Marshalltown Medical & Surgical Center

CENTRAL IOWA HEALTHCARE Marshalltown, Iowa

ADMINISTRATIVE POLICY & PROCEDURES

Policy Number: 159

Subject: Hand Off Communication

Purpose: To provide accurate information about a patient’s care, treatment and services, current conditions and any recent or anticipated changes when patient care responsibilities are being transferred from one care provider to another.

Policy: Central Iowa Healthcare will utilize the ISBAR model as its standard approach to “hand off” communications between all personnel within all healthcare settings. This standardized approach to “hand off” communication will occur in, but is not limited to, the following circumstances:  Shift change or bedside report in nursing units  Assuming temporary responsibility for care when staff leave a unit for a short period of time (e.g. lunch breaks)  Transfer of patients between units, i.e., transferring a patient from one internal level of care to another, including admissions from the Emergency Department.  Internal transfers between nursing units will include continuation of the physician’s medical plan of care which includes, but is not limited to, IV therapy, respiratory therapy, cardiac and respiratory monitoring, and isolation standards.  Internal transfers between nursing units will culminate with caregiver to caregiver in person patient care hand off.  Transfers between nursing units and ancillary departments.  Upon transfer of patient between ancillary departments for tests/procedures e.g. Diagnostic Imaging Services, whenever the ancillary department is moving the patient from the bed or chair.  Transfer of a patient from the Emergency Department or other hospital unit to another hospital or healthcare organization.  All Ambulance transfers.  Discharges to home with Home Health, Hospice, or other caregiver agency.

Definitions: “Hand off” is defined as the provision of verbal or written information from one healthcare provider to another so that pertinent care, treatment or service needs as well as the patient’s current condition are accurately communicated. I – Introduce S – Situation B – Background A – Assessment R – Recommendations/Requests Additional Information: 1. There must be an opportunity for interactive communication between the giver and receiver of patient information. 2. The patient information will be up-to-date regarding the patient’s care, treatment and services, condition, intake & output and any recent or anticipated changes. 3. A review of the patient’s relevant historical data, including past care, treatment and services will be made available. 4. Hand off communication can be verified by repeat back or read back as appropriate. 5. Interruptions will be minimized. 6. Appropriate patients will receive shift report by walking bedside rounds to include the patient in the plan of care. 7. The patient’s medical record is a primary source of care communication and shall be accessible wherever the patient is located. 8. “Hand offs” can be verbal and/or written. In cases where report is written, their receiving caregiver shall have the ability to contact the sending party by phone to provide an opportunity for clarification. 9. Individual units may customize content to meet patient/department needs, but the ISBAR model will be adhered to. 10. If written handoff is indicated, the Ticket to Ride tool will be used.

Procedure: When communicating with other caregivers, use the I-SBAR process: 1) I-Introduce: 2) S-Situation: What is happening? What is the situation you are communicating? Have available the pertinent information; ie. name, physician, allergies, meds, IV fluids, lab/results, vital signs, code status, intake & output. 3) B-Background: Admitting diagnosis, medical history, and treatments to date. What information is known? 4) A-Assessment: What do you think is happening; ie. abnormal or changing physician or emotional assessment? What is the nurse’s assessment of the situation? 5) R-Recommendation/Request: What is the nurse’s recommendation or what does he/she want? What responses are requested? Readback any physician orders. 6) Left Side of Ticket – Patient Hand-Off a) Transporting department (i.e., Nursing) will bring ticket with them to receiving department (i.e., Diagnostic Imaging). b) Transporting department must complete the “S” Situation section. (see top orange highlighted area) c) RN on sending unit must complete “B”, “A”, “R” sections. (see pink highlighted area) i) Must be completed at time of transport (not ahead of time). ii) RN must verbally connect with the receiving RN to give a report…either by phone or in person. d) Transporter must complete bottom box “transported by” and date and sign. (see bottom orange highlighted area) 7) Right Side of Ticket – Return Ticket a) RN sending patient back to nursing unit must complete “S”, “B”, “A”, R”” sections. RN must still give report to receiving nurse. (see green highlighted area) b) Receiving unit RN must sign and date box below the “R” box. (see pink highlighted area) c) Transporter returning patient to unit must fill in lowest box on right side, time and date. (see green highlighted area) 8) The transporter is whoever transports the patient from unit to unit. 9) An ancillary department can be the receiving unit if receiving a patient from anyone other than the floor units. At that point, another Ticket to Ride needs to be used to transport patient back to the floor. 10) If a patient moves between modalities within the same department, no new ticket needs to be used.

References: 1. Journal on Quality and Patient Safety; Volume 32, Number 11, November 2006. 2. Joint Commission on Accreditation of Healthcare Organizations, 2006. 3. Hand Off Communications: Practical Strategies and Tools for JCAHO Compliance; HCPro, Inc. 2006. 4. Transforming Care at the Bedside, Robert Woods Foundation and the American Hospital Association 5. Lean.org: Ticket To Ride form and completion instructions

Originated by: QI/Ed Council Effective date: 3/07 Authorized by: ______Chief Nursing Officer Date Review date: 5/13 Revision date: 6/09, 5/10, 2/16 Distribution: