3 Ways to Make Shift Changes Safer for Patients

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Bedlam ensues at 7 a.m. and 7 p.m. every day in many hospitals and other medical facilities as the nurses’ shift changes set off frenzied exchanges of information. The well-being of the patients is at stake.

Shift changes, says conventional wisdom, are a launch pad for mistakes, and there has long been talk of reform.

After all, the reduction of daily handoffs from three to two is a principal reason that 12-hour shifts for nurses have become prevalent. But mistakes are still occurring. So reform efforts are focusing on what goes on during those 7 p.m. and 7 a.m. exchanges of information. Many hospitals are even bringing patients in on the exchanges of information by conducting the conferences at bedside.

Boundaries are still being set on that increasingly popular front, but nurse educators are employing three more widely accepted approaches toward making shift changes an asset instead of a liability.

They are:

  • Reforming the too-often random order in which patients are discussed
  • Using technology to improve the flow of information
  • Communicating clearly to reduce misunderstandings

Here’s how nurses can use these suggestions to make shift changes easier and safer.

1. Discuss patients in order of the severity of their conditions

Medical personnel almost invariably devote the most discussion to the patient on the top of a list. That list might be based on bed number or alphabetical order instead of importance, according to a study published in the journal Archives of Internal Medicine. The patient at the bottom of the list gets half the attention of the patient on top.

That’s why the most severe cases should be addressed first. That’s the policy at Massachusetts General Hospital, according to Cheryl Ryan, a medical nurse specialist in the surgical ICU. Physicians at Mass General begin discussing the patients requiring the most attention first, and then move on to the rest. This method ensures that the patients who need the most attention aren’t lost in the shuffle.

The University of Michigan’s Dr. Michael Cohen says many hospitals do not discuss the severe cases first and therefore risk making medical errors as a result. A recent study by Cohen indicates that the miscommunication that occurs during hand-offs poses an enormous threat to a patient’s safety and could be one of the factors contributing to preventable medical errors.

2. Use technology to make shift changes safer

Electronic records can make transmitting patient information for shift changes more efficient. The availability of portable computers for nurses’ rounds allows nurses to view each patient’s medications, plan of care and IVs with information up-to-date as of the previous shift.

Nurses can also improve shift change communication using recordings that multiply interaction between nurses who have limited face time. And tapes can readily provide repetition of information.

Creating a standardized worksheet will quickly accustom nurses to an order in which patient information is relayed and even provide updates on which procedures are indicated or not needed.

3. Avoid the use of terms or abbreviations that could be misinterpreted

The Joint Commission has officially banned the use of two abbreviations that were creating an ambiguity that could cause harm: “QD” could be mistaken as “QOD.”

A handwritten order for dispensing a medication daily is “QD,” whereas “QOD” is used for medication being dispensed every other day. Confusing these terms could be detrimental to a patient’s health.

Therefore, nurses should avoid the use of these abbreviations, said the Joint Commission, as well as any others that could potentially confuse colleagues.

Changing the routines

The move to 12-hour shifts for nurses has not been a panacea for reducing mistakes. There are conflicting theories as to whether 12-hour shifts prevent more problems than they create. Some say tired nurses have become more mistake-prone. Others say the flow of information has been improved.

Either way, communication is the key to most efforts to reduce mistakes. By utilizing the three suggestions listed above, nurses can improve the shift change process and reduce the risks to their patients.

edited by Colin Seymour

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