Mohamed Ait Aiss, Delmy Vesho, Christi Bowe, Maria C Franco Vega, Son Chau, Jeff Beno, Marina George, Carol Porter, Diane Bodurka
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Abstract
Background: Communication failures can cause medical errors that harm patients. Handoffs occur frequently every day-every time a patient is transferred from one nurse to another (eg, shift change, hospital location). At our comprehensive cancer centre, handoffs became a priority focus area in our institution.
Purpose: We implemented the evidence-based handoff tool I-PASS (Illness Severity, Patient Summary, Action List, Situation Awareness and Contingency Planning, and Synthesis by Receiver) for all nurses at our comprehensive cancer centre and assessed the uptake of the new framework and subsequent compliance and safety outcomes.
Methods: Our team comprised representatives from nursing education, operations and informatics; a healthcare systems engineer; and electronic health record (EHR) analysts. Based on our observations of handoffs in different settings and feedback from focus group sessions, we developed an I-PASS handoff workflow in our EHR with the engagement of frontline staff and unit leaders. Various education modalities were implemented, and compliance was monitored through an EHR dashboard. Handoff audits were conducted for over a year after I-PASS was implemented to observe compliance with I-PASS reports for verbal handoffs. The institution's regularly administered safety culture survey results were assessed in the category of handoffs and information exchange.
Results: Our process measures, all nurses were trained to use I-PASS by 28 November 2022. Compliance in documenting I-PASS handoffs varied between 86% and 88% of all handoffs between December 2022 and April 2024. I-PASS elements were present in above 95% of verbal handoffs between April 2023 and April 2024. The percentage of clinical nurses who reported favourable handoffs in our institutional safety culture survey improved from 64% in 2022 to 72% in 2024. For our outcome measure, a rate of zero high-harm events was maintained during the same period.
Conclusion: The dissemination method led to the full implementation of I-PASS across all nursing areas and improved handoff quality.
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