Boston Medical Center has achieved positive results from its two years of testing a set of web and cloud-based tools from I-PASS Patient Safety Institute that standardize the patient hand-off process during nurse shift changes.
A published study in the New England Journal of Medicine finds a 30 percent reduction in medical errors during patient handoffs at the hospital, with potential cost savings from prevention of adverse events estimated at $10 million to 20 million over three years.
I-PASS defines what information needs to be included in a patient handoff. For example, is the nurse coming off shift worried about the status of a particular patient, or is the patient stable? How does the status of the patient tie into the plan for the patient? These are questions that the nurse coming off shift and the nurse or physician coming on shift should consider during the handoff.
I-PASS is integrated in the electronic health record, and the nurse coming off shift documents in the EHR why the patient was hospitalized, patient condition, treatments given, what services need to be done and any other recommendations. It uses that handoff-note at the bedside to verbally hand the patient to the next nurse or to a physician. The clinician receiving the handoff verbally repeats what was told to them during the handoff.
“I-PASS is really a best practice in communication to ensure that no information gets missed during the handoff,” says James Moses, MD, a vice president and chief quality officer at Boston Medical.
In 2015, the hospital trained nurses and residents on using I-PASS. The residents proved to be a challenge as they are transitory and move elsewhere after their residency, so new residents must be trained each year. Consequently, residents in general are trained but they rarely achieve full adoption of I-PASS as they come and go.
However, Moses worked with leaders in various departments to ensure that residents while at Boston Medical use I-PASS to create a culture for use elsewhere.
While I-PASS is designed to support tablet computers, Boston Medical Center, a safety-net hospital, has found EHR documentation at nurse stations to be sufficient and less costly than tablets.
In 2017, the hospital has achieved enterprise-wide use of the technology but now needs to work on sustaining the effort, Moses contends. “The vast majority of clinical staff are using it, but not all the time and not completely.”
Organizations considering implementation of I-PASS should be aware that it is an enterprise process with nurses and physicians using it together, Moses advises. Other organization may have one group start before others, but the hospital learned that starting together improves communication and builds a culture, he adds.
“This is not just a lever or a button you can push or pull, but a journey to continuously improving patient handoffs,” he contends. “I-PASS helped us identify a strategy to provide feedback to clinicians through measuring of adherence and use to know which departments are doing well with I-PASS and in which areas the use rate is not so good, so we constantly know where our gaps are.”
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