Nursing Malpractice in patient handoffs
Sources: Journal of Advanced Nursing 2013 69(2):247-62; University of Maryland School of Nursing Study
from the University of Maryland in Baltimore sheds light on a common nursing practice in hospital and surgical settings, which you might not be aware of -patient handoffs. Patient handoffs (“taking report”) occur when nursing staff changes shift, from am to pm or when a patient is transported to or from an operating room to a particular floor or unit of the hospital. Handoffs are nursing communication which can range from the patient’s latest vital signs to areas of particular concern or changes during a particular shift or prior to a transfer. Handoffs may take place at a nursing station or at a patient’s bedside. It was once a common practice to simply discuss a particular patient anywhere within the hospital, which is why you see signs in hospital elevators reminding staff not to discuss patients.
So how can handoffs result in nursing malpractice? Nursing errors may be compounded by the failure of a nurse to do something for a patient on one shift, such as re-positioning a patient in bed, followed by a failure to note this at handoff time. This could result in the patient not being re-positioned on two subsequent shifts. More obvious examples include failing to report significant changes in a patient’s vital signs or mental acuity to the incoming nurse at the time of handoff. Compiling research from medical databases, including studies from 1980-March 2011 in peer-reviewed journals, the researchers aimed to “synthesize outcomes from research on handoffs to guide future computerization of the process on medical and surgical units.”
Among their conclusions were that, “Handoffs can create important information gaps, omissions and errors in patient care.”
The study’s authors recommend computerization of handoffs as a way to prevent errors that may constitute nursing malpractice and which may result in harm to a patient. Verbal handoffs (where nurses communicate with one another regarding patients when transferring shifts) serve important functions beyond information transfer and should be retained. A Greater consideration was felt to be needed on analysing handoffs from a patient-centered perspective (oddly, we assumed this was always the perspective nurses took when attending to patients). The study suggested that handoff methods should be highly tailored to nurses and their contextual needs. The current preference for bedside handoffs (where a nurse changing shift discusses the patient at bedside, in front of the patient) is not supported.
The specific handoff structure for all units may be less important than having a structure for contextually based handoffs. Research on pertinent information content for contextually based handoffs is an urgent need. Without it, handoff computerization is not likely to be successful. Researchers need to use more sophisticated experimental research designs, control for individual and unit differences and improve sampling frames.
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