Seeking to cut 'bad handoffs' in child patient care

(MCT) -- With all handoffs, fumbles can happen.

When those mishaps occur in a hospital and involve young patients, the consequences can be especially dire.

According to new national research lead by a critical care doctor at Akron Children's Hospital, establishing standardized ways to transfer patient care during shift changes or between units can reduce "handoff-related care failures" by nearly 70 percent.

Although the study didn't track actual incidences of patient harm, failure to share vital information when care is transferred can result in mistakes, said lead author Dr. Michael T. Bigham, a pediatric critical care doctor at Akron Children's Hospital.

Potential problems from handoff mistakes include medications being administered too close together, Bigham said.

"Ultimately, what we want is fewer kids to be harmed," he said. "We know bad handoffs harm patients. We want those kids to be safer."

The study was released online at Pediatrics in July and will appear in the August edition of the national medical journal Pediatrics.

A total of 23 children's hospitals nationwide participated in the study, which examined the impact of standardizing procedures on nearly 8,000 patients' handoffs.

Each hospital selected the type of handoffs they wanted to study. At Children's, the initial work focused on shift changes, transferring patients from the Emergency Department to an inpatient unit and moving inpatients to the Radiology Department for testing.

Participating hospitals then set standards to ensure every transition of care included methods to share important patient information - things such as patient weight, allergies and guardianship status.

Nationwide, transitions of care "continue to be a big safety problem," said Carol Haraden, vice president of the Institute for Healthcare Improvement, a national nonprofit agency dedicated to improving medical care.

Complicated cases involving numerous specialists and hospital-based physicians can be particularly challenging.

"It's very important that there is a standardized tool," she said.

As part of the study, hospitals received training and developed standardized methods to make sure handoffs were done the same way each time and in a "distraction-free zone," Bigham said.

At Akron Children's, for example, the Emergency Department staff accompanying an admitted patient to the inpatient unit doesn't begin talking about the child with the unit nurse until after all the equipment is connected and the patient is settled into the room, Bigham said.

"We all wait until everybody is committed and attentive before we begin the handoffs," Bigham said.

The Radiology Department also developed what's called a "ticket to ride," which staffers from the inpatient unit fill out with important patient information before transferring children for tests.

In some units, the outgoing nursing coordinator used to record messages on a tape recorder with updates about each patients for the incoming nurses to hear, Bigham said.

"With that, there would be no opportunity to ask any clarifying questions," he said. "The parents wouldn't really be able to be logically introduced with their nurse at the change of shift. There weren't any safety checks."

Now the outgoing and incoming nurse meet face to face in the patients' rooms during shift changes to review the electronic medical records and go over important information.

On a recent evening, Carrie Christian, a registered nurse in the Pediatric Intensive Care Unit, spent the last several minutes of her 12-hour shift talking with fellow PICU nurse Katy Saiben about a 3-week-old patient.

Christian reviewed the baby's congenital heart problems, his recent surgery and details about his care during the preceding 12 hours to help prepare Saiben to care for the baby during the next 12 hours.

Saiben said the face-to-face handoffs are helpful.

"You know what has been going on," she said. "There are no surprises. When you're in the ICU, you don't like surprises."


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