Running Head: STANDARDIZED NURSING HANDOFF

Informatics Project

Susan Hensler

Delaware Technical Community College

NUR 410 Nursing Leadership

April 15, 2018

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Standardized Electronic Nursing Handoff

Nursing informatics is making its way into all aspects of nursing, especially electronic

health records (EHR) and communications. The end of the shift nursing handoff report is a

critical period of communication during transfer of care between nurses. When crucial patient

information is left out during transfer of care from one nurse to another, the consequences can

have serious implications. According to Perry, Christiansen, and Simmons (2016), The Joint

Commission (TJC) indicates that communication failure is a common source of sentinel events,

consequently, TJC’s Patient Safety Goal 2 mandates health care providers improve

communication.

Taylor (2015) stated that trying to remember the large amount of information received

during a verbal handoff for several patients can be difficult. Failure to retain everything results in

information gaps and jeopardizes patient care. Taylor (2015) went on to say that in an effort to

improve efficiency, workflow, and safety, the Robert Woods Johnson Foundation has

recommended supplementing the verbal end-of-shift handoff between nurses with an automated,

structured electronic format performed bedside with patient participation, when appropriate.

But should all electronic hand off formats should be the same? Staggers (2016) discussed

that the handoff is not just an exchange of information between nurses, but an intense process of

data evaluation and critical thinking geared toward the care of each individual patient. During

handoff, nurses are processing information and deciding what course of action they will take

with each patient, which may vary significantly from patient to patient. With that in mind,

Staggers (2016) suggested that generic electronic handoffs are not suitable for all patients and

that handoffs should have the capability of being geared toward the needs and requirements of

each patient. In 2016, Chapman, Schweikert, Swango-Wilson and Heyman demonstrated that a
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standardized electronic handoff bearing minimal data sets could be personalized by the nurse to

reflect the needs of each patient, thereby reducing information gaps and providing additional data

as needed. Chapman et al. (2016) further illustrated that nurses felt communication and patient

safety improved as did collaboration and work efficiency when using the electronic handoff to

aid patient transfer of care.

Sewell (2016) explained that the Quality and Safety Education for Nurses (QSEN)

focuses on patient centered care, teamwork and collaboration, evidence-based practice, quality

improvement, safety and informatics. By using computerized charting with the same software for

the entire interdisciplinary healthcare team, a patient’s needs are better met in all six of the

QSEN competencies.

Safeguarding Privacy

While the advent of the EHR has significantly improved access to patient information by

the healthcare team, it has also given rise to privacy and security concerns (Sewell, 2016). Title

II of the Health Insurance Portability and Accountability Act of 1996 (HIPPA) was enacted by

Congress to set national standards regulating the privacy and security of health information in

electronic form. Additionally, Title II requires that policies and procedures be implemented by

healthcare organizations to protect patient data (Office for Civil Rights, 2017). Various measures

may be implemented by healthcare facilities to fulfill the HIPPA mandates. It is essential that

computerized patient health records be accessed in a private area where visitors and those not

directly involved with patient care might view patient information is essential. Equally important

to prevent unauthorized access is ensuring that staff log out when leaving computers (Medical

Ethics Advisor, 2015). Trossman (2009) discussed using software filters that limit a patient’s

EHR access to only those directly assigned to a patient’s care. However, while limiting access
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may protect the patient’s privacy, it may also create patient safety issues during lunch breaks or

in an emergency such as a code, when additional team members are called upon to assist and

need quick access to patient information. Staff members should be equally familiar with not only

their healthcare facility’s policies, but also and state and federal privacy laws. Brent (2013)

advises healthcare facilities to develop policies and procedures for the use of EHRs, such as

yearly education for all employees. Discussions during huddle and at staff meetings regarding

HIPPA, privacy, and security measures are also recommended. These daily briefings can act as a

reminder of the importance of privacy and electronic security.

Principles and Codes of Ethics

Nurses understand that there are principles and codes of ethics that guide their profession.

The American Nurse’s Association’s Code of Ethics mandates that nurses advocate for the rights

and safety of their patients and maintain the integrity of their profession (Edge & Groves, 2006).

Patient privacy is also protected through the Universal Principles of Biomedical Ethics of

autonomy, nonmaleficence, beneficence, role fidelity and confidentiality as discussed by Edge

and Grove in 2006. As nurses we must remain true to our patients and always act in their best

interest. We are expected to behave in a way that benefits the patient, does no harm to the

patient, and in a manner that is faithful to our role as nurses.

Improving Shift Change Workflow

The Robert Woods Johnson Foundation recommends the use of an automated end-of-

shift report with structured patient information in order to increase efficiency, workflow, and

patient safety (Taylor, 2015). Multiple studies show an increase in nursing satisfaction and a

decrease in time spent during handoff. Rather than having to create a handoff format at each

shift, EHR software contains a permanent template with data headers (see Appendix A for
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workflow chart). With a template formatted, admission information for new patients is recorded

under the headers. For patients already admitted, the nurse updates existing information and

prints the handoff, streamlining the process and eliminating critical information gaps. Chapman

et al. (2016) found that nurses spent less time during handoff report and with post-shift charting

after the implementation of a new standardized EHR handoff. Furthermore, in addition to nurses

reporting increased job satisfaction, and perhaps a direct cause of the increased satisfaction, was

the decrease in overtime hours. Administration may not initially believe that spending money on

new handoff software is feasible, but a cost analysis can demonstrate the decrease in overtime is

a worthwhile return on investment. Taylor reminded us in 2015 that effective end-of-shift

practices maximize the transmission and retention of critical patient information resulting in

increased patient safety, which is arguably the most important case for an enhanced electronic

handoff.

Nursing Technology and Evidence-Based Patient Care

The American Nurses Association Standards of Professional Nursing Practice mandate

that nurses use current evidence-based nursing knowledge to guide their practice (Academy of

Medical-Surgical Nurses, 2013). Sewell (2016) related that the use of informatics such as

Clinical Decision Support Systems (CDSS) can improve point-of-care clinical decision making.

CDSS can generate evidence-based computerized reminders for nurses to perform preventive

care, alerting them to possible drug errors, creating patient care order sets, and suggesting

disease management. In an article discussing evidence-based informatics, Cassano (2014)

confirmed that the use of electronic charting enables nurses to quickly and efficiently access

information to improve nursing workflow. Based on the evidence presented for patient safety,
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workflow efficiency and increased nursing satisfaction a standardized electronic handoff should

be considered.

Policy Development and Implementation

An evidence-based informatics policy should be implemented to provide guidance

regarding legal issues, provide an avenue for staff training, and give direction to users of the new

technology (Brent, 2013). Ray (2017) recommended that administration, financial officers, IT

representatives, nursing managers and supervisors, as well as bedside nurses be involved in the

initial planning of a policy to ensure feasibility. A policy for the use of the standardized

electronic handoff can be found in Appendix B (Arkansas Hospital Association, 2018) (Boise

State University, 2018).

Conclusion

A standardized written handoff can play a pivotal role in aiding nurses and ensuring

patient safety. Being able to readily find and share critical information with the healthcare team

improves workflow and eliminates potentially dangerous information gaps. Informatics is here to

stay in the nursing workplace, and with good reason: informatics can help us to remember vital

information about multiple patients and aid communication with other providers, ensuring not

only patient safety but nursing satisfaction as well.

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References

Academy of Medical-Surgical Nurses. (2013, February). Evidence-Based Practice: An

independent study short course for medical-surgical nurses. Retrieved from Academy of

Medical-Surgical Nurses: https://www.amsn.org/sites/default/files/documents/practice-

resources/evidence-based-practice/Evidence_Based_Practice_Module_I.pdf

American Association of Critical Care Nurses. (2014). Involve Nurses When Designing

Healthcare Technology. AACN Bold Voices, 21-21.

Arkansas Hospital Association. (2018). Policy and Procedure Template. Retrieved from

Arkansas Hospital Association:

http://www.arkhospitals.org/archive/WristbandToolkit/Policy%20and%20Procedure-

AR%20Alert%20Wristband%20Standardization.pdf

Boise State University. (2018, March). Policy and Procedures Writing Guide: Drafting a Policy

- Policy Format. Retrieved from Boise State University:

https://policy.boisestate.edu/policy-writing-guide/

Brent, N. (2013, May 13). Legal Issues Every Nurse Informaticist Should Consider. Retrieved

from HIMSS: http://www.himss.org/news/legal-issues-every-nurse-informaticist-should-

consider

Cassano, C. (2014, October). The Right Balance - Technology and Patient Care. Online Journal

of Nursing Informatics, 18(3). Retrieved from HIMSS: http://www.himss.org/right-

balance-technology-and-patient-care

Chapman, Y., Schweikert, P., Swango-Wilson, A. A.-E., & Heyman, A. (2016). Nurse

Satisfaction with Information Technology Enhanced Bedside Handoff. MEDSURG

Nursing, 313-318.
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Edge, R., & Groves, J. (2006). Ethics of Health Care. Clifton Park: Delmar Cengage Learning.

Medical Ethics Advisor. (2015). EHR use growing fast, but ethical concerns are, too. Medical

Ethics Advisor, 31(7).

Office for Civil Rights. (2017, June 16). HIPPA for Professionals. Retrieved from U.S.

Department of Health and Human Services: https://www.hhs.gov/hipaa/for-

professionals/index.html

Perry, V., Christiansen, M., & Simmons, A. (2016). A Daily Goals Tool to Facilitate Indirect

Nurse-Physician Communication During Morning Rounds on a Medical-Surgical Unit.

MedSurg Nursing, 83-87.

Ray, L. (2017, September 26). How to Write Nursing Policies Procedures. Retrieved from

Bizfluent: https://bizfluent.com/how-5009640-write-nursing-policies-procedures.html

Sewell, J. (2016). Informatics and Nursing: Opportunities and Challenges. Philadelphia: Wolters

Kluwer.

Staggers, N. (2016). Rethinking e-Handoff Designs. Online Journal of Nursing Informatics,

20(1).

Taylor, J. (2015). Improving Patient Safety and Satisfaction With Standardized Bedside Handoff

and Walking Rounds. Clinical Journal of Oncology Nursing, 414-416.

Trossman, S. (2009). No peeking allowed. American Nurse Today, 4(2).

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Appendix A

Workflow Chart of Standardized Electronic Patient Handoff

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Appendix B

Standardized Electronic Handoff Policy

Delaware General Hospital Policy Number: 0123.7.18.1

Effective Date: July 1, 2018

STANDARDIZED ELECTRONIC NURSING HANDOFF

Purpose:
The implementation of a standardized electronic nursing handoff sheet (SENHS) to facilitate a
smooth nursing shift change

Additional Authority:
Health Insurance Portability and Privacy Act (HIPPA) Privacy Rule Title II, Delaware General
Hospital policies and procedures that may apply.

Scope:
Registered Nurses

Responsible Parties:
Director of Nursing, Clinical specialists, General Hospital IT department, SEHNS Policy Team.

I. Purpose

The automated, pre-formatted standardization of the electronic nursing handoff sheet

in order to facilitate teamwork and collaboration during and after shift change in an
evidence-based environment conducive to patient-centered care with the end goal of
patient safety.

II. Objectives

A. To enhance and improve communication between caregivers

B. To improve accuracy and avoid information gaps during shift change
C. To expedite the transmission of patient information
D. To promote patient safety

III. Procedures

A. The SENHS will follow a formatted layout (see section IV, Handoff) as defined
by the SEHNS policy team and will be uniform throughout the facility.
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B. The SENHS should be completed by the end of the period of patient care with
information updated to present to the nurse assuming patient responsibility.

C. The SENHS contains private patient information and must be safeguarded

according HIPPA regulations.

D. Nurses will receive yearly SENHS and HIPPA Net Learning education modules.

E. The SENHS may be reevaluated as needed and changes made as required by the
SEHNS policy team. Recommendations for evaluation and change may be
submitted to the Unit Nurse Manager or to the SEHNS policy team.

IV. SEHNS Handoff Format

The SEHNS should follow the format as outlined below:

Patient Handoff

Neuro:

Cardiac

Respiratory:

GI:
Diet:
LBM:

GU:

Musc:

Skin:

Pain:

IVs / Lines / Drains:

Labs:

Procedures: