30 Second Head-To-Toe: Cultivating Safety in Handoff

Communication Debbie Popovich, MSN, ARNP, CPNP

Assistant Professor, University of Florida College of Nursing

© Copyright 2011 University of Florida College of Nursing

All Rights Reserved

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Purpose

•  Your contract with the child and family that you will ensure safe care.

•  Hand-off communication is accurate and complete.

•  Safety and error reduction. •  Conceptual thinking process. •  Assess child and environment rapidly. •  Tools to succeed.

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Improved Patient Safety and Quality of Care

•  Institute of Medicine (IOM), 2001. •  The Joint Commission (TJC)

– Sentinel events – Root cause error – Communication most significant

contributing factor to medical error with 50% occurring during hand-off (2006)

– Safety goals (2007)

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Effective Communication

•  Timely •  Accurate •  Completely unambiguous •  Understood by recipient •  Elm, 2004, L&D shift report

•  REDUCED ERROR AND IMPROVED PATIENT SAFETY

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Polling Question

Does your organization engage nursing students in patient safety activities? A. Yes B. No

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Discussion Question

How does your organization

engage nursing students in patient safety activities?

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Cultivate a Culture of Safety and Professional Expectation

•  Nurse to nurse •  Nurse to student •  Student to nurse •  Student to student

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Benefits to Thorough Handoff

•  Identify obstacles hazardous to health care. •  Provide day/date RN and unlicensed

personnel information. •  Fresh perspective, point of verification and

opportunity to increase detection of errors using simple techniques.

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Staff morale improves because nurses are working together to

ensure patient safety rather than blaming each other for mistakes

and errors of omission. (ED Nursing, 2006)

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Discussion Question

How does your organization work with clinical instructors to

encourage patient safety learning?

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30 Second Head-To-Toe (HTT)

•  Increases confidence that necessary, consistent and accurate information is communicated.

•  Minimizes risk related to human error. •  Structured follow-up process with

nursing students validates knowledge, confidence, critical thinking and safety.

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A Discrepancy

Is a lack or contradiction regarding what was verbalized at report or was on orders/chart

related to labels, settings, reminder, or calculation---and what the student observed

firsthand at the bedside.

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30 Second Head-To-Toe

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For Example (N=106/30% Errors)

•  Identification Band ON THE PATIENT, appropriate size and non-restrictive (No = 36%)

•  EDR is posted at bedside. (Emergency Drug Reference with Current & Accurate Weight) (No = 14%)

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Examples of Teaching Moments

1.  IV site communicated in report and documented on the Medication Administration Record (MAR) –  right AC versus right wrist

2.  Site—MUST be unwrapped! No coban! Site is without infiltration/phlebitis 3. IV fluids date hung but not time

Date and time IVF bag is due to be changed 4.  Fluids changed but tubing due to be changed

ignored Professional responsibility and accountability

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Examples of Teaching Moments (con’t)

5.  Nasal cannula oxygen Oxygen is humidified

Oxygen NA

Y N 1. Flowmeter is set correctly. Y N 2. Oxygen is humidified. Y N 3. Nasal cannula is taped securely. Y N 4. Nasal mucosal irritation noted.

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Polling Question #2

A child undergoing chemotherapy for leukemia has a platelet count of 50,000/mm3. After morning hand-off report you enter the room to perform a 30 second head-to-toe. Which of the following requires further assessment because it potentially increases his risk of bleeding?

1. A sign over his bed reads “no needle punctures.” 2. He is receiving 2 liters of oxygen via nasal cannula. 3. He has an intermittent infusion device in his hand. 4. A tympanic membrane sensor is in the room.

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Examples of Teaching Moments (con’t)

6.  Salem Sump Nasogastric Tube NGT NA

Y N 1. Suction setting correct. Y N 2. Suction is working. Y N 3. Mini canister drainage emptied at 0600. Y N 4. Sump tube blue pigtail patent. Y N 5. Replacement fluids ordered If not, WHY?

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Conclusion

•  Factors that increase risk of errors during routine shift changes.

•  Intercept potential problems at the beginning of the shift.

•  Empower nurses and student nurses to proceed with care assured of safety.

•  Why would you NOT complete a HTT?!

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Your contract with the child and family to ensure safe care.

© Copyright 2011 University of Florida

College of Nursing All Rights Reserved

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Discussion Question

How do you think nursing schools

should address patient safety in their curriculum?