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Itrace tool at handoff1/27/2024 Although research findings suggest improvement in handoff information after implementing standardization ( Johnson, Jefferies, & Nicholls, 2012 Pothier, Monteiro, Mooktiar, & Shaw, 2005), the overall evidence linking improvement strategies with patient safety remains weak ( Abraham, Kannampallil, & Patel, 2014 Cohen & Hilligoss, 2010 Patterson & Wears, 2010 Riesenberg, Leitzsch, & Little, 2009 Riesenberg et al., 2010 Staggers & Blaz, 2013). To address information deficiencies, researchers have focused on standardizing the content of handoff information with support from written or computerized tools ( Collins, Stein, Vawdrey, Stetson, & Bakken, 2011 Flemming & Hubner, 2013 Holly & Poletick, 2013 Patterson & Wears, 2010 Staggers et al., 2011 Strople & Ottani, 2006). Furthermore, handoff information is frequently inaccurate, incomplete, biased or misunderstood ( Dowding, 2001 Flemming & Hubner, 2013 Holly & Poletick, 2013 O'Connell et al., 2008 Pezzolesi et al., 2010 Rabol et al., 2011 Riesenberg, Leisch, & Cunningham, 2010 Sexton et al., 2004 Staggers & Blaz, 2013 Strople & Ottani, 2006 Welsh et al., 2010). Handoffs pose risks to patient safety because handoff communication is challenged by time constraints, interruptions, noise, and interpersonal tensions ( Carroll et al., 2012 Kerr et al., 2011 Meissner et al., 2007 O'Connell et al., 2008 Randell et al., 2011 Staggers & Jennings, 2009 Welsh, Flanagan, & Ebright, 2010). Although nurses perceived improvements in patient safety after changing to bedside handoff ( Chaboyer, McMurray, & Wallis, 2010 Sherman, Sand-Jecklin, & Johnson, 2013), overall data are inconsistent regarding the comparative strengths and limitations of different handoff methods in maintaining patient safety ( O'Connell, Macdonald, & Kelly, 2008 Sherman et al., 2013 Staggers & Blaz, 2013). Handoff methods vary and include written, tape recorded, and oral face-to-face at or away from the patient's beside ( Carroll, Williams, & Gallivan, 2012 Kerr, Lu, McKinlay, & Fuller, 2011 O'Connell & Penney, 2001 Randell, Wilson, & Woodward, 2011 Staggers & Blaz, 2013 Street et al., 2011 Strople & Ottani, 2006). Thus handoff information must be accurate, complete, relevant, and timely ( Australian Commission on Safety and Quality in Health Care, 2010 Staggers, Clark, Blaz, & Kapsandoy, 2011).Handoff Communication and Patient Safety By safety, we mean preventing errors and reducing risks by coordinating multiple aspects of patient care, identifying and intercepting hazards, monitoring, surveillance, and detecting when patient status deteriorates ( Mitchell, 2008). Quality handoff information enables nurses to recognize quickly changes in patient status and to anticipate risks ( Patterson, Roth, Woods, Chow, & Gomes, 2004), thereby promoting safe care. Nurses' handoffs are situated within a 24-hour cycle of clinical care in which the nursing, medical, and technical knowledge relevant to each patient needs to be transferred seamlessly between offgoing and oncoming nurses as they work to maintain safety. Intershift handoff is defined as the exchange of information, responsibility, and accountability between nurses about patients at shift change ( Australian Commission on Safety and Quality in Health Care, 2010 Cohen & Hilligoss, 2010). Future research needs to examine handoff practices and outcomes on units with good and poor practice environments. Improvement efforts need to target the different processes involved in grasping the story and painting a full picture. However, intra-shift disruptions often impeded nurses in their processes to grasp the story thus posing risks to patient safety. Arriving and leaving the handoff with this level of information promoted patient safety. When oncoming nurses understood the picture being conveyed at the handoff, nurses jointly painted a full picture. Results indicated that offgoing nurses' ability to grasp the story intra-shift was essential to convey the full picture during handoff. The purpose of this qualitative study was to examine medical-surgical nurses' (n=21) perspectives about processes that promote and hinder patient safety intra-shift and during handoff. ![]() Research is needed to understand how information processes occurring intra-shift impact handoff effectiveness. Effective handoff communication is critical for patient safety.
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