New Study Reaffirms Link between Effective Nurse Communication and Patient Safety

American Journal of Nursing Study Reveals Minimal Research Available on Best Practice for Nursing Handoffs

Newswise — A systematic review of nursing handoff literature found that minimal research has been done to identify best practices, despite well-known negative consequences of inadequate nursing handoffs. The article was published in the April issue of the American Journal of Nursing (AJN) (www.ajnonline.com). AJN, the leading voice of nursing since 1900, is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals and institutions in medicine, nursing, allied health, and pharmacy.

“Nursing handoffs occur when shifts change two or three times daily, seven days a week, yet despite the frequency of these events, there are few evidence-based standardized procedures to ensure that communication is managed effectively,” said Lee Ann Riesenberg, director of Medical Education Research and Outcomes, Academic Affairs, Christiana Care Health System, Newark, Delaware and research assistant professor, Jefferson School of Population Health, Thomas Jefferson University. “Errors in communication give rise to substantial clinical morbidity and mortality and, therefore, must be addressed.”

In 2005, the Joint Commission found, after reviewing a decade’s worth of data, that “breakdowns in communication” were implicated in two-thirds of all types of sentinel events. Furthermore, a 2009 Agency for Healthcare Research and Quality survey found that almost half (49%) of hospital staff respondents reported that important patient care information is lost during shift changes.

“This study underscores the need for more research in this area,” said Maureen Shawn Kennedy, MA, RN, editorial director and interim editor-in-chief of AJN. “Even though the Joint Commission is now requiring the standardization of patient handoffs, there’s little evidence to indicate how to most effectively accomplish this process.” The Study A systematic review of articles, published between January 1, 1987 and August 4, 2008, identified all articles about nursing handoffs in the United States. The authors conducted a systematic review of research studies and a qualitative review of barriers to, and strategies for, effective handoffs.

The study notes that there are risks involved in implementing interventions for which evidence of effectiveness is lacking and calls for high-quality outcomes studies. While standardized handoff reporting makes intuitive sense and may yield greater accuracy, increase patient and nurses’ satisfaction and save nurses time, evidence is needed to identify the best structured protocols and interventions. It also was noted that no one format will suffice across all departments or facilities; therefore, handoff elements will have to be adapted for different nursing areas.

Barriers for effective handoffs. The qualitative analysis identified barriers in several major categories. Of these categories, communication barriers were most frequently noted, including lapses in communication or failures to communicate; lengthy or irrelevant content; inaccurate recall of communicated information; illegible handwriting and poor communication between nurses and physicians. Other barriers included lack of supportive behaviors among nurses and poor peer relationships, problems associated with standardization of tools and systems and environmental issues (poor lighting, distractions). Strategies for effective handoffs. Strategies included increased standardization for communicating, including technology (use of computerized handoff systems); tailoring report tools to specific departments; and ensuring recognition that a transfer of responsibility had occurred.

Strategies also included addressing environmental problems such as poor lighting and excessive noise; providing training or education; more staff involvement in the development of training programs; allowing adequate time to plan for a new handoff process as well linking the handoff process to performance evaluation.

About the American Journal of NursingThe American Journal of Nursing (AJN) is the leading voice of nursing and the most established nursing journal in the world, since 1900 (www.ajnonline.com). It has received numerous awards for editorial excellence and dissemination of information. It is published by Lippincott Williams & Wilkins (www.LWW.com).

Lippincott Williams & Wilkins Lippincott Williams & Wilkins (LWW) is a leading international publisher for healthcare professionals and students with nearly 300 periodicals and 1,500 books in more than 100 disciplines publishing under the LWW brand, as well as content-based sites and online corporate and customer services.

LWW is part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals and institutions in medicine, nursing, allied health and pharmacy. Major brands include traditional publishers of medical and drug reference tools and textbooks, such as Lippincott Williams & Wilkins and Facts & Comparisons®; and electronic information providers, such as Ovid®, UpToDate®, Medi-Span® and ProVation® Medical.

Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company. Professionals in the areas of legal, business, tax, accounting, finance, audit, risk, compliance, and healthcare rely on Wolters Kluwer’s leading, information-enabled tools and solutions to manage their business efficiently, deliver results to their clients, and succeed in an ever more dynamic world.

Wolters Kluwer has 2009 annual revenues of €3.4 billion ($4.8 billion), employs approximately 19,300 people worldwide, and maintains operations in over 40 countries across Europe, North America, Asia Pacific, and Latin America. Wolters Kluwer is headquartered in Alphen aan den Rijn, the Netherlands. Its shares are quoted on Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices.