Safety & Quality in the Preop/PACU setting

Report
Safety & Quality in the
Preop/PACU setting
1:15-2:15
Objectives
• Describe quality improvement and patient safety
goals.
• Identify safety practices that affect the patient and
the nurse in the perianesthesia arena.
Safety Culture
Best practices and best outcomes are important in today's
healthcare environment.
The perianesthesia environment of care is constantly
challenged with:
Introduction of new technologies,
Improved medications
Advances in surgical and nonsurgical procedures
Fast turnover
Increasing volume
High-acuity patients.
The integration of principles of safety and evidence-based
principles is a core value of perianesthesia practice.
National PATIENT SAFETY Goals (NPSG)
Effective 1/1/2013
• Joint Commission 2012 Patient Safety Goals
– Promote improvement
– Highlight problematic areas of health care – describe
evidence & expert based solutions
– System wide solutions
– Guided by sentinel Event Advisory Group
• Nationally recognized experts with hands-on
experience in health care organizations
• Annually recommend core and specific NPSG
•
Revised for 2012
Goal 1- Improve the accuracy of
patient identification
• NPSG.01.01.01 Use at least 2 patient identifiers
when providing care, treatment, and services.
• 1. Use at least 2 patient identifiers when administering
medications, blood, or blood components; when
collecting blood samples and other specimens for clinical
testing; and when providing treatments or procedures.
Patient’s room or physical location is Not used as an
identifier
• 2. Label containers used for blood and other specimens
in the presence of the patient.
Goal 1- Improve the accuracy of
patient identification
• NPSG.01.03.01 Eliminate transfusion errors related to patient
misidentification.
– 1. Before initiating a blood or blood component transfusion:
• Match the blood or blood component to the order..
• Match the patient to the blood or blood component.
• Use a 2 person verification process or a one person verication
process accompanied by automated identification technology, such
as bar coding.
– 2. When using a 2 person verification process; 1 conducting the ID
verification is the qualified transfusionist who will administer the blood
or blood component to the patient
– 3. When using a 2-person verification process, the second individual
conducting the ID verification is qualified to participate in the process,
as determined by the hospital.
Goal 2 – Improve the effectiveness of
communication among caregivers.
• NPSG.02.03.01 Report critical results of tests and
diagnostic procedures on a timely basis.
– 1. Develop written procedures for managing the
critical results of tests and diagnostic procedures:
– 2. Implement the procedures for managing the
critical results of tests and diagnostic procedures
– 3. Evaluate the timeliness of reporting the critical
results of tests and diagnostic procedures
Goal 3 – Improve the safety of using
medications
• NPSG.03.04.01 Label all medications, medication
containers and other solutions on and off the sterile field
in perioperative and other procedure settings.
• 1. In periop/procedural settings both on and off the
sterile field label meds and solutions that are not
immediately administered, even if only 1 med is used.
• 2. labeling occurs when any medication or solution is
transferred from the original package to another
container.
• 3. medication or solution labels include the following:
– Med name; Strength, Quantity; Diluent & volume;
Expiration date when not used within 24 hours;
Expiration time when occurs in less than 24 hours.
Goal 3 – Improve the safety of using
medications
• NPSG.03.04.01
• 4. Verify all meds or solution labels both verbally &
visually. Verification is done by 2 individuals qualified
to participate in the procedure..
• 5. Label each med or solution as it is prepared
• 6. Immediately discard any med or solution found
unlabeled.
• 7. remove all labeled containers on the sterile field
and discard their contents at conclusion of procedure
• 8. All meds & solutions both on and off the sterile
field and their labels are reviewed by entering &
exiting staff responsible for the management of meds
Goal 3 – Improve the safety of using
medications
• NPSG.03.05.01 Reduce the likelihood of
patient harm associated with the use of
anticoagulant therapy.
• 1. use only unit-dose products, prefilled
syringes, or premixed bags when these
products used
• 2. use approved protocols
• 3. Assess patient’s baseline coag status before
starting on warfarin
Goal 3 – Improve the safety of using
medications
• 4. use authoritative resources to manage
potential food & drug interactions for patients
receiving warfarin
• 5. When heparin is administered, use
programmable pumps.
• 6. A written policy addresses baseline and
ongoing lab tests
• 7. Provide education regarding anticoagulant
therapy and importance of follow-up monitoring
& compliance
• 8. evaluate anticoag safety practices.
Goal 3 – Improve the safety of using
medications
• NPSG.03.06.01 Maintain and communicate accurate patient
medication information.
• 1. Obtain information of meds patient taking
• 2. Define the types of medication information to be
collected in non-4 hour setting
• 3. Compare the med info brought to the hospital with meds
ordered in the hospital for pt.
• 4. Provide the patient with written info on the meds they
should be taking when discharged from the facility.
• 5. Explain the importance of managing med information to
the patient when discharged from the facility.
Goal 7 – Reduce the risk of health careassociated Infections.
• NPSG.07.01.01: Comply with the current CDC
hand hygiene guidelines or the WHO hand hygiene
guidelines
1. Implement a program that follows either the
CDC or the WHO hand hygiene guidelines
2. Set goals for improving compliance with hand
hygiene guidelines
3. Improve compliance with hand hygiene
guidelines based on established goals.
Goal 7 – Reduce the risk of health
care- associated Infections.
• NPSG.07.03.01: Implement evidence-based
practices to prevent healthcare-associated
infections due to multidrug-resistant organisms in
acute care hospitals.
• 1. Conduct periodic risk assessments for
multidrug resistant organism acquisition and
transmission
• 2. Based on results of risk assessment, educate
staff about health care – associated infections,
multidrug resistant organisms & prevention
strategies at hire and annually thereafter.
Goal 7 – Reduce the risk of health
care- associated Infections.
• 3. Educate patients and their families
• 4. Implement a surveillance program for
multidrug-resistant organisms based on the risk
assessment
• 5. Measure and monitor multidrug-resistant
organism prevention processes and outcomes…
• 6. Provide multidrug-resistant organisms process
& outcome data to key stakeholders including
leaders, LIP, nursing staff & other clinicians
Goal 7 – Reduce the risk of health
care- associated Infections.
• 7. implement policies and procedures aimed at
reducing the risk of transmitting multidrug
resistant organisms…..
• 8. when indicated by the risk assessment,
implement a lab based alert system that
identifies new patients with multidrug-resistant
organisms…..
• 9. When indicated by the risk assessment,
implement an alert system that identifies
readmitted or transferred patients who are know
to be positive for multidrug-resistant organisms.
Goal 7 – Reduce the risk of health
care- associated Infections.
• NPSG.07.04.01 Implement evidence based
practices to prevent central line-associated
bloodstream infections.
• 1. Educate staff and LIP who are involved in
managing central lines about central linesassociated bloodstream infections and the
importance of prevention
• 2. Prior to insertion of a Central venous cath,
educate patient and as needed their families
about central line associated bloodstream
infection prevention
Goal 7 – Reduce the risk of health
care- associated Infections.
• 3. Implement policies and practices aimed at
reducing the risk of central line – associated
blood stream infections.
• 4. Conduct periodic risk assessments for central
line-associated blood stream infections, monitor
compliance with EBP, and evaluate the effectives
of prevention efforts
• 5. Provide central line – associated bloodstream
infection rate data and prevention outcome
measures to key stakeholders…
Goal 7 – Reduce the risk of health
care- associated Infections.
• 6. Use a catheter checklist 7 standardized
protocol for CVP insertion.
• 7. Perform hand hygiene prior to cath
insertion/manipulation.
• 8. For adults, do not insert catheters into
femoral vein unless no other site available.
• 9. Use a standardized supply cart that
contains all necessary components for
insertion.
Goal 7 – Reduce the risk of health
care- associated Infections.
• 10. Use a standardized protocol for sterile barrier
precautions during Central venous cath insertion.
• 11. Use an antiseptic for skin prep during CVP
insertion that is cited in scientific literature and
endorsed by professional organizations.
• 12. Use a standardized protocol to disinfect
catheter hubs and injection ports before
accessing the ports.
• 13. Evaluate all CVP catheters routinely and
remove nonessential catheters.
Goal 7 – Reduce the risk of health
care- associated Infections.
• NPSG.07.05.01 Implement EBP for preventing
surgical site infections
• 1. Educate staff and LIP involved in surgical
procedures about surgical site infections and
the importance of prevention. Educate on hire
and annually thereafter.
• 2. Educate patients & families as needed
• 3. Implement P&P aimed at reducing the risk
of surgical site infections…
Goal 7 – Reduce the risk of health
care- associated Infections.
• 4. As part of the effort to reduce surgical site infections
(SSI)
– Conduct periodic risk assessments for SSI in a time
frame determined by the hospital.
– Select surgical site infection measures using best
practices or EBP guidelines
– Monitor compliance with best practices or EBP
– Evaluate the effectives of prevention efforts
• 5. Measure SSI rates for the first 30 days following
procedures that do not involve inserting implantable
devices
• 6. Provide process and outcome measure results to key
stakeholders
Goal 7 – Reduce the risk of health
care- associated Infections.
• 7. Administer antimicrobial agents for
prophylaxis for a particular disease/procedure
according to methods cited in scientific
literature or endorsed by professional
organizations.
• 8. When hair removal is necessary, use a
method that is cited in scientific literature or
endorsed by professional organizations.
Goal 7 – Reduce the risk of health
care- associated Infections.
• NPSG.O7.06.01 Implement EBP to prevent
indwelling catheter-associated urinary tract
infections (CAUTI). This is not applicable to ped
patients.
• 1. Insert indwelling urinary catheters according
to established EBP that address
– Limiting use and duration to situations necessary for
patients
– Using aseptic techniques for site prep, equipment and
supplies
Goal 7 – Reduce the risk of health
care- associated Infections.
• 2. Manage indwelling catheters according to
established EBP that address:
– Securing catheters for unobstructed urine flow
and drainage.
– Maintaining sterility of urine collection system.
– Replacing the urine collection system when
required
– Collecting urine samples
Goal 7 – Reduce the risk of health
care- associated Infections.
• 3. Measure and monitor cath-associated
urinary tract infection prevention processes
and outcomes in high volume areas by doing
the following:
– Select measures using EBP/best practices
– Monitor compliance with EBP/best practices
– Evaluating the effectiveness of prevention
efforts
Goal 15- The hospital identifies safety
risks inherent in its patient population
• NPSG.15.01.01 Identify patients at risk for suicide.
{Applies to psych hospitals & those patients being
treated for emotional or behavioral disorders in general
hospitals}
– 1. Conduct a risk assessment that identifies patient
characteristics and environmental features that may
increase or decrease risk for suicide.
– 2. Assess patient’s immediate safety needs
– 3. When a patient at risk for suicide leaves the care
of the hospital, provide suicide prevention
information
U.P. The organization meets the
expectations of the Universal Protocol
• UP.01.01.01 ®Conduct a pre-procedure
verification process
– 1. Implement a preprocedure process to verify
the correct procedure, for the correct patient at
the correct site.
– 2. Identify the items that must be available for
the procedure and use a standardized list to verify
their availability
– 3. Match the items that are to be available in the
procedure area to the patient
U.P. The organization meets the
expectations of the Universal Protocol
UP.01.02.01 Mark the procedure site
1. Identify those procedures that require
marking of the incision or insertion site. At a
minimum, sites are marked when there is more
than one possible location.
2. Mark the procedure site before the
procedure is performed and, if possible, with the
patient involved.
3. The procedure is marked by a LIP who is
accountable for the procedure & will be present
when the procedure is performed.
U.P. The organization meets the
expectations of the Universal Protocol
• 4. The method of marking the site & the type
of mark is unambiguous and is used
consistently throughout the hospital.
• 5. A written, alternative process is in place for
patients who refuse site marking or when it is
technically or anatomically impossible or
impractical to mark the site. ( mucosal
surfaces, perineum)
U.P. The organization meets the
expectations of the Universal Protocol
• UP.01.03.01 A time-out is performed before the procedure.
– 1. Conduct a time-out immediately before starting the
invasive procedure or making the incision.
– 2. The time-out has the following characteristics:
• Standardized as defined by the hospital
• Initiated by a designated member of the team.
• Involves the immediate members of the team:
–Individual doing the procedure, -Anesthesia
–Circulating nurse,
-Operating room tech
– Participants involved in the procedure from the
beginning
U.P. The organization meets the
expectations of the Universal Protocol
• 3. When 2 or more procedures are being
performed on the same patient, and the person
performing the procedure changes, perform a
Time Out before each procedure is initiated.
• 4. During the Time Out, the team members agree
at a minimum, on the following
– Correct patient identity; Correct site; Procedure to be
done.
• 5. Document the completion of the Time Out
www.jointcommision.org
QUALITY IMPROVEMENT
• Formal approach to analysis of performance
and systematic efforts to improve
• Ongoing effort to make things better.
Surgical Care Improvement Project
(SCIP)
• Large national partnership dedicated to
reducing the number of preventable surgical
complications
• A national campaign was launched to
substantially reduce surgical mortality and
morbidity through collaborative efforts.
• Steps that can be taken to lower the number
of surgical problems.
SCIP: Infection
• 1. Prophylactic antibiotic received within one hour prior to
surgical incision
• 2. Prophylactic antibiotic selection for surgical patients
• 3. Prophylactic antibiotic discontinued within 24 hours
after surgery end time. (48 hours for cardiac patients)
• 4. Cardiac Surgery patients with controlled 6AM
postoperative serum glucose (200 mg/dL)
• 6. Surgical patients with appropriate hair removal
• 7. Colorectal surgical patients with immediate
postoperative normothermia.
• 9. Urinary catheter removed on POD 1 or POD 2 with day
of surgery being day 0.
• 10. Surgery patients with perioperative temperature
management.
SCIP: Cardiovascular
• 2. Surgical patients on a beta-blocker prior to
arrival that received a beta blocker during the
perioperative period.
SCIP: Thromboembolic
• VTE 1: Surgical patients with recommended
venous thromboembolism prophylaxis
ordered.
• VTE 2: Surgery patients who received
appropriate venous Thromboembolism
prophylaxis within 24 hours prior to surgery to
24 hours after surgery.
Staff Safety
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Violence in the Workplace
Shift work & Long hours
Musculoskeletal Injuries
Needle sticks
Chemical Occupational Exposures
Mental Health Effects of Nursing work
Violence in the Workplace
• OSH Act of 1970 mandates employers have a
duty to provide workplace free from recognized
hazards likely to cause death or serious harm
• 25/10,000 FT nurses were assaulted in 2000
Physician (Patient ) shoots nurse in Denver
hospital
What is Horizontal Violence?
• Horizontal violence or lateral violence can be
described as overt or covert aggressive and
destructive behavior of nurses against each
other.
• It’s more than ‘Nurses eat their young’….
Workplace Violence
• Intimidation
– Stalking
– Actions to frighten &
coerce
• Threats
– Expression of intent to
cause physical or mental
harm
• Property damage
– Intentional damage to
property
• Physical Attacks
– Unwanted hostile
physical contact
– Hitting
– Fighting
– Pushing
– Shoving
– Throwing objects
• Sexual harrassment
Sexual Harrassment
Unwelcome Advances
Requests for sexual favors
Verbal or physical conduct of a sexual nature
When submission to or rejection of this conduct explicitly
or implicitly affects:
-person’s work or educational performance
-creates an intimidating, hostile or offensive working or
learning environment
Types of Behaviors
Types of Behaviors
Types of Behaviors
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Backstabbing
Disrespectful behaviors
Failure to respect privacy
Belittling remarks
Persistent criticism
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Intitmidation
Humiliation
False accusations
Social isolation
Unreasonable workloads
Risk Factors for Violence
• Working directly with
volatile people
• Transporting patients
• Long waits for service
• Overcrowded,
uncomfortable waiting
rooms
• Drug & alcohol abuse
• Access to firearms
• Unrestricted movement
of the public
• Poor environmental
design
• Working when under
staffed
– Meal times
– Visiting hours
– Call hours
• Working alone
• Lack of staff training &
policies for managing
crises
• Poorly lit corridors,
parking lots and other
areas
• Inadequate security
Alternative terms
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Mobbing
Bullying
Lateral Violence
Nurse Hazing
Horizontal Violence
Verbal Abuse
Workplace Violence
Workplace Aggression
Incidence
• Scandinavian Countries – 1 to 5 %
• UK and US – 10 to 38 %
• Australia – 50 to 57%
• Turkey – 86.5%
Causes
• Apathy towards ‘bad’ behaviors
– Desensitized
– “It is what it is.”
• Enabling
– “That’s just the way she/he is”
– “She/he is just having a bad day”
• Complacency
– “I don’t have time to deal with it”
– “I don’t want to get involved”
– “A silent witness”
• Fear of retaliation
– “If I say something, I’ll be the next target”
Causes
• Subservient role to MDs
(oppressed-group model =
perceived lack of power)
– Nursing, under
Florence Nightingale,
developed as a very
hierarchical system
where submission was
‘expected, encouraged,
indeed, demanded’.
• Low self esteem
• Leadership too
authoritarian/too ‘laissezfaire’
• Stressful work
environment – volatility
– Shrinking resources
– Downsizing
– Restructuring
• Demanding work
Workplace Violence
• Nurses are responsible for reporting any
disruptive behavior in the workplace to the
management team
• Leaders and educators must educate and
mentor nurses empowering them to manage
perceived workplace violence
• Leaders must develop guidelines within their
own settings to incorporate this position
statement
(CSPS)
Council on Surgical & Perioperative Safety
• Position Statement:
-Violence or threat of such must NOT be tolerated
-Violence directed toward the Periop team interferes
with the provision of safe competent and ethical care
-Responsibility for providing an environment free of
violence is shared among the org, members of the
periop team, patients and
their
families
(CSPS)
Council on Surgical & Perioperative Safety
Position Statement (cont)
-Organizations should implement policies that support
violence-free workplaces
-The confidentiality of the individuals involved should
be taken into consideration but not interfere with an
aggressive approach to the issue
Shift work & Long hours
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Musculoskeletal Injuries
Needle sticks
Chemical Occupational Exposures
Mental Health Effects of Nursing work
Musculoskeletal Injuries
• Health care workers at high risk for Back, neck and upper
extremity injuries
• Lead to sick days, disability and turnover
• Physical/postural risk factors
– Static postures maintaining tension on instruments in
OR- Head, neck, back stress
– Lifting & stooping associated with arm and neck
complaints
– Pushing & Pulling motions associated with shoulder
complaints
Musculoskeletal Injuries
• Impact of Work schedules
– Long hours leads to musculoskeletal injuries:
• Extended exposure to physical/postural risk
• Insufficient recovery time
– Rotating shifts
• Inadequate sleep
Musculoskeletal Injuries
• Evidenced Based Interventions for MSD
– Patient handling equipment/devices (height
adjusted electric beds, patient lifts, bed
repositioners)
– No-lift policies (Minimize manual patient handling)
– Training on proper use of patient handling
equipment/devices
– Patient lift teams (2 physically fit people
competent in lifting techniques)
Needlesticks
• In a 2008 ANA survey 2/3 of 700 nurses surveyed say
needlesticks and bloodborne infections are major
concerns
• 1/2 go unreported
• 64% involve nurses
• Occupation acquired
– Hepatitis B: 6-30%
– Vaccine: HBV
– Hepatitis C: 0.4-1.8%:
– No vaccine
– HIV: 0.3%
• Safer needle devices
Chemical Occupational Exposures
• Hazardous chemical exposures occur in a
variety of forms
– Aerosols
– Gases
– Skin contaminants
• Substances used can cause asthma or trigger
asthma attacks
Nitrous Oxide
• Anesthetic Gas
• Harmful effects
– Hematological alterations
– Neurological alterations
• Decreases in mental performance
• Decreases in Audiovisual ability
• Decreases in manual dexterity
– Reproductive abnormalities
• Spontaneous abortion
• Birth defects
• Reduced fertility
Krajewski W, M. Kucharska, Wesolowski et al. Occupational
exposure to nitrous Oxide. AORN Journal
September 2008 pp. 466-467
Nitrous Oxide
• Occupational exposure limit in the air should
not exceed 25 ppm in USA
• Should have no greater than 2ppm of volatile
hydrogenated hydrocarbon when combined
with Nitrous Oxide
Krajewski W, M. Kucharska, Wesolowski et al. Occupational exposure to nitrous Oxide. AORN Journal
September 2008 pp. 466-467
Latex Exposure
• Latex exposure from natural proteins in
rubber latex
• Symptoms:
– Contact dermatitis
– Asthma
– Anaphylaxis
• ANA position statement: Use of low-allergen
powder free gloves and remove latex
containing products from worksite
Mental Health Effects of Nursing Work
with job strain
• Tension
• Depression
• Anger
• Anxiety
• Anxiety
disorders
• Depressed
• Psychotic
mood
disorders
• Mental fatigue
• sleep
disturbance
Major Morbidities
ASPAN Position Statement
on Fatigue
• 2010-2012 PeriAnesthesia Nursing Standards and
Practice Recommendations Statement
– Position Statement 4A: ASPAN Fatigue Evaluation Check
List
– ASPAN recognizes fatigue among nurses is a potentially
dangerous situation.
– Factors related to nurse fatigue include
• Professional scheduling factors (on call; Mandatory OT)
• Personal factors (age, OT, work more than 1 job)
• Job performance (fall asleep, struggle to stay awake)
• Nurse health (Musculoskeletal injury, needle stick)
Sleep deprivation
• Research has shown that a person can recover
from sleep deprivation after 2 consecutive
nights of adequate sleep (6-8 hours), even
after several days of working 12 hour shifts.
Staff Safety
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Violence in the workplace
Shift work & long hours
Musculoskeletal injuries
Needle sticks
Chemical occupational exposures
Mental health effects of nursing work
Handoffs –
Transfer of Care
• Transfer of patient information and
responsibility between health care
providers
• Handoffs occur at every shift change and
whenever a patient changes locations
Handover
• Communication that related the process of
passing patient specific information from one
caregiver to another; from one team of
caregivers to the next, or from caregivers to
the patient and family for the purpose of
ensuring patient care continuity and safety
10 Most Common Hospital Patient HandOffs
• Ambulance to ED
• ED to inpatient unit
• ED to test (eg,
radiology)
• Direct admit from
clinic
• During procedures
• During surgery
• After surgery
• From inpatient unit
to inpatient test
• Nursing shift
change
• MD to MD report
Communication Breakdown
Studies reveal that a majority of avoidable
adverse events are due to the lack of
effective communication…
– Lost information
– Misinterpretation
– Misdirected or missed actions
...this has spurred a national movement to
improve communication during handoffs and
patient care transitions
Poor Communication
• “…several studies have shown that twice as
many errors occur due to poor
communication than to incompetence.
• An astounding 26% of medical errors can be
attributed to poor communication between
caregivers.”
Handoffs
• “In other contexts, such as air traffic control,
handoffs are structured and practiced
repeatedly to ensure successful transitions
from one person to another, yet most
healthcare organizations still rely primarily on
ad hoc, loosely managed exchanges between
care team members.”
http://www.mercurymd.com/en/Solutions/PatientHandoff/
Communication Breakdown
• Anesthesia related
events
• Delays in treatment
• Infection
associated events
• Maternal deaths &
injuries
• Medication errors
• Operative/Postop
events
• Perinatal deaths &
injuries
• Restraint deaths
• Ventilator events
• Wrong-site surgery
Handoffs –
Transfer of Care
• Joint Commission Requirements
2008 National Patient Safety Goal
– Implement a standardized approach to
“hand off” communications, including an
opportunity to ask and respond to
questions
• Written or taped reports between shifts - do
not allow for questions to be asked
TJC “Attributes” of Effective Hand-Off
Communications
• Hand offs are interactive communications
allowing the opportunity for questioning
between the giver and receiver of
patient/client/resident information
• Hand offs include up-to-date information
regarding the patient’s/client’s/resident’s
care, treatment and services, condition, and
any recent or anticipated changes
TJC “Attributes” of Effective Hand-Off
Communications
• Interruptions are limited during hand offs to
minimize the possibility that information
would fail to be conveyed or would be
forgotten
• Hand offs require a process for verification of
the received information, including repeatback or read-back, as appropriate
TJC “Attributes” of Effective Hand-Off
Communications
• The receiver of the hand off information has
an opportunity to review relevant
patient/client/resident historical data, which
may include previous care, treatment, and
services
Verbal or Face-to-Face Report
• Is a verbal or face-to-face interaction between
sender and receiver required?
– Requirement: there must be “an
opportunity to ask and respond to
questions”
– This is an opportunity - need to have
standardized processes in place to assure
communication occurs
– How do you provide for questions to asked,
answered?
ASPAN
Safe Transfer of Care
• The receiving unit will be notified of
impending transfer
– How do you do this?
• The receiving licensed nurse will be given a
complete report before or at the time of
transfer
– How is this accomplished?
Safe Transfer
• Opportunity was present for questioning
between the giver and receiver of the
patient
– Follows NPSG statement
– What does this look like where you are?
Tools to Use
for Better Handoffs
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I PASS THE BATON (AHRQ)
Ticket To Ride
Nursing Knowledge Exchange (Kaiser Permanente)
SBAR –(Situation-Background-Assessment,
Recommendations)
• SHARED (Standardized Critical Content-Hardware
within system- Allow opportunities to
Ask ?, Reinforce Quality & Measurement)
• SHAR-Q- (Situation-History-AssessmentRecommendation-??)
HANDOFF
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H – Hello
A – Assessment
N – Necessary patient information
D – Danger of Risks
O – Occurrernce
F – Framework
F- Future Recommendation
S-Seek ????
Keys to
Successful Handoffs
• Communication
– Interdisciplinary
– Multidisciplinary
• Tools
– Develop standardized tools to provide consistent
information across all areas
• Provide means for feedback and process
improvement
Handoffs –
Transfer of Care
• What methods are working in your practice
environment?
• What improvements would you
recommend?
• What data supports your process for
handoffs?
Let’s be Safe
[email protected]

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