide guidelines and structure in the handover process.
After seeking feedback from physicians and nurses and with the support of leadership, a post-procedure checklist tool that contains all relevant information was developed, formatted on SBAR method and built in the electronic patient information chart (EPIC).The checklist will be filled-out and completed by Cath Lab nurses prior to transferring patient to the nursing care units and will be used during post-procedure handover. Cath lab nurses underwent training and orientation of the tool. The implementation of the new process was closely monitored to ensure compliance to the initiative.
Post-intervention interventions indicated outstanding improvement in the endorsement process. Data showed 100% compliance with the completion of post-procedure checklist prior to handover by Cath Lab nurses. Fewer phone calls were received pertaining to handover information over time and there were no reported adverse events related to communication.
Effective communication is one of the international patient safety goals that must be addressed and focused in an organization to ensure patients achieve better health outcomes. Deficiency in handovers is the main factor, as JCIA 2018 commented. Leadership plays an essential role in ensuring the standard of handoff communication is in place. A post-procedure checklist in SBAR format implemented in the Heart and Vascular Department as a communication tool is found to be effective and efficient tool during handover process to ensure patient safety and continuity of care.