Development of a Communication Tool for Handoffs Involving Patients Cared for by Sitters: An Evidence-Based Practice Project.

PROBLEM: Communication has been found to be central to patient safety and colleague engagement. Poor communication was identified in a Level III trauma hospital in the midwestern US between "sitters" (staff members assigned to monitor patients identified as having safety concerns) and the nurses assigned to care for those patients, including lack of a formal handoff process.

APPROACH: A Patient/Problem, Intervention, Comparison, Outcome (PICO) statement guided an evidence-based project and identification of an intervention to improve the handoff process. Using the evidence-based format of Situation/Background/Assessment/Recommendation (SBAR), a Patient Safety Attendant Handoff Form was developed and implemented.

RESULTS: Initially, Registered Nurses (RNs), Licensed Practical Nurses (LPNs), or Certified Nursing Assistants (CNAs) were used as sitters, taking them away from other responsibilities. A formal position, Patient Safety Attendant (PSA), was created to perform the sitter role. The Patient Safety Attendant Handoff tool was made an official hospital form and implemented as a new standard of practice. Analysis of data from completed forms identified the top reasons for assigning a sitter were mental health and behavioral concerns. In a six-month post-implementation survey, most PSAs reported receiving adequate information about the patients during handoffs using the new form.

CONCLUSION: Using SBAR for the Patient Safety Attendant Handoff Form improved communication between RNs and PSAs and also enhanced communication between PSAs. A key safety feature of the form is the Recommendation section which includes "triggers to avoid," de-escalation techniques, and things the patient enjoys. Developing a structural model from the aggregated data on the completed forms helped in analyzing the information.