Computerization in Nursing Handoffs

Computerization in Nursing Handoffs

Computerization in Nursing Handoffs

Patricia Poore, RN, and Nicole Farrell, RN, include the patient in their bedside report at Christiana Hospital in Wilmington, Delaware. Photo © Christiana Care Health System.

Handoff, the transferring of patient information between nurses or other health care providers at shift change, is a vital part of effective and efficient patient care. It can also lead to significant errors in care if information is omitted or overlooked. And although computerization of the handoff process could serve to address that problem, not enough is known about the process on medical and surgical units to guide the creation of computerized handoff systems. Computerization in Nursing Handoffs

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Recognizing the need for guidance in creating such a system, two nurse researchers synthesized the literature on nursing handoffs. What they found was that, unsurprisingly, nursing handoffs are complex endeavors—particularly on medical and surgical units, where a nurse might be caring for four or five patients with many comorbidities—and that mandating the use of one handoff method across units ignores that complexity. The authors note that “determining a standard and method for handoffs may be less important than creating a consistent, predictable structure and method tailored to individual medical and surgical units.”

Even the best and most flexible of computer systems won’t replace every aspect of standard handoff practice. The review found problems with the currently popular system of bedside handoffs, which can disturb resting patients and make discretion difficult. At the same time, however, there are distinct benefits to verbal handoffs that are worth preserving.

The handoffs serve functions other than simple information transfer, says Nancy Staggers, professor of informatics at the University of Maryland and lead author of the study. They also are team-building exercises; they can be coaching moments for new nurses with more senior nurses, and they can be problem-solving opportunities if the outgoing nurse isn’t sure about something she or he has seen. “The face-to-face time is very valuable,” Staggers says. The report itself suggests that any future work on handoff methods include the beneficial aspects of those face-to-face interactions.

Before effective computerized systems for medical and surgical units can be created, however, more research is needed to determine which information is pertinent to handoffs on those units. In the meantime, suggests Staggers, nurses should do what they can to customize existing systems to their patients’ needs.

One way to improve handoffs is to have information already available—separated into primary categories on the computer—allowing the conversation to touch only on current problems rather than devolve into a rehashing of all the routine information, Staggers says. “The first step is for nurses on a unit to sit down and talk about what’s important to know—and in what order. If they have a generic computer program, they can work with the informatics people to help tailor it.”—Laura Wallis

Staggers N, Blaz JW J Adv Nurs. 2013;69(2):247–62

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