The Standardizing Communication During Patient Transfers Essay

The handoff communicating procedure is the verbal and/or written exchange of pertinent information sing the duty and authorization of activities during a patient ‘s transportation of attention ( Catalano, 2009 ) . “ The skip of accurate, seasonably, easy accessible, critical information by wellness attention suppliers significantly increases hazard of patient injury and can hold annihilating effects for patient attention ” ( Goldsmith, Boomhower, Lancaster, & A ; Antonelli, 2010, p. 256 ) . The 2006 National patient safety ends of the Joint Commission on Accreditation of Healthcare Organization ( JACHO ) requires organisations involved with patient attention to standardise the handoff communicating between health care professionals. The Standardizing Communication During Patient Transfers Essay. This demand was instituted after JACHO reviewed a decennary ‘s worth of informations describing that “ dislocations in communicating ” were associated in two-thirds of all types of lookout events ( Croteau, 2005 ) . Unfortunately, in 2012 “ The Joint Commission reported that hapless communicating remains the taking cause of sentinel events and that more than one tierce of all patient handoffs are faulty ” ( Jukkala, James, Autrey, Azuero, & A ; Miltner, 2012, p. 240 ) .

Recently, the Trihealth organisation converted to an electronic medical record ( EMR ) system. Transitioning from the standard paper charting in the Post Anesthesia Care Unit ( PACU ) has created many challenges and alterations, particularly in our flow of patient information. Prior to EMR, during the handoff procedure, the PACU nurses relied on informal manus written paper signifiers and were efficient in voyaging through a paper chart to happen necessary information. Now in a “ paperless system ” the post-operative handoffs have become simply a verbal procedure. Patient attention handoffs postoperatively are cognitively intense, dynamic, complex, and filled with a myriad of critical information, which typically lasts 5 proceedingss. Splinters of information presented in a handoff by the operating room ( OR ) squad include name, age, allergic reactions, anaesthesia, analgesia, antibiotics, presser agents, positioning, blood loss, volume expanders, IV fluid consumption, endotracheal tubing size, type of dressing, complications, etc. Every piece of information is critical for the safe continuance of accurate and proper attention. The Standardizing Communication During Patient Transfers Essay. Remembering this wealth of information from memory can be backbreaking, particularly when holding to cover with multiple diverse patients. Jukkala et al. , ( 2012 ) assert factors act uponing handoff studies include emphasis, weariness and the inability to accurately remember the information. Since the execution of EMR, departmental clinicians have noticed the peri-operative handoffs deficiency in quality, deepness and continuity. While the construct of EMR is advantageous in many facets, practicians find EMR non really user friendly and hard to voyage, which unluckily leads to missed information.

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It appears that the issues described refering the handoff in the PACU warrant a thorough strategic reappraisal procedure ( SR ) . A SR is the first stage in a alteration procedure that has three chief constituents, embracing constructions, procedures and administration ( Sare & A ; Ogilvie, 2010 ) . The intent of strategically reexamining this standardized handoff in the PACU is to reexamine the procedures constituent. A SR is a mechanism that helps find what strategic methods are working, what needs to alter and what might perchance be unnoticed ( Sare & A ; Ogilvie, 2010 ) . Strategic Planning ( SP ) is the mechanism working in tandem with SR to rectify lacks in the system that could harm patients as in this instance, during patient handoffs. This paper describes the SR to standardise and better the patient handoff procedure. The Standardizing Communication During Patient Transfers Essay.

Purpose and Aims

The organisational SP must be congruous with the SR procedure in developing values, vision, mission, ends, aims and schemes for a standardised handoff. The cardinal intent of strategic planning ( SP ) is to aline the organisational public presentation between its set mission, vision, and values ( Harrison, 2010 ) . Sare & A ; Ogilvie ( 2010 ) emphasis “ being clear about the “ why we are here ” launches the procedure of finding the aims and ends that we want to accomplish ” ( p. 131 ) . Once team members define the ends in a SR, the strategic “ how-to ” aims are established ( Sare & A ; Ogilvie, 2010 ) . These strategic aims are utilised to place the larger image of the mission, helping to carry through ends ( Sare & A ; Ogilvie, 2010 ) . The ultimate end is to continuously happen ways to better patient safety. The primary aim of standardisation is to supply accurate information about a patient ‘s attention, intervention, services, status or alterations ( Patterson & A ; Wears, 2010 ) . Planing a standardised individualised patient handoff tool relevant to the content in the peri-operative country will heighten and better high quality patient attention and safety.

Strategic Review Team Members

The primary stakeholders included as squad members in developing a standardised tool would incorporate at least one representative from each of the three departmental subjects involved and a facilitator. This would include a clinician from the PACU, anaesthesia and the OR. The Standardizing Communication During Patient Transfers Essay. The three clinicians will keep the functions of designer, planing the program based on the findings, and moving as alteration agents that “ construct ” the program ( Sare & A ; Ogilvie, 2010 ) . The facilitator ‘s function will be to keep the coaction and procedures of the undertaking in focal point and on piece of land.

What will be assessed?

In a SR, nurses use their critical appraisal accomplishments and cognition to look inward on nursing itself ( Sare & A ; Ogilvie, 2010 ) . An “ environmental appraisal ” or “ situational analysis ” will be performed to see the demographic profile, community served, internal and external forces, past and current public presentations, every bit good as chances and tendencies. A SR is truth seeking that reveals and exposes the positives and negatives of procedures and people. Once the SR squad members assess the demand for a alteration, the squad will consistently measure and place the indispensable information that must be conveyed during a handoff. Using an environmental appraisal and strategically analysing all the factors involved, the squad will find which features of those elements are polar to utilize in the standardised handoff tool design. Sare & A ; Ogilvie ( 2010 ) attest, “ the SR procedure encompasses the art of focussed appraisal, cognizing what to measure and holding the ability to construe the findings ” ( p 118 ) . The Standardizing Communication During Patient Transfers Essay.

Identify expertness to construe

Knowledge development and acquisition is a valuable plus to any organisation, giving a competitory advantage. Best patterns and standardisation are identified through the punctilious usage of current grounds, clinician expertness and patient results to steer wellness attention determinations. We will utilize grounds based research to place and develop a standardised handoff tool. The SR squad will execute a systematic procedure of researching equal reviewed literature through informations bases such as MEDLINE, the Cochrane Collaboration, PubMed and Ovid therewith accessing the expertness needed to construe what is discovered.

How to construe findings?

Analyzing and understanding big sums of qualitative informations ever presents a challenge. The key is being able to cut down the natural information, placing the significance, and making an lineation to pass on the kernel of what the information reveals ( Bloomberg & A ; Volpe, 2008 ) . The Standardizing Communication During Patient Transfers Essay. All SR squad members will expose and depict their consequences clearly. The squad will analyse the information collected, expression at the differences and similarities, construe the relationships and tie in the grounds to be believable in respects to easing the development of the standardised handoff procedure. To farther facilitate construing findings or decide confusion, aid can be obtained through Trihealth ‘s full clip nurse research worker, research council and/or the Hatton research centre located on the evidences at Bethesda North.

Who will be responsible for doing recommendations?

Powerless nurses become unproductive nurses. Empowered nurses that have entree to information, support, resources and chances to larn and turn are motivated productive employees ( Peters, 2009 ) . The SR procedure empowers nurses to alter and put waies for patient attention. The squad members in a SR utilizing a strength, failing, chance and menace ( SWOT ) analysis are prizewinning Judgess of how to inquire the of import inquiries in a SR of patient attention. Ultimately, these SR squad members hold the duty for decision-making and strategic planning recommendations. Sare & A ; Ogilvie ( 2010 ) assert, “ waies in attention must be set up by the attention experts, whom we know must include nurses ” ( p. 122 ) .

Schemes

The challenge in making a standardised handoff across subjects is to place methods and schemes that defend against information decay and funneling. ( Friesen & A ; White, 2008 ) . Acknowledging what works in one scene might non needfully be good in another, given each subject ‘s demands. Strategic methodological analysiss used during the SR procedure, in a prioritized order, include 1 ) a SWOT analysis to place internal and external factors of import to accomplish aims. 2 ) A force field analysis will be conducted measuring internal and external forces that can work towards or against the solution. 3 ) A spread analysis to acknowledge where our public presentation presently stands with our prospective public presentation. 4 ) Creation of a strategic map to show the constituents of the standardisation handoff-building undertaking. 5 ) Designation of a quality project-planning theoretical account, such as the Plan-Do-Check-Act rhythm, to transport out this alteration. The Standardizing Communication During Patient Transfers Essay.

How will you measure scheme success?

A SR procedure is a collaborative attempt and in order for the SR procedure to win, the SR squad must be supportive, have organisational support, and be engaged. It is indispensable for the strategic aims, ends and values to be clear and accomplishable. The vision and mission of the SR must be in focal point and aligned with the organisation. Measuring strategic success is measured by accomplishing the established undertakings, short and long ranged ends, and values. The continual monitoring, feedback, and coverage is critical in measuring the success of the SR procedure.

Decision

Surprisingly, research-based grounds is still unavailable that supports the usage of a standardised attack to handoff communicating in infirmaries ( Ardoin & A ; Broussard, 2011 ) . The grounds presented by The Joint Commission is compelling, proposing the demand for such a tool which is important for patient attention and safety. The Standardizing Communication During Patient Transfers Essay. Patterson & A ; Wears ( 2010 ) assert, “ Approximately 20 % -30 % of information conveyed during handoff updates is non documented in the medical record ” ( p. 52 ) . In my workplace, the PACU, when a patient arrives from the OR there is a blare of activities go oning all at one time and with the new EMR system, proper handoffs have become highly ambitious. The uninterrupted analysis to implement alteration to better patient safety and high quality attention should be evaluated. This execution of a standardised handoff tool in the peri-operative country has the potency of positively impacting the environment.

In July 2012, the Trihealth organization converted to an electronic medical record (EMR) system. Transitioning from the standard paper charting in the Post Anesthesia Care Unit (PACU) has created many challenges and changes, especially in our flow of patient information. The handoff communication process is the verbal and/or written exchange of pertinent information regarding the responsibility and authority of activities during a patient’s transfer of care (Catalano, 2009). The 2006 National patient safety goals of the Joint Commission on Accreditation of Healthcare Organization (JACHO) requires organizations involved with patient care to standardize the handoff communication between healthcare professionals. This requirement was instituted after JACHO reviewed a decade’s worth of data reporting that “breakdowns in communication” were associated in two-thirds of all types of sentinel events (Croteau, 2005). Unfortunately, in 2012 “The Joint Commission reported that poor communication remains the leading cause of sentinel events and that more than one third of all patient handoffs are defective” (Jukkala, James, Autrey, Azuero, & Miltner, 2012, p. 240).  The Standardizing Communication During Patient Transfers Essay.Prior to EMR, during the handoff process, the PACU nurses relied on informal hand written paper forms and were efficient in navigating through a paper chart to find necessary information. Now in a “paperless system” the post-operative handoffs have become merely a verbal process. Patient care handoffs postoperatively are cognitively intense, dynamic, complex, and filled with a myriad of critical information, which typically lasts 5 minutes. Slivers of information presented in a handoff by the operating room (OR) team include name, age, allergies, anesthesia, analgesia, antibiotics, presser agents, positioning, blood loss, volume expanders, IV fluid intake, endotracheal tube size, type of dressing, complications, etc. Every piece of information is vital for the safe continuation of accurate and proper care. Recalling this wealth of information from memory can be arduous, especially when having to deal with multiple diverse patients. Jukkala et al., (2012) assert factors influencing handoff report include stress, fatigue and the inability to accurately recall the information (p. 240). Since the implementation of EMR, departmental clinicians have noticed the peri-operative handoffs lack in quality, depth and continuity. While the concept of EMR is advantageous in many aspects, practitioners find EMR not very user friendly and difficult to navigate. “The omission of accurate, timely, easily accessible, vital information by health care providers significantly increases risk of patient harm and can have devastating consequences for patient care (Goldsmith, Boomhower, Lancaster, & Antonelli, 2010, p. 256).

It appears that the issues described concerning the handoff in the PACU warrant a through strategic review process (SR). The three main components that encompass a strategic review (SR) are structures, processes and governance (Sare & Ogilvie, 2010). The purpose of strategically reviewing a standardized handoff in the PACU is to review the processes component. A SR is a mechanism that helps determine what strategic methods are working, what needs to change and what might possibly be unnoticed (Sare & Ogilvie, 2010). Trends and issues are the driving force behind a SR, looking at past, current and future performances as well as opportunities (Sare & Ogilvie, 2010).

Purpose and Objectives

The organizational SP must be congruent with the SR process in developing values, vision, mission, goals, objectives and strategies for a standardized handoff. The fundamental purpose of strategic planning (SP) is to align the organizational performance between its set mission, vision, and values (Harrison, 2010). Sare & Ogilvie (2010) stress “being clear about the “why we are here” launches the process of determining the objectives and goals that we want to achieve” (p. 131). Once team members define the goals in a SR, the strategic “how-to” objectives are established (Sare & Ogilvie, 2010). These strategic objectives are utilized to identify the larger picture of the mission, assisting to accomplish goals (Sare & Ogilvie, 2010). The ultimate goal is to continuously find ways to improve patient safety. The Standardizing Communication During Patient Transfers Essay. The primary objective of standardization is to provide accurate information about a patient’s care, treatment, services, condition or changes (Patterson & Wears, 2010). It is crucial for handoffs to be accurate and pertinent during the exchange of patient information to ensure safe patient care, especially with the increasing complexity for patients in acute care institutions (Staggers, Clark, Blaz, & Kapsandoy, 2011). Designing a standardized individualized patient handoff tool relevant to the content in the peri-operative area will enhance and improve high quality patient care and safety.

Strategic Review Team Members

The primary stakeholders included as team members in developing a standardized tool would include at least one representative from each of the three departmental disciplines involved. This would include a clinician from the PACU, anesthesia and the OR. This collaboration is necessary because anesthetists and recovery nurses often have different expectations concerning content and timing of information transfer (Manser, Foster, Flin, & Patey, 2012). Sare & Ogilvie (2010) affirm, “In the SR, it is crucial to have the right people asking the right questions” (p 122). Working collaboratively, a framework to guide and design an assessment enables reflections and comments on their own practices. The Standardizing Communication During Patient Transfers Essay.

What will be assessed?

In a SR, nurses use their vital assessment skills and knowledge to look inward on nursing itself (Sare & Ogilvie, 2010). An “environmental assessment” or “situational analysis” will be performed to view the demographic profile, community served, internal and external forces, past and current performances, as well as opportunities and trends. A SR is truth seeking that reveals and exposes the positives and negatives of processes and people. Once the SR team members assess the need for a change, the team will systematically assess and identify the essential information that must be conveyed during a handoff.The Standardizing Communication During Patient Transfers Essay.  Utilizing an environmental assessment and strategically analyzing all the factors involved, the team will determine which characteristics of those elements are pivotal to use in the standardized handoff tool design. Sare & Ogilvie (2010) attest, “the SR process encompasses the art of focused assessment, knowing what to assess and having the ability to interpret the findings” (p 118).

Identify expertise to interpret

Knowledge development and acquisition is a valuable asset to any organization, giving a competitive advantage. Best practices and standardization are identified through the meticulous use of current evidence, clinician expertise and patient outcomes to guide health care decisions. We will use evidence based research to identify and develop a standardized handoff tool. The SR team will perform a systematic process of researching peer reviewed literature through data bases such as MEDLINE, the Cochrane Collaboration, PubMed and Ovid accessing the expertise needed to interpret what is discovered.

How to interpret findings?

Analyzing and understanding large amounts qualitative data always presents a challenge. The key is being able to reduce the raw data, identifying the significance, and constructing a framework for communicating the essence of what the data reveal (Bloomberg & Volpe, 2008). All SR team members will display and describe their results clearly. The team will analyze the data collected, look at the differences and similarities, interpret the relationships and associate the evidence to be credible in regards to facilitating the development of the standardized handoff process. To further facilitate interpreting findings or resolve confusion, assistance can be obtained through Trihealth’s full time nurse researcher, research council and/or the Hatton research center located on the grounds at Bethesda North. The Standardizing Communication During Patient Transfers Essay.

Who will be responsible for making recommendations?

Powerless nurses become unproductive nurses. Empowered nurses that have access to information, support, resources and opportunities to learn and grow are motivated productive employees (Peters, 2009). The SR process empowers nurses to change and set directions for patient care. The team members in a SR using a strength, weakness, opportunity and threat (SWOT) analysis are champion judges of how to ask the important questions in a SR of patient care. Ultimately, these SR team members hold the responsibility for decision-making and strategic planning recommendations. Sare & Ogilvie (2010) assert, “directions in care must be set up by the care experts, whom we know must include nurses” (p. 122). The Standardizing Communication During Patient Transfers Essay.

Strategies

The challenge in creating a standardized handoff across disciplines is to identify methods and strategies that protect against information decay and funneling. (CITE) Recognizing what works in one setting might not necessarily be beneficial in another, given each discipline’s requirements. Strategic methodologies used to during the SR process, in a prioritized order, include 1) a SWOT analysis to identify internal and external factors important to achieve objectives. 2) A force field analysis will be conducted evaluating internal and external forces that can work towards or against the solution. 3) A gap analysis to recognize where our performance currently stands with our prospective performance. 4) Creation of a strategic map to demonstrate the components of the standardization handoff-building project. 5) Identification of a quality project-planning model, such as the Plan-Do-Check-Act cycle, to carry out this change.

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How will you assess strategy success?

A SR process is a collaborative effort and in order for the SR process to succeed, the SR team must be supportive, have organizational support, and engaged. It is essential for the strategic objectives, goals and values to be clear and achievable. The Standardizing Communication During Patient Transfers Essay. The vision and mission of the SR must be in focus and aligned with the organization. Assessing strategic success is measured by achieving the established tasks, short and long ranged goals, and values. The continual monitoring, feedback, and reporting is critical in evaluating the success of the SR process.

Conclusion

Surprisingly, research-based evidence is still unavailable that supports the use of a standardized approach to handoff communication in hospitals (Ardoin & Broussard, 2011). The evidence presented by The Joint Commission is compelling, suggesting the need for such a tool is crucial for patient care and safety. Patterson & Wears (2010) assert, “Approximately 20%–30% of information conveyed during handoff updates is not documented in the medical record” (p. 52). In my workplace, the PACU, when a patient arrives from the OR there is a cacophony of activities happing all at once and with the new EMR system, proper handoffs have become it extremely challenging. The continuous analysis to implement change to improve patient safety and high quality care should always be evaluated. This implementation of a standardized handoff tool in the peri-operative area has the potential of positively impacting the environment.  The Standardizing Communication During Patient Transfers Essay.