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A Proposal of Handoffs Communication Improvement in the Cardiovascular Unit
The quality of the communication between various healthcare participants is critical for the delivery of safe healthcare services. Based on the survey conducted in the Cardiovascular care unit, CVCU at South Miami hospital, this paper discusses the importance and the existing gaps in the communication between the interventional vascular radiology nurses, cath lab nurses, and CVCU nurses. It is advisable to change the perception of the handoff communication between interventional vascular radiology nurses, cath lab nurses, and CVCU nurses by conducting educational sessions and arranging mentoring programs by the senior staff of the hospital. As a result, the percentage of mistakes will be lower, whereas the quality of healthcare for the patients in the CVCU will be higher.
As will be evident from the survey results, the major problem is the poor communication during the handoffs between the interventional vascular radiology nurses, cath lab nurses, and CVCU nurses. The exacerbation of the handoff communication between the abovementioned medical professionals is caused by the enormous workload, scarcity of time, and cultural differences that impact the way information is conveyed from one nurse to another. In fact, there are three behavioral objectives that the hospital should incorporate into the change proposal, and they include:
- To give a nurse a guide that will standardize the procedure of the handoffs communication, describe its integral steps, and specify the information and its volume that the nurses are to share;
- To increase nurses accountability for the handoffs communication by demonstrating the statistics on mistakes related to the poor verbal interaction and their impact on the healthcare quality;
- To raise the awareness of the nurses about the differences in cultural backgrounds, as well as verbal and non-verbal language.
Purposes of the Proposal
The goals of the change proposal are to develop a standardized procedure that covers major steps in the handoffs communication between the nurses and to minimize the number of mistakes caused by poor verbal interaction. The importance of the first aim is related to the fact that currently the handoffs procedure is based on the historically established way of how the interventional vascular radiology nurses, cath lab nurses, and CVCU nurses should transmit the healthcare data.
The nurses do not fully realize that this way of handoff communication leads to serious flaws in the quality of patient care due to numerous mistakes. Moreover, the cultural diversity of the workforce makes communication even more difficult. Thus, after the introduction of the standardized handoff communication procedure, and the changes in the awareness of the related mistakes as well as differences in the cultural background, the second goal is to minimize the number of medical errors caused by the poor handoff communication between the above-mentioned workers.
To receive factual results concerning the existing problems in the cardiovascular care unit at South Miami hospital, it was rational to develop a questionnaire. Particularly, the nurses had to identify the duration of work in the unit, state what problems they found the most acute in the unit, and suggest reasonable ways to improve the situation. In the process of the survey, it was crucial to guarantee the respondent's anonymity and to elucidate the goal of the given study.
The survey results allowed us to identify several problems in the CVCU. Specifically, among seven nurses who took part in the survey, 14,3 percent of the respondents were employed for less than one year, while 42,3 percent had worked in the hospital between 1-4 years and more than 4 years. The problems identified entailed a non-proactive attitude of the nurses (12 percent), not timely orders (12 percent), improper communication during handoff procedures (37 percent), issues with patients scheduling (25 percent), and technical errors, such as unlocked hallway computer (12 percent).
Review of Literature
Blaz and Staggers (2012) define nursing handoff as a communication between two shifts of nurses occurring with the transfer of responsibility for a patient when information about patients and their care is exchanged (p.1). The authors underline that nurses use this data to make appropriate decisions on further patients treatment. Moreover, the information they share allows them to prioritize patient care. The handoffs process is also the way how nurses socialize, further practically learn, and professionally develop, as well as express emotional support.
The Joint Commission (2017) reports the most frequent problem with handoff communication is that the expectations of a sender of the information do not coincide with those of a receiver. This misalignment is the primary area where the handoffs miscommunication arises. When the receiver obtains incomplete, inaccurate, misinterpreted, and not timely information, this often leads to noticeable weaknesses in the treatment process. The Joint Commission (2017) argues that communication failures in U.S. hospitals and medical practices were responsible at least in part for 30 percent of all malpractice claims, resulting in 1,744 deaths and $1.7 billion in malpractice costs over five years (p.2). Therefore, the issue of poor handoff communication is a critical problem that hinders the safety and well-being of the patient.
Blaz and Staggers (2012) write that the process of conducting the handoffs procedure along with communication as its central part emerged historically in each medical unit. It is frequently characterized as individualized and informal. The authors underline that a lack of standardized guidelines for the uniform structure of the handoffs process led to the development of its numerous variations implemented in the hospitals. Each medical institution tries to adjust the handoff tools to assist medical personnel in communicating the information in the most efficient way prioritizing safety and continuation in the patient's treatment process.
According to Manser and Foster (2011), poor communication during the handoffs procedure may lead to a diagnosis and treatment delay, incorrect treatment methods, prolonged stay in the hospital, unnecessary laboratory tests resulting in lower healthcare service quality, and complaints from the patients. Dayton and Henriksen (2007) outline more structured forms of communication between the medical workers to enhance clarity, ensure the fullness of the information and reduce the ambiguity of the data.
The Joint Commission (2017) recommends that a medical establishment should avoid introducing either solely electronic or written handoff communication. It underlines that the receiver and the sender must accompany the documents with the oral explanations in a face-to-face meeting, or, if not possible, via video conference or telephone. Additionally, there should be enough time for the handoff participants to ask questions. The information should be synthesized, containing at minimum the contact information of the sender, illness and its severity assessment, patient summary on the hospital course, the list of the needed actions, allergy list, contingency plan, medication list, code status, dated vital signs, and dated laboratory tests.
The Joint Commission (2017) also underlines that the changes to the handoffs communication process must be implemented under the supervision of strong leadership. In particular, it has to employ all the necessary resources for the implementation, reinforcement, and continual monitoring of handoff practices. The main purpose of the handoffs communication improvement is to follow the most efficient practices integrated into the hospital's culture that will promote patient safety and the positive image of the medical establishment. According to the Joint Commission (2017), it is necessary to conduct an examination of the current handoff communication processes and to find the weaknesses that require intervention.
Murphy (2011) claims that cultural competence plays a crucial role in making communication clearer and open. Each nurse must be aware not only of the cultural background of the patients but also of the attitudes, values, and peculiarities of the decision-making that the representatives of the different cultures have. Mastering the understanding of verbal signs and non-verbal body language can also assist nurses in improving the communication process by declining misunderstandings or false assumptions. Murphy (2011) also states that it is essential to improve the knowledge about different communication features and patterns to minimize the impact of stereotypes on the way how nurses communicate.
Implication for Nursing Practice
To meet the first objective in the form of developing the standardized form of conducting the handoffs communication process, Blaz and Staggers (2012) recommend using either templates or spreadsheets to ensure a more detailed and structured transmission of the information. Communication between the interventional vascular radiology nurses, cath lab nurses, and CVCU nurses should become more structured to guarantee the accuracy and credibility of the information that the nurse delivers to the patient. This standardization must be partially in written form and partially in electronic form, according to the recommendations of the Joint Commission.
Moreover, compliance with the approved standardized spreadsheets or templates can increase satisfaction among nurses, because it will decline the likelihood of stress related to the mistakes that frequently happen during the handoffs communication. Thus, a nurse in the cardiovascular care unit, CVCU at South Miami hospital, receives a guide that will help to improve the communication process as an outcome of the execution of a more standardized handoffs procedure, which includes the steps it should involve and the information it should focus on.
South Miami hospital must organize and conduct educational sessions with the nurses involved in the handoff procedures. The core aim of these events is to inform them about the eventualities described above, potential mistakes that happen during the handoffs process, and the serious consequences for patient safety. Thus, the training will increase nurses' accountability for the handoffs communication and facilitate the improvement of the healthcare quality.
It is also essential not only to give the nurses the standardized guide on how to establish the handoffs communication but also to improve their cultural competence to be able to differentiate various cultural backgrounds as well as verbal and non-verbal language. Subsequently, this will simplify the communication process and make it more efficient.
To conclude, the handoff communication between the interventional vascular radiology nurses, cath lab nurses, and CVCU nurses is not solely the transmission of the information about the patient's medical history; it is the process of transferring responsibility for patient safety from one nurse to another. Therefore, the handoff communication between nurses in the cardiovascular unit should be safe and effective. Ineffective interaction leads to the distortion or omission of essential information about the patient's health state. Such interventions as the introduction of more standardized spreadsheets and templates for the transfer of the patient information, educational sessions aimed at increasing nurses' accountability related to the mistakes that occur during the handoff process, and the improvement of the nurse's cultural competency are needed.