Abigail Sutton and Stacie Hunsaker, Nursing Department
In establishing patient safety, communication is one of the most important components to consider. In order to coordinate a patient’s care properly, the multiple and diverse healthcare providers must operate smoothly as a team through well-constructed communication techniques. TeamSTEPPS is a government designed program to educated healthcare professionals on how to work and communicate effectively as a team. The program initiators included specific tools to be used to perform hand-offs. Hand-offs is when a healthcare professional transfers crucial information requiring a patient’s care with another healthcare professional. This is an extremely important process because it can cause devastating results if the information is not completely and concisely given. An estimated 80% of all sentinel events have been connected to ineffective hand-off communication between medical staff (The Joint Commission, 2010). In 2006, the Joint Commission National Patient Safety Goals altered their requirement to have hospital implement a standardized hand-off communication approach that allowed medial staff to answer and ask questions regarding the patient’s care during the hand-off (Advance Healthcare Network for Nurses, 2005). Since this is a requirement for hospitals, it is natural that nursing schools should also instruct their students to use a standardized hand-off tool to practice effective team communication. Currently, Brigham Young University’s (BYU) College of Nursing is not using a standardized hand-off mnemonic to train novice nursing students to convey serious information about a patient’s care. This jeopardizes the practice of giving complete, concise, and consistent hand-off reports and further endangers patient safety. Therefore, the purpose of this project is to introduce a standardized hand-off mnemonic tool for nursing students to utilize and determine its effectiveness in assisting nursing students to convey information efficiently and establish confidence.
First we created a standardized hand-off tool modeled after the teamSTEPPS SHARQ tool with a conformed decision from the BYU facility. In the second semester nursing communication course, students were already being taught about the SHARQ hand-off tool and how to use it. We instructed our simulation instructors on how to use the tool based on what our students are taught about the tool. However, the tool was not stressed by all facility and was not made a standard. Our goal was to test to see if our tool would be an effective standardized tool for our nursing students, therefore we received Institutional Review Board (IRB) approval to conduct this research.
Brigham Young University nursing students who were enrolled in simulation courses were allowed the opportunity to participate. We randomly selected different simulation lab sections to be our control and experimental groups. With the groups that were our experimental, the simulation instructor was encouraged to require students to use the standardized hand-off tool. With the control groups, the instructor would have the tool available but students were not required to use it. The simulation TAs were instructed to record the hand-off report for the simulations on video and were taught where to save the data for the researchers to collect. Consent forms were distributed on the student’s first day of simulation as well as an initial questionnaire about the student’s thoughts on their hand-off confidence and experience. The students were also given an end questionnaire to determine if there were significant changes in the students’ perceptions of hand-off before and after the use or non-use of the tool.
For each simulation hand-off used for the study, the researchers will view the recordings to collect data to evaluate the effectiveness of the hand-off tool by comparing with the control group. The researchers will then compare the overall hand-offs and questionnaires of experimental groups with that of the control groups to determine if the SHARQ hand-off would be an effective standardized tool for the Brigham Young University nursing students.
In the early stages of this research, we presented at the 2017 TeamSTEPPs National Conference about our progress and plans with our research in adding a standardized tool for hand-offs to our nursing curriculum. We also presented our research this past October at the Brigham Young Nursing Scholarly Works conference. In addition, the research has been approved for a poster presentation at the Western Institute of Nursing Conference this coming April 2018. Our hope is that more nursing schools will establish a standardized tool to aid in more effective communication during hand-off reports and therefore, increasing patient safety.
From our collected research, we expect the data to achieve our purpose in proving the SHARQ mnemonic is effective in supporting student to transmitted critical information in a complete, concise, and consistent manner. There are a few limitations to consider when analyzing our data. First, students’ initial thoughts on their hand-off skills might be exaggerated due to initial thoughts of confidence about their skills. Therefore, there might not seem to be statistical significance between the initial questionnaire and the end questionnaire. Second, there is variability between the different simulation instructors and their consistence with stressing or not stressing the use of the tool. Thirdly, after debriefing in the first few simulations, individual students in the control group could realize the importance of using the hand-off tool and choose to use it more thoroughly during other simulations intended for research.
In conclusion, communication is a major component to ensuring patient safety through effectively transmitting critical information about patient care. Brigham Young University’s nursing program should implement a standardized hand-off to be consistent with The Joint Commission’s request for hospitals to establish a standardized hand-off tool. Including a standardized hand-off tool will create future nurses who are conscious of patient safety and have established good communication habits to provide the best quality of care to patients.