In late 2007, staff members at Abington (PA) Memorial Hospital (AMH) knew their handoff process could use some work.
Their process, like that of many other hospitals, used a paper form to communicate important patient information from one provider to the next. However, the form would often be filled out improperly, labels would be missing, and ultimately, the receiver might not be aware of everything he or she needed to know about a patient, putting the patient at risk for an error in care.
The hospital also needed to stay in compliance with the National Patient Safety Goal concerning handoff communication, currently NPSG.02.05.01. Additionally, nurses often had to double-document information on the handoffs that had already been captured in the electronic medical record.
AMH had implemented computer physician order entry and clinical documentation by September 2007 and decided to utilize the EMR to enhance its handoff process. At the time, the hospital also used another system that pulled information from the EMR to provide patients with a daily care report.
"We thought maybe we could use that type of technology—that report writing—to get better, more accurate information in a simple way to ancillary staff," says Diane Humbrecht, MSN, RN, C, nurse director of informatics at AMH.
Humbrecht and her colleague Linda Mimm, RN, BC, DL, CPHQ, safety and quality specialist at AMH's Center for Patient Safety & Quality, worked with a team to decide how the process would function and what information should appear on the new "electronic hall pass."
The team decided that the information contained on the handoff should be pulled directly from the EMR, using the documentation notes that the nurse wrote up each morning. However, only data deemed pertinent would be included, as the team wanted to limit the printout to one page. This included items such as whether the patient was a fall risk, whether the patient was on oxygen, and the patient's isolation and code statuses. Since the effort launched, a team of support staff members reviews this list of items regularly to ensure that they are the most important ones to include.
Nurses were trained to use the EMR so that if a patient was to be transported to another department, they could merely go into that patient's record and click "print hall pass" for all of the necessary information to be printed.
Transfer staff members were trained to make sure that any patient ready to be escorted had a printed hall pass and to reconcile that information. If any patient information was missing, the transfer staff member would stop the process until he or she could locate the information.
The departments receiving patients from a transfer played a large role in redefining this process. Mimm says she originally was collecting data regarding whether the information on the hall pass was present, but she has since shifted to understanding who is receiving and using that information.
"What's nice is we can give monthly feedback to the receiving departments on how they are doing with reviewing the hall pass, and we're able to hit compliance because they were getting timely feedback," says Mimm.
This process has worked well since implementation and has increased the awareness of the support staff, without whom this process redesign would not have been possible, says Mimm.
"The whole process made me really appreciate the people outside of the nursing department who really need to know more about our patients and are concerned about their safety," she says.
Plans for future alterations
The simple set of directions for preparing the electronic hall pass is something that AMH staff members hope can be easily taught to transfer staff members. Instead of having nurses print the hall pass after updating the patient's record during rounds, AMH is planning to engage the escort staff members in the process more to minimize risks.
"If the hall pass is printed at 9 o'clock in the morning, it's only as good as the information updated until 9 o'clock," says Humbrecht. To that end, transfer staff members will be trained on how to enter the patient's record and print the most up-to-date hall pass upon arriving to pick up the patient.
Although Humbrecht and Mimm stress that the idea is to keep the printout as simple as possible, they are considering adding patient allergies to the form.