Utilization of a Standardized Handoff Tool (PSYCH) to Reduce Errors of Omission

Abstract

Problem: The “handoff process” between nurses at shift change on an inpatient behavioral health unit of a large community teaching hospital in the Baltimore-Washington area was characterized by ineffective communication patterns that posed a risk to patient safety. Common problems with the handoff process include regular omissions of pertinent background information, inclusion of repetitive or non-essential health information, and patient overviews which are limited to the most recent nursing shift. Purpose: The purpose of this quality improvement project (QIP) was to implement a standardized handoff tool, PSYCH, on an inpatient behavioral health unit, and to evaluate the utility of this intervention in supporting the handoff process between nurses at change of shift. Methods: The QIP was implemented over eleven weeks. During this time, an evidence-based handoff tool was selected, an implementation team was mobilized, and change champions were mentored on the use of implementation tactics. A learning module was developed to educate nurses on how to use the handoff tool prior to implementation. The handoff was audited before and during implementation to obtain data for the identified outcome measure – nursing satisfaction – and the two identified process measures - utilization of the handoff tool and inclusion of specific patient information during handoff. Project outcomes were audited on a weekly basis and shared with the nursing staff to provide a marker for progress and to support behavioral changes. Results: Findings suggest that the majority of nurses were willing to use the PSYCH handoff tool to give report (90% average utilization rate during the implementation period), and specific patient information (e.g., code status, allergies, medical diagnosis, psychiatric diagnosis, and reason for admission) was reported with greater frequency when a standardized handoff tool is used. Staff members were also more likely to report higher satisfaction with the handoff process when a standardized communication tool was used compared to no standardized tool. Conclusions: Utilization of a standardized communication tool on an inpatient behavioral health unit has the potential to increase patient safety as nurses are more likely to report key aspects of the patients’ health condition.