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Topic: Nursing Documentation (charting- physician orders), Report Hand offs & SBAR
Article: Effective Handoff Communication (Jan, 2014) by Kim K. Wheeler, MSN, RN CNOR
According to the article, communication breakdowns are the major cause for medical errors; this was supported by a statistic indicating that the Joint Commission reported that out of 4000 adverse events 70% of it was caused by miscommunication. In order to reduce this number the Joint commission required healthcare organizations to implement a standardized approach to handoff communication.
Apparently “in a teaching hospital, there are an estimated 4000 patient handoff everyday”. Handoff is transfer of essential patient information when the responsibility of patient care transfers from one health care provider to another. If the healthcare provider does not provide complete, accurate and necessary information related to patient care there is a high chance the patient’s safety will be jeopardized. Some of the reasons why handoffs can be incomplete are fast paced environment in the health care facility that requires nurses to share patient information quickly. These information sharing is not done in a standardized manner. Every nurse has a different opinion and approach to patient care and can miss pertinent information when there is no standardized format used.
The OR is one of the places where most handoffs occur in a short period of time, according to the article “4.8 handoffs per case occur in the OR” this includes preoperative, intra-operative, and postoperative handoffs. The article suggests that we view the number of handoffs in a positive light. Effective handoff can create an opportunity for a fresh pair of eyes to detect potential errors, collaborate on a plan of care, and improve the quality of patient care.
The article goes on to list a couple of solutions for effective handoffs. The Joint commission requires a standardized process to be used; however they did not state which

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