New Study Reaffirms Link between Effective Nurse Communication and Patient Safety

A systematic review of nursing handoff literature found that minimal research has been done to identify best practices, despite well-known negative consequences of inadequate nursing handoffs. The article was published in the April issue of the American Journal of Nursing (AJN) (www.ajnonline.com). AJN, the leading voice of nursing since 1900, is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals and institutions in medicine, nursing, allied health, and pharmacy.

“Nursing handoffs occur when shifts change two or three times daily, seven days a week, yet despite the frequency of these events, there are few evidence-based standardized procedures to ensure that communication is managed effectively,” said Lee Ann Riesenberg, director of Medical Education Research and Outcomes, Academic Affairs, Christiana Care Health System, Newark, Delaware and research assistant professor, Jefferson School of Population Health, Thomas Jefferson University. “Errors in communication give rise to substantial clinical morbidity and mortality and, therefore, must be addressed.”

In 2005, the Joint Commission found, after reviewing a decade’s worth of data, that “breakdowns in communication” were implicated in two-thirds of all types of sentinel events.

Furthermore, a 2009 Agency for Healthcare Research and Quality survey found that almost half (49%) of hospital staff respondents reported that important patient care information is lost during shift changes.

“This study underscores the need for more research in this area,” said Maureen Shawn Kennedy, MA, RN, editorial director and interim editor-in-chief of AJN. “Even though the Joint Commission is now requiring the standardization of patient handoffs, there’s little evidence to indicate how to most effectively accomplish this process.”

The Study

A systematic review of articles, published between January 1, 1987 and August 4, 2008, identified all articles about nursing handoffs in the United States. The authors conducted a systematic review of research studies and a qualitative review of barriers to, and strategies for, effective handoffs.

The study notes that there are risks involved in implementing interventions for which evidence of effectiveness is lacking and calls for high-quality outcomes studies. While standardized handoff reporting makes intuitive sense and may yield greater accuracy, increase patient and nurses’ satisfaction and save nurses time, evidence is needed to identify the best structured protocols and interventions. It also was noted that no one format will suffice across all departments or facilities; therefore, handoff elements will have to be adapted for different nursing areas.

Barriers for effective handoffs. The qualitative analysis identified barriers in several major categories. Of these categories, communication barriers were most frequently noted, including lapses in communication or failures to communicate; lengthy or irrelevant content; inaccurate recall of communicated information; illegible handwriting and poor communication between nurses and physicians. Other barriers included lack of supportive behaviors among nurses and poor peer relationships, problems associated with standardization of tools and systems and environmental issues (poor lighting, distractions).