290 - Integrating an Electronic-sbar Handoff Process Inpatient-to-OR
Description: NATIONAL EVIDENCE-BASED PRACTICE CONFERENCE – EBP ABSTRACTTitle: Integrating an Electronic-SBAR Handoff Process from Inpatient-to-ORAuthor(s): Rosellen Kalaw, BSN, RN-BC, Opokua Osei-Yeboah, MSN, RN-BC, CNL, Mary Brion, MSN, CMSRN,ONC, Brandy Faustino, BSN, RN, Juna Amigable, BSN, RN, Lavern Jone, RN, and Anna Perez, BSN, RN
Introduction: Our unit follows the motto, “Learning from our mistakes,” which began after encountering acommunication pitfall that involved a surgical patient going through the perioperative phases. As a team, weacknowledged this as a failure and wanted to prevent additional communication errors from occurring. Questionsregarding the how, what, and why were brought up during our safety huddles and unit-based council meetings. Weacknowledged the why question as the most important to answer first, since the answer determined our goals. Together,we wanted to achieve reliability in our communication process that improved patient outcomes and nursing workflow.Therefore, our unit chose to invest in a culture of safety by promoting mindfulness, collaboration, and evidence-basedpractice. Prior to initiating this journey, all staff were educated on the evidence-based process and how to conduct aliterature review search. A thorough evaluation of our handoff process was conducted, and we identified areas that wereprone to communication errors. After a careful review of the gathered research articles, it was decided that utilizingCPRS in conjunction would yield a process of efficiency and reliability. This resulted in developing a template thatutilized the SBAR process from inpatient-to-OR, which enabled the redesign of our communication handoff process.Throughout this journey teamwork dynamics, collaboration, innovation, and learning from one another grew even moreand led us to wanting to achieve more for ourselves and our veterans.Purpose and Rationale: The purpose of this pilot study is to determine if an integrated electronic handoff communicationtemplate will improve information efficiency and accuracy, nursing workflow, and delivery of quality care. Theperioperative process is complex and highly vulnerable to communication gaps and information loss. Communication ofthe preoperative assessment is identified as a crucial moment for a surgical patient and considered as a critical phaseinfluencing the entire surgical experience. The nursing environment is predisposed to unpredictable events that affectworkflow processes and it is imperative to analyze current practices so that safety and reliability are maintained.Synthesis of Evidence: A systematic review conducted by Pucher, Johnston, Aggarwal, Arora, & Darzi (2015) examinedthe effectiveness of interventions used for patient handover in surgery. They identified that utilizing a checklist orsupportive-based intervention may improve the transfer of information. Bakon et al. (2017) conducted an integrativereview that explored different handoff models and processes and their effectiveness in enhancing nursing handoffcommunication. They found utilization of various handoff models, yet not one demonstrated as highly effective. A fewstudies have acknowledged the importance of the preoperative care dimension and considered a critical phase of theperioperative process. Turunen, Meittinen, Setala, and Vehvilainen-Julkunen (2016) conducted an integrative review onthe preoperative care structure and found supportive tools as valuable resources for the preoperative nurse to positivelyimpact patient outcomes and coordination of care. Many studies have shown varied results with the use of a paperhandoff tool such as an SBAR in improving information efficiency between providers. According to Fox et al. (2015),lack of a standardized process is another factor that impacts reliability of the exchanged handoff information and areshown to negatively impact patient outcomes. However, with technology advancements, utilizing the EHR system canimprove the handoff process (Chapman et al., 2016; The Joint Commission, 2017).Practice Change and Implementation Strategies: The unit and OR nurses identified potential safety events that werepredisposed to the occurrence of medical errors and delay of procedures. Our team recognized inefficiencies in ourpreoperative checklist and handoff process. A literature review on evidence-based practice of communication and handoffidentified innovative ideas that steered towards utilization of the electronic health records system. Pre-implementationsurveys were distributed prior to the launch of our new inpatient-to-OR nursing SBAR template. All the nurses were keptinformed of the progress and also included with the development of the new handoff template and process.Evaluation: The pilot study was from October 15, 2018, to January 14, 2019. A post-implementation survey wasconducted following the three-month period. The result of the survey was compared with the pre-implementation surveythat analyzed nursing satisfaction scores.ReferencesConclusions and Implications for Practice: The development of the new nursing SBAR template and handoff processenabled elimination of patient information redundancy and instead provided pertinent preoperative nursing care of thesurgical patient. The post-implementation survey results demonstrated a high reliability in transfer of patient informationand nursing workflow. Our next goal is to integrate the electronic handoff template and process hospital wide. This willhopefully influence a culture of safety and high-reliability organization.
References: Bakon, S., Wirihana, L., Christensen, M., & Craft, J. (2017). Nursing handovers: An integrative review of the differentmodels and processes available. International Journal of Nursing Practice, 23(2), 1-8.Binder, J., Lewis, B., Patton, L., Tidwell, J., & Young, V. (2017). Ensuring Safe Transfer of Pediatric Patients: A QualityImprovement Project to Standardize Handoff Communication. Journal of Pediatric Nursing, 34 (2017),44-52.Bostwick, S. B., Fred, M. R., Stein, D. M., Stetson, P. D., & Vawdrey, D. K. (2013). Implementation of a ComputerizedPatient Handoff Application. AMIA Annual Symposium Proceedings, 2013, 1395–1400.Chapman, Y., Heyman, A., Schweickert, P., & Swango-Wilson, A. (2016). Nurse Satisfaction with InformationTechnology Enhanced Bedside Handoff. MedSurg Nursing, 25(5), 313-318.Eberhardt, S. (2014). Improve Handoff Communication with SBAR. Nursing2014, 14 (8), 17-20.Fox, P., Gonzales, M., Moon, T., & Woods, A. (2016). Improving the Quality of the Operating Room to Intensive CareUnit Handover at an Urban Teaching Hospital Through a Bundled Intervention. Journal of ClinicalAnesthesia, 2016 (31), 5-12.Johnson, M., Sanchez, P., & Zheng, C. (2016). Reducing patient clinical management errors using structured contentand electronic nursing handover. Journal of Nursing Care Quality, 31, 245-253.Pucher P.H., Johnston M.J., Aggarwal R., Arora S., Darzi A. (2015). Effectiveness of interventions to improve patienthandover in surgery: A systematic review. Surgery, 158(1), 85-95.The Joint Commission. (n.d.). Sentinel Alert Event. 2017 (58). Retrieved Nov. 15, 2017, fromhttps://www.jointcommission.org/