Hit a Handoff Homerun: Cover All the Bases

Cedars Sinai Medical Center, Los Angeles, California

CSI Summary

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CSI Presentation

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CSI Toolkit

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Project Topic:

Bedside handoff

Hospital Unit(s):

6 Saperstein – Cardiac Surgical ICU

CSI Participants:

  • Bethanne Dehler BSN, RN, CCRN
  • Christina Sadoma BSN, RN, CCRN-CSC
  • Keny Tan BSN, RN, CCRN

Project Goals/Objectives:

  1. Reduce post-handoff discrepancies to 25% or less by March 2023
  2. Create a standardized handoff tool with an emphasis on safety checks specific to our Cardiac Surgery population
  3. Improve continuity of care and rapport
  4. Build an environment of safety and accountability

Project Outcomes:

  1. Reduced post-handoff discrepancies from 73.6% to 25.5%
  2. 70% of staff consistently used tool during bedside report
  3. Since the start of the project in October 2022, zero medication errors were reported; 9 had been reported in the 6 months prior to the project’s start.
  4. These project outcomes resulted in an estimated annual fiscal impact of $103,428.

Project Overview:

Our Cardiac Surgery ICU lacked a standardized handoff routine for its specialized acute care population. This lack of a standard is attributed to post-handoff errors in areas including IV drips, orders not being carried out, lab values not being acknowledged and more.

In our baseline survey, approximately 74% of survey responses indicated common discrepancies included orders not carried out, history and labs not reviewed and incorrect chest tube water levels. In the 6 months prior to our project, our unit reported 9 medication errors.

Our CSI team decided to build an inclusive handoff tool focused on safety checks to address the following:

  • Pacemaker settings matching order
  • Correct chest tube water levels (allowing proper suction post-operatively)
  • IV drip verification and ensuring proper connection
  • Lab result review
  • Reviewing order history from prior shift

In October 2022, we kicked off our project and implemented our handoff tool. All staff were educated about the goals of the project and the importance of building safety checks into handoffs. Regular audits enabled us to measure usage, get critical feedback and champion our project. In January 2023, we reeducated the staff including new hires and pushed toward changing the unit culture. For meaningful recognition, we invited staff to enter their peers into a raffle when handoff was completed. We created visual aids to show progress toward our goal.

Our post-project survey showed that we reduced post-handoff discrepancies from 73.6% to 25.5%, with 70% of the unit nurses utilizing the tool. Zero medication errors have been reported since October 2022, which has a potential fiscal impact of $51,714 (based on Agency for Healthcare Research and Quality estimates).

Our unit culture is changing toward a safety-focused, standardized, efficient handoff practice. To sustain this change, CSI members and preceptors will educate new staff, encourage peer-to-peer accountability and recognition, and audit compliance.

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The materials associated with this AACN Clinical Scene Investigator (CSI) Academy project are the property of the participating hospital noted above, not AACN. Requests to use content contained in the CSI team’s summary, presentation or toolkit should be directed to the hospital. We suggest reaching out to the hospital’s Communications, Marketing or Nursing Education department for assistance.

The AACN CSI Academy program supports change projects based on quality improvement methods. Although CSI teams seek to ensure linkage between their project and clinical/fiscal outcomes, data cannot be solely attributed to the project and are estimations of impact.