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Nur 598 Ineffective Patient Handoff Essay

1867 words - 8 pages

Ineffective Patient Handoff: A Clinical Issue

Ineffective Patient Handoff: A Clinical Issue

Patient care errors occur in health care due to lack of effective communication. It is estimated that 80 percent of serious adverse events involve ineffective handoff between medical providers (Joint Commission Center, 2013, para. 1). “The majority of avoidable adverse events are due to the lack of effective communication” (Solet, Norvell, Rutan, & Frankel, 2005, p. 1094). Varying styles of communication and interruptions are barriers to the effective handoff and can be a detriment to successful implementation of an effective communication strategy. The inquiry for this investigation is ...view middle of the document...

Performing a bedside handoff will permit the nurses to see the patient and instantly detect any immediate problems.

The objective is to provide solutions and support to the implementation of a bedside
handoff that includes a standardized tool to be rolled out by week eight. This project will show data that will provide best practice themes and theoretical frameworks giving health care personnel tools and skills in providing best patient care. Situation, background, assessment, and recommendation (SBAR) is the tool proposed for standardized use. The investigation of bedside handoffs along with the SBAR communication tool uses a population, intervention, comparison, and outcome (PICO) question and is stated as follows: For hospital patients, does the implementation of standardized bedside handoffs using SBAR reduce the risk of patient errors compared with handoffs that do not use a formal tool and take place outside the patient hospital room? The use of Lewin’s change theory (CT) and Battey’s humanizing nursing communication theory (HNCT) will guide the project to success using the theoretical concepts from each that support a practice change and basic human needs. The success of this project will include measureable goals that will be evaluated on a consistent basis by staff and leadership until the bedside handoff using SBAR is imbedded into hospital processes.
Bedside handoff using SBAR will begin as a pilot for one medical surgical floor in the hospital and by week 12 the process implemented on all floors. The plan is to implement bedside handoff using SBAR after proper training of personnel has completed. Organizational support will also be the driving factor in achieving successful implementation of this project. “Changes in long-standing patterns of ineffective communication will not be improved without the support of organizational leadership and the application of systems thinking” (Jukkala, James, Autrey, Azuero, & Miltner, 2012, p. 245). Allotting time for key staff members of the task force team along with staff to engage in the change process with regular meetings and obtaining proper training will ensure success. Staff, physician, and patient satisfaction will increase due to increased skill levels of the nurses through online learning modules.
This project uses Lewin’s change theory (CT) to assist in creating practice change by unfreezing, moving, and refreezing. The unfreezing will take place at staff meetings on two separate occasions a week apart to ensure that nurses are present during the informative process. The informative meetings will help nurses to realize the need for change and will facilitate staff involvement. A task force is created appointing key nurses who will move forward with this project. On week 3, the moving process of CT will begin to occur and new ideas will emerge on bedside handoff. The task force elicits ideas from the nurses and begins to create a workable SBAR tool. On week 4, bedside...

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