Assessing Standardized Handoff Adherence to Improve Continuity of Diabetes Care Management
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So, Grace
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Abstract
Problem: At a maternal-fetal care center in a mid-sized community hospital, Advanced Practice Registered Nurses (APRNs) provide care for patients with type 2 diabetes during pregnancy but are no longer involved in care after delivery. Consequently, there is a gap of care from the intrapartum to postpartum care period. Internal data revealed that 57.1% of these patients had a hemoglobin A1c level greater than 6.5%, indicating that there is a need for continuity of diabetes care management post-delivery. Purpose: The purpose of this quality improvement project was to improve continuity of care among women with pre-existing type 2 diabetes in pregnancy at a maternal-fetal care center by implementing and measuring Situation-Background-Assessment- Recommendation (SBAR) handoff, an evidence-based practice change. Methods: The Project Leader utilized various strategies to establish this new practice change. The Project Leader created a SBAR template in the electronic health record using SmartText phrases and educated the three clinic APRNs via visual demonstration. The three APRNs were tasked with providing referrals for patients without a Primary Care Provider (PCP) and sending SBAR handoff notes to the patients’ PCPs. The Project Leader performed weekly chart audits to track the percentage of referrals sent and handoff notes completed. Results: Only patients with type 2 diabetes with estimated delivery due dates within September to December 2024 were included in the data collection. Of the eligible patients, 44.4% of referrals were provided for patients who did not have a PCP, and 50% of handoff notes were sent for patients who identified a PCP. Conclusions: SBAR handoff is an evidence-based tool recommended to improve communication and the handoff process. The new practice changed improved continuity of care and can be utilized for future practice to help smooth transitions across patient care. Keywords: APRN, continuity of care, SBAR, handoff, type 2 diabetes