Maintaining Patient Safety during transition depends on effective communication among healthcare team members. It is a priority in the healthcare industry to promote positive patient outcomes. The Joint Commission requires communication among healthcare team members during the transition of care to avoid preventable medical errors.
There is clinical evidence that ineffective communication is one of the leading causes of medical errors. Therefore, an effective report is essential to promote patient safety during patient transfer.
Maintain Patient Safety During Transfer
The hand-off is a standard communication tool that most healthcare facilities adopted to promote continuity of care among team members and ancillary staff. Most organizations follow an SBAR – Situation, Background, Assessment, and Recommendations model during patient transfer.
Situation: The sending nurse and the Provider briefly review the current status of the patient with the receiving unit or department. For instance, the patient is admitted following a fall and sustained a left clavicle dislocation. Thus, Surgical intervention is not necessary.
Background: This section covers the patient’s past medical history. Thus, the patient has a history of Parkinson’s disease and multiple falls due to abnormal gait. He lives alone and receives private duty care three times a week.
Assessment & Recommendations
Assessment: This section includes a summary of the patient’s current clinical findings. The patient is alert and oriented to self, place, situation, date, and time ( AOX 3-4). Furthermore, the patient can follow simple instructions, works with Physical Therapy and Occupational Therapy to improve strength, and to promote self-care.
Recommendations: The patient needs frequent safety rounds and keep him near the nursing. His left arm is in a sling for immobilization. Lastly, The nursing staff needs to supervise all activities and continue the fall prevention measures.
The example above is based on focused assessment and report, but nurses should follow their facilities’ protocol. Effective communication can reduce and eliminate preventable medical errors. Nurses can maintain patient safety during the transition of care by completing a report.
Maintain Patient Safety by Conducting Team Rounds
The Joint Commission requires that healthcare organizations establish criteria to share pertinent clinical information about each patient. Thus, team rounds usually include the primary Provider, discharge planning, nursing, rehabilitation, and other services. Team communication will facilitate nursing to maintain patient safety during transfer.
MultiDisciplinary- MultiD team rounds: This round usually occurs on the nursing ward, at an approved time. The nurse often updates the team about patient status, response, and compliance with care. The nurse also updates the clinical documentation records.
The primary Provider is ultimately responsible for coordinating the care of the patient. The Provider is also accountable to follow up on consultation services’ recommendations and serial diagnostic testing. Rehabilitation is accountable to determine activity level and appropriate post-hospitalization physical activity requirements.
Maintain Patient Safety Through Professional Accountability
Discharge planning is responsible for collecting clinical data from the meeting and the patient’s records to coordinate safe discharge. Thus, that department will take care of Durable Medical Equipment-DME and other supplies that the patient will need upon discharge. The team will maintain the patient’s safety during the transition of care through effective planning.
The primary Provider is responsible for entering orders for the patient. Thus, The Provider will discuss the treatment plan with nursing and other team members. Nurses should review their facility’s protocol for verbal orders because most organizations approve verbal orders during an emergency only.
The team round is an opportunity to review the patient’s records and clarify orders. Therefore, The meeting enables healthcare staff to maintain patient safety during transfer.
What To Do Before Transferring Patients Off A Unit
Most hospitals and other healthcare facilities require a ticket to ride during the patient’s transport. A ticket to ride contains a brief clinical summary of the patient. A ticket to ride is not usually necessary when a nurse travels with the patient.
The sending nurse should give a report to the receiving nurse or staff who will receive the patients. Besides, the receiving department or other clinics should obtain a report about the patient. In addition, the receiving staff needs to know the patient’s mental status, mobility status, precautions, diet, lines, and drains.
The clinical information is valuable to maintain patient safety and continuity of care. Every staff who is involved in the patient’s care should receive a report according to their role. Thus, nurse to nurse, technician to technician, Provider to Provider report should occur.
Accompany Patient To Maintain Safety During Transfer
A licensed professional must accompany all patients during transfer to a higher level of care. Besides, the professional will manage care in case the patient rapidly deteriorates while en route. Sending nurses can give a report at the bedside. If the higher level of care nurse is already on the lower level of care unit, that nurse can travel with the patient.
The sending nurse should send the patient’s chart if there is one. Moreover, nursing staff should send the patient’s belongings, treatments, some of the medications i.e insulin pens, inhaler, home medications. Please remember to inform the patient’s healthcare partner.
Communicate With Surgical Team
It is a Joint Commission requirement to communicate pertinent information about the patient during the transition of care. For instance, nurses should give a report before surgery. The sending unit should follow the organization’s protocol to complete the preoperative checklist.
The nurses should discuss the patient’s last NPO ( nothing by mouth) status, most recent Echocardiogram when Indicated. Moreover, the nurse will review abnormal lab results, and specifically potassium, magnesium, INR and PTT. The staff nurse must report the last medication that was given and vital signs within one hour of the procedure.
The primary nurse has to send all medications that the patient should receive before surgical cutting time. The nurse needs to discuss intake and output, lines and drain present before the procedure. It is also important to report skin conditions. Thus, a report will promote patient safety during the transition of care to the perioperative department.
Maintain Patient Safety During Transition To Outside Facilities
There is a misconception that outside facilities receive clinical updates from case management only. Discharge planning remains in contact with receiving hospitals or facilities. However, Providers and nurses are responsible for giving a report to their counterparts.
The sending staff should follow the SBAR model as mentioned above. For example, the patient’s mental status and the most recent assessment findings should be part of the report.
The report includes neurological status, cardiac, pulmonary, gastrointestinal, genitourinary, musculoskeletal, skin, pain, last medication administration, restrictions and safety precautions. In addition, nurses should discuss the availability of equipment i.e oxygen concentrators, assistive devices, respiratory equipment and more.
Maintain Patient Safety By Preventing Readmission
Nurses can prevent unnecessary readmission when they communicate effectively with receiving facilities. Thus, nurses should ensure the patient’s transfer package is ready before transferring the patient to new facilities. The package usually includes code status, list of medications, clinical, and discharge summary. Lastly, nurses should discuss prescribed medications during the report to prevent medication errors.
Maintain Patient Safety Through Safe Discharges
Following a doctor’s order to discharge a patient home, the nurse should follow the checklist below.
Discharge order: The nurse should verify that the primary Provider enters an order in the patient’s medical records.
Discharge criteria: The nurse should validate that the discharge criterion is met based on the treatment plan. Please verify that the patient completes the specific tests and activities that the doctor ordered.
Clinical summary: The nurse should review the discharge summary and discharge medications to develop a teaching plan.
Care management: The nurse should validate home care arrangements and transportation with case management/ discharge planning when necessary. Thus, the nurse needs to promote a safe home discharge.
Medications prescriptions: The nurse must ensure that the patient receives medications that the facility or hospital’s pharmacy should dispense before sending the patient home.
Maintain Patient Safety During Transition And Safe Discharge Process
Complete the patient’s discharge: The nurse has to inform the patient of the discharge process and verify transportation with the patient or case management. In addition, the nurse has to review all discharge instructions, home precautions, home safety, and follow up with the patient.
Home supplies: The nurse may give the patient some supplies if needed for home care i.e., wound care or line care, etc.
Patient’s pick up or transportation: The nurse can delegate a nursing assistant to accompany the patient to his or her transportation. Besides, the nurse must give the patient or significant other copies of discharge instructions.
Documentation: The nurse must document the time of discharges, patient teaching, and last vital signs one hour before discharge. The nurse will also remove lines and drains according to the facility or hospital’s protocol.
Implications for Nurses
Nurses and other healthcare professionals should receive training about effective communication, nursing report and patient safety during orientation and periodically. Leadership should allocate funds to support the training program and identify a plan for sustainment.
Nurses should adapt to the communication software and tools that the industry will acquire to promote patient safety. For instance, many facilities or hospitals use a portable communicable device. Thus, most healthcare professionals use it to share patients’ information during the transition of care.
Nurses are responsible for implementing their organization’s communication tools to promote patient safety. Moreover, nurses should receive education about the tools and participate in compliance audit activities to identify process gaps or system failures.
Healthcare staff must improve patient safety by following the Joint Commission National Patient Safety Goals- NPSG. Ineffective communication is one of the leading causes of medical errors. Thus, healthcare professionals ought to communicate effectively to reduce or eliminate preventable errors. Many healthcare facilities adopt team rounds to facilitate the patient’s care discussion among healthcare team members.
The rounds often lead to transparency and continuity of patient care. Handoff- is a standard communication tool in the healthcare industry. It enables the team members to communicate the patient’s clinical status during the transition of care. Overall, healthcare professionals can promote patient safety during the transition of care by communicating effectively across all clinical care settings.
Nurse Sophie has been a registered nurse for over a decade. I have a Master's degree in nursing, and my clinical experiences include staff nurse, clinical nurse supervisor, and manager, and most recently, nurse consultant in Patient Safety and legal nursing. I was always passionate about system operations and practice standards.
I have completed over 2000 hours of medical chart reviews. I am an expert in clinical investigations, and I also develop event timelines. I can assist the legal team with the Discovery process: Deposition, Interrogatories questionnaire, event timelines, locate expert witnesses, and more. I provide and formulate clinical opinions based on the investigative summary.
Nurse Sophie, MSN, RN, LNC
Legal Nurse Consultant
Patient Safety Specialist
Email: [email protected]