ACCREDITATION Field Report

Best practices found in survey at KY hospital

Surveyors impressed with handoff processes

After the Agency for Healthcare Research and Quality (AHRQ)'s Hospital Survey on Patient Safety Culture was completed by staff at Our Lady of the Way Hospital in Martin, KY, results revealed that improvements were needed for communication during handoffs.

Rapid cycle improvement processes were implemented, beginning with a single unit that served as a pilot, focusing on handoffs from the ED to the medical/surgical unit for patients being admitted. "We put some processes in place for direct communication between the ED nurse and the receiving nurse on the inpatient unit," says Billie Turner, the organization's vice president of clinical operations and chief nursing officer. "They do their communication via phone and this is done in front of the patient."

A template is used by both nurses to make sure that the ED nurse is giving all the information that the team feels is important, and that the receiving nurse is filling in all the blanks. To measure the results of the new process, quality managers used the hospital's patient satisfaction survey, which asks patients how nurses work as a team.

"We were using that as a metric to measure how we were doing with this, because we give the report in front of the patient," says Turner. "We did see some big improvements in our patient satisfaction that we attributed to this process."

After the initial pilot went smoothly, the handoff process was implemented in all hospital departments, as well as the organization's six rural clinics where patients are admitted from. "The process is done the same way there," says Turner. "The nurse at the clinic calls the inpatient unit and gives the report." The same process is used for patients going to diagnostic testing from the inpatient unit, and patients going to surgery or returning from surgery.

During a February 2007 Joint Commission survey, the surveyor gave high marks to the handoff process. "He particularly liked the fact that we had expanded it through all the other areas, including diagnostic testing," Turner says. "He was pleased that we have a consistent process. Whether patients are coming from a clinic, surgery or the ED, everybody uses the same format to give and receive report."

Here are other areas The Joint Commission surveyors were impressed with:

The medication reconciliation process.

"He said it was a best practice they were planning to share with other organizations," says Turner. "Our handoff process played a big role in that, actually. Our pharmacy is very involved in our process, and we feel that has been a big benefit for us."

The process starts at admission, wherever the patient is admitted, and is used throughout the organization. A list of the patient's medications is obtained and sent with them to the inpatient unit. "If for some reason the list doesn't come with them, then it is done on that unit," says Turner. "That list is reviewed by the physician and serves as an order sheet as to whether or not the medications will be continued."

Wallet-sized medication cards are given to patients to carry and present each time they come to the ED or clinic, and upon discharge from the hospital, the patient is given a printout of their medications. "We encourage them to bring that back in with them when they come," says Turner.

Nursing admission assessment for inpatient units and care planning.

"He liked this process because the way we have it set up, it actually triggers things that go into the care plan," says Turner. "Our care plan is very multidisciplinary and he was able to see all of the discipline's input into the care plan."

Education assessment.

"If you look at The Joint Commission standards, in the elements of performance it's very specific as to what you have to have," says Turner. "We listed it all on a single sheet and we check it off. The surveyor said it made it really easy for him to find it."

[For more information, contact:

Billie Turner, Vice President Clinical Operations/Chief Nursing Officer, Our Lady of the Way Hospital, PO Box 910, Martin, KY 41649. Phone: (606) 285-5181, ext. 6401. E-mail: bturner@olwh.org.]