1 University of Rochester Medical Center, Rochester, NY.
2 Yale New Haven Health, New Haven, CT.
J Oncol Pract. 2019 May;15(5):e480-e489. doi: 10.1200/JOP.18.00245. Epub 2019 Apr 4.
Ineffective handoffs contribute to gaps in patient care and medication errors, which jeopardize patient safety and lead to poor-quality care. The project aims are to develop and implement a standardized handoff process using an electronic medical record (EMR)-based tool to ensure optimal communication of treatment-related information for patients receiving cancer treatment between oncology nurses.
A multidisciplinary team convened to develop a standard and safe treatment handoff process. The intervention was developed over a series of phases using Plan-Do-Study-Act methodology, including current workflow process mapping; identifying gaps, limitations, and potential causes of ineffective handoffs; and prioritizing these using a Pareto chart. An EMR-based tool incorporating a standardized treatment handoff process was developed. Study outcomes included proportion of handoff-related medication errors, tool utilization, handoff completion, patient waiting time, and nurse satisfaction with tool. All outcomes were evaluated before and after the intervention over a 1-year period.
The proportion of medication errors as a result of ineffective handoffs was reduced from 10 of 17 (60%) pre-intervention to 11 of 34 (32%) postintervention ( = .07). The EMR-based handoff tool was used in 9,274 of 10,910 (85%) patient treatment visits, and the handoff completion rate increased from 32% pre-intervention to 86% postintervention. Patient waiting time showed an average reduction of 2 minutes/patient/month. A majority of nurses reported that the new tool conveyed necessary information (85% of nurses) and was effective in preventing errors (81% of nurses).
Multidisciplinary stakeholders guided the development and implementation of a standard handoff process and an EMR-based tool to optimize communication between nurses during patient transition. The intervention was associated with a reduction in the proportion of medication errors as the result of ineffective handoffs. In addition, the intervention improved communication between nurses.
无效的交接班会导致患者护理和用药错误的出现，这会危及患者安全并导致护理质量下降。该项目旨在开发和实施一种基于电子病历（EMR）的标准化交接班流程，以确保肿瘤科护士在为接受癌症治疗的患者交接时能最佳地传递与治疗相关的信息。
一个多学科团队召开会议，以制定标准化且安全的治疗交接班流程。该干预措施使用计划-执行-研究-行动（PDSA）方法分多个阶段进行开发，包括当前工作流程映射；识别交接班过程中无效的地方、限制因素以及潜在原因；并使用帕累托图对这些因素进行优先级排序。一个基于 EMR 的工具，其中纳入了标准化的治疗交接班流程。研究结果包括因交接班不当而导致的用药错误比例、工具利用率、交接班完成情况、患者等待时间以及护士对工具的满意度。所有结果在干预前后的 1 年期间内进行评估。
因交接班不当而导致的用药错误比例从干预前的 17 次中的 10 次（60%）减少到干预后的 34 次中的 11 次（ =.07）。在 10910 次患者治疗就诊中，有 9274 次使用了基于 EMR 的交接班工具，交接班完成率从干预前的 32%提高到了干预后的 86%。患者等待时间平均减少了 2 分钟/患者/月。大多数护士报告说新工具传达了必要的信息（85%的护士），并且在防止错误方面很有效（81%的护士）。
多学科利益相关者指导了标准交接班流程和基于 EMR 的工具的开发和实施，以优化护士在患者交接期间的沟通。干预措施与因交接班不当而导致的用药错误比例降低有关。此外，该干预措施还改善了护士之间的沟通。
