Improving RN Communication during Shift-to-Shift Handoff

Brittany Wils, BSN, RN, CMSRN, Bree Nacsa, BSN, RN, CMSRN, Mark Moon, MS, BSN, RN-BC, Angela Geschrey, MSN, BSN, RN, CMSRN, John Overby, BSN, RNC-NIC, Shirley Ambutas, DNP, APRN, CCRN, CCNS, Mary Carol Racelis, MSN, APRN, ACNS-BC, Denina McCullum-Smith, MSN, CMSRN, Nicole Wynn, DNP, RN-BC, Aaron Franklin, MSN, RN, CMSRN, Carline Guerrier, MSN, APRN, AGPCNP-BC, Cathy Smith, MSN, CMSRN, Kerem Korkmaz, MSN, RN, CENP, Janet Stifter, PhD, RN, CPHQ

Brittany Nacsa and Brittany Wils
L. to R., Brittany Nacsa and Brittany Wils

In February 2019, the 9 South Unit Advisory Committee implemented a unit-based quality improvement project to standardize nurse-to-nurse patient report.

The project was developed based on The Joint Commission (TJC) report, which noted communication breakdown to be a top cause of sentinel events from 2011 to 2013. Improving shift hand-off communication was noted as a primary solution.

The Epic “Inpatient Handoff” tool for Registered Nurses (RN) was developed by Mark Moon, Project Lead for Clinical Applications. This aligns with TJC recommendations to maximize use of the electronic medical record.

The categories guiding the handoff tool are represented by I-PASS, which stands for illness severity, patient summary, action list, situation awareness and contingency plans, and synthesis by receiver.

There are narrative portions completed by the RN, as well as information that auto-populates from Epic documentation. This interactive hand-off tool is updated during each shift by the off-going nurse. During shift handoff, face-to-face communication occurs at the bedside, utilizing a computer between the off-going and on-coming nurses. Following this, nurses go to the bedside for the ‘Synthesis by Receiver’ portion, where the plan of care is reviewed with patient/family, introductions take place, and safety checks are completed.

Following the pilot, which ran from February 2019 to May 2019, 80% of 9 South staff members chose to continue using the tool. When comparing pre and post implementation data, the self-reported time in minutes taken to give report decreased by almost 10 minutes. Pre and post implementation survey results revealed a 30% increase in staff who were ‘very satisfied’ with the new shift handoff process.

Improved efficiency was reflected by decreased RN overtime from prolonged shift report. When reporting how well staff understood their patient information after receiving handoff using the new versus previous, more variable communication method, 41% felt they had an improved understanding of their assigned patients’ information.

Due to the success of the 9 South pilot project, Brittany Wils and Bree Nacsa led a cross-area nursing team to share this best practice across 12 inpatient acute care units at RUMC. The I-PASS tool went live across these units on September 14, 2020 with early measures of successful adoption and positive feedback from nurses.