Upgrade your facility’s nursing handoff reports

Don’t let crucial patient information slip between the cracks during shift handoffs. 

Improving shift handoffs at your facility can significantly impact patient outcomes and healthcare costs. 

Learn what handoff reports are, why shift handoffs are so important, and how your facility can help nurses successfully transfer crucial information during shift changes.

What are shift handoff reports?

Shift handoff reports are essential exchanges of information and responsibility between healthcare professionals. 

They occur at transition times between shifts to guarantee continuity of care. Handoff reports also occur when patients are transferred to other units where they will be under the care of new healthcare teams. 

In nursing, shift handoff reports may take place at the bedside, allowing patients and family members to participate and ask questions. Nurse bedside shift reports take approximately five minutes. During this time, the oncoming nurse can assess all lines, drains, wounds, and equipment in the room. Sensitive information that is not appropriate to share with the patient or family should be discussed outside of the patient’s room.

The Importance of effective handoff reports

Ineffective communication, including errors in clinical handoffs, contributes to over 80 percent of serious preventable adverse events in healthcare, according to a study titled “Comparison of a Nurse-Nurse Handoff Mnemonic With Real-World Handoffs.”

Efforts to improve communication in healthcare must include improving handoffs, as these are the most frequent types of communication in hospital settings. 

An estimated 4,000 handoff reports occur in a single teaching hospital in one day. 

Ineffective handoffs can lead to all of the following:

• Prolonged lengths of patient stays
• Avoidable readmissions
• Delayed or inadequate treatment
• Care omissions
• Increased healthcare costs

It is not surprising that the World Health Organization considers handoff communication a top international patient safety priority. The organization calls for standardizing and structuring handoff approaches within clinical guidelines.

Types of handoff reports

Handoff reports can take different forms: written, oral, recorded, bedside, etc. Here are some characteristics of the most common types.

Written handoff reports

Written handoff reports relay important information to incoming nurses, including the patient's medical background, situation, treatment, and care plan.

Unfortunately, this method does not allow these nurses to ask questions to clarify information. 

Recorded handoff reports 

Recorded reports are similar to written reports in that they both relay information without providing the opportunity for clarification between nurses or interaction with patients and family members. 

Recorded reports are time-efficient but may have drawbacks, such as unclear recordings. 

E-handoff reports

Electronic handoffs are increasingly being integrated into electronic health record (EHR) systems. They ensure handoff reports are complete, well-documented, and accessible for incoming nurses to review. They are especially beneficial in virtual care.

Verbal handoff reports 

Oral reports in private settings allow nurses to interact and clarify information.

However, they do not allow nurses to interact with patients and family members, and are also typically time consuming.

Bedside handoff reports

Face-to-face bedside handoffs are the only ones that involve the outgoing and incoming nurses, patients, and family members.  

Blended handoff reports

Handoff reports often merge two or more of the previous types. 

For example, part of the handoff report may be written or included in the patient’s EHR, in addition to nurses meeting face-to-face. 

Furthermore, nurses may meet privately before continuing the handoff report at the bedside. 

Tools and mnemonics for standardized protocols

In line with the WHO’s recommendations, health systems strive to standardize handoffs to reduce errors related to different communication styles. Mnemonics are often used as tools to standardize handoff communication. 

Although various handoff approaches exist, all approaches attempt to cover the same primary areas of information. 

The following are among the most widely used mnemonics to standardize handoff reports. 

SBAR

Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) is a national initiative aimed at improving quality, safety, and efficiency in healthcare. SBAR is one of TeamSTEPPS’s most widely used tools.

SBAR stands for the following:

• S = Situation (What are the patient’s vital signs?)
• B = Background (What is the patient’s relevant medical history?)
• A = Assessment (What is the patient’s current problem?)
• R = Recommendation (What does the patient need?)

I-PASS

The I-PASS tool has proven effective as a handoff tool for physicians. The mnemonic stands for the following aspects of a handoff report:

• I = Illness severity
• P = Patient summary 
• A = Action list
• S = Situation awareness and contingency planning 
• S = Synthesis by receiver 

The I-PASS tool has been adapted into what is called the NPAS for handoff reports in nursing in the following way:

• N = Nursing or nurse
• P = Patient summary (Relevant data to guide nursing care)
• A = Action plan (Holistic view of the patient’s needs, including recommendations for interventions)
• S = Synthesis (Exchange of information between the sending and receiving nurses)

ISHAPED

The ISHAPED tool was originally created in paper format in 2010 to standardize patient-centered bedside handoff reports, including face-to-face communication between caregivers. 

Since then, it has also been turned into an electronic tool that can be updated in real time and used simultaneously by all the patient’s care providers.

Here is what ISHAPED stands for:

• I = Introduce (e.g., allergies, code status, contact information, advance directives, provider teams, ancillary consults)
• S = Story (e.g., hospital problem, treatment plan, admission screening information, learning assessment)
• H = History (e.g., links to the emergency department summary, link to history and physicals in the notes, medical and surgical history, blood administration history for the past 72 hours)
• A = Assessment (e.g., vital signs, activities of daily living, diet orders, pain management, assessments, current medications, a summary of intake and output, lab results, radiology results from the past 24 hours)
• P = Plan (e.g., care plan goals, orders to be acknowledged and completed, current infusions, PRN medications, nursing orders, patient-initiated and patient-advocate goal documentation)
• E = Error prevention (e.g., high-alert warnings, patient-specific medication information)
• D = Dialogue (e.g., shift report provided, involvement of patient and family members)

Components of a handoff report

Although the specific tool may vary from one facility to another, the following is an example checklist that nurses can use to ensure they carry out a complete and effective bedside handoff report:  

1. Introduce the incoming nurse and invite the patient and family members to participate in the report.
2. Access the patient’s medical record.
3. Conduct a handoff report using the facility’s standardized tool (e.g., SBAR) using language the patient and family members can understand.
4. Conduct a focused assessment of the patient (e.g., inspect wounds, IV sites, etc.) and a safety assessment of the room.
5. Review pending tasks (e.g., required labs, tests, or medications).
6. Identify the patient’s and family members’ needs or concerns (e.g., level of pain, feedback for the outgoing nurse, etc.).

Tips for a successful shift handoff report

Ensuring effective handoff reports can be challenging. 

Healthcare is a fast-paced environment, and facilities are often understaffed. Without clear policies and procedures in place, facilities risk nurses rushing these handoffs and omitting critical information. 

Here are some tips to ensure successful nursing handoff reports at your facility.

1. Use an evidence-based handoff tool

Consistency is essential for effective shift handoff reports. Extensive research has gone into developing standardized handoff tools. 

Facilities should use these available resources to ensure critical content is communicated during shift changes. 

2. Develop a handoff checklist for your clinicians to use

Aside from implementing a standardized tool, facilities should customize handoff checklists for nurses to follow during shift handoffs. 

Creating, testing, and assessing this handoff report template should be a team effort involving the nurses who will use it. 

3. Provide nurses with handoff training

Handoff training is one of the strategies The Joint Commission recommends for improving the quality of handoffs. Training can help nurses identify critical information they should transmit during shift changes.

4. Involve patients in shift handoffs

Shift handoff reports should routinely take place at the bedside.

Active participation by patients and family members improves patient safety and quality of care by providing opportunities for them to ask questions and better understand their care plan. 

More ways to provide better patient care with Nursa

Improving shift handoffs can reduce the lengths of patient stays, avoidable readmissions, care omissions, and delayed care, improving patient outcomes and reducing healthcare costs.

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Find more useful resources on Nursa’s facility blog, including a guide on leading productive nurse performance evaluations and some of the latest healthcare staffing trends.

Our PRN healthcare staffing platform can also help you provide better patient care by easily covering staff call outs and maintaining adequate staffing levels. 

Sources:

• Agency for Healthcare Research and Quality: Strategy 3: Nurse Bedside Shift Report
• Journal of Nursing Care Quality: Comparison of a Nurse-Nurse Handoff Mnemonic With Real-World Handoffs
• Nursing Management: The secrets to successful nurse bedside shift report implementation and sustainability
• American Nurse: Standardizing handoff communication