Passing the Baton with Huddles and Bedside Handoffs

Purpose:
The purpose was to implement huddles and bedside handoffs on a medical/surgical unit to improve communication between nurses at change of shift and include patients. Benefits of huddles and handoffs include improved communication strategies impacting both nursing and patient satisfaction scores.

Significance:
The 2012 NDNQI Conference inspired the director to implement bedside handoffs to enhance huddles. Low scores on the Practice Environment Scale (PES): patient satisfaction; falls and pressure ulcers were above the median. Huddles and handoff benefits motivated the shared governance unit council.

Strategy and Implementation:
Change of shift huddles were implemented, then Unit Council implemented bedside handoffs to impact communication between the nurses and patient. Huddles include Process Change Alerts, Announcements, Safety Focus, Improvement Opportunities and Metrics Dashboard. The handoff includes: introduction between nurses and patient; pain management; plan of care; patient issues during the shift; and discussion of information on the patient's white board. The nurse alerts the patient with scripting, “at the change of shift we do report with the oncoming nurse, so your needs are discussed. If you have needs prior to this, please let us know so that we can do it before report.” At the night shift change of shift, this alert allowed the patient to opt out without being disturbed while sleeping. The Patient Care Technician (PCT) was more attentive with call lights at handoff. A three week pilot by unit council nurses at handoff prompted peer participation to do a “small test of change.”

Evaluation:
Nursing leadership and Unit Council on the medical/surgical orthopedics floor will monitor patient satisfaction data, nursing satisfaction data and elements about pain management. Improvements in these measures may relate to change in communication between the nurses and the patients.

Implications for Practice:
Huddles and handoffs reinforce standardization in process, communication tools, leadership, staff buy-in,and nurse to nurse and nurse to patient relationships. They improve culture of safety with reduced distractions, interruptions, multi-tasking, nursing fatigue, stress, and information overload.