Quality improvement of interdepartmental patient handoff involving adult patients on high alert medication -

Abstract

Background: Hand-off communication, referred to as the real-time process of passing patient-specific information from one caregiver to another or from one team of caregivers to another, is a high risk area for adverse events affecting patient’s safety, quality and continuity of care. Patients’ admission through the Emergency Department (ED) is an area with the highest volume of hand-off processes often associated with high incidence of adverse events due to ineffective communication. Of particular concern are those patients admitted on high alert medications defined as drugs that bear a heightened risk of causing significant patient harm when they are used in error. To reduce the incidence of these adverse events, several institutions, including the institution where this study is conducted, adopted the Situation, Background, Assessment and Recommendation (SBAR) tool for standardizing the hand-off process and to guide communication. Purpose: This quality improvement project aims to examine the completion and accuracy of using the SBAR handoff communication involving adult patients on high alert medication admitted through ED to inpatient units in one health care institution in Lebanon. Design: Approach: Retrospective medical records review was conducted using a data abstraction form. SBAR electronic sheet completion and accuracy was evaluated and adverse events were checked. Sampling: Eligible adult patients 18 and older admitted to ED between January 1st and October 31st2015 and transferred to in-patient units on high-risk alert medication were identified. Data analysis: Descriptive statistics were used to describe the demographic and process characteristics, completeness and accuracy of documentation, as well as adverse event incidence. Bivariate association between incomplete and inaccurate sections versus explanatory (age, gender, main diagnosis and medical history) and predictor variables (shift, disposition, length of stay in ED and high alert medication) was conducted. Fisher test for categ