It is not surprising that communication is identified as a risk factor for civil and criminal action against nurses. We all know that even with the best of intentions communication is not always sent or received in the manner in which it was intended. Sadly, in 2017 the Becker’s Hospital Review identified hand-off communication as “the weakest link in health care”. The Joint Commission has identified hand-off communication as a sentinel event alert providing tools for improvement in health care environments https://www.jointcommission.org/resources/patient-safety-topics/sentinel-event/sentinel-event-alert-newsletters/sentinel-event-alert-58-inadequate-hand-off-communication/.

Last year, my father was admitted to a hospital for bilateral subdural hematoma’s and I witnessed first-hand the risks that occur with hand-off communication. The failure to communicate was so apparent that we were required as a family to remain at the bedside and be present for every unit to unit transfer to be sure his pertinent history and current symptoms were being shared and shared correctly. He had at least 6 unit to unit transfers during this stay. At least one point in care hand-off communication could have resulted in a failure to rescue of my father’s worsening condition.

Another example is in conjunction with COVID-19. I can’t begin to tell you how many social media posts I read from nurses who identified communication between care providers and between care providers and families as a major problem. This became a realization due to the fact that patients could not be accompanied by family members to the hospital and clinical staff were so busy that communication and hand-off was difficult to achieve. Becker’s Hospital Review (2017) identified that clinical providers are interrupted up to 23 times per hour. It is no wonder communication processes between care providers is inefficient and pose significant risk to patient safety.

Just like every person has a different way to learn, communication requires that multiple strategies are used to improve the quality of the communication sent and received. These strategies must be considered and applied with some basic understandings about communication when designing your hand-off communication processes. Some of these are:

• Understand that communication is not a one-way-street

• Understand that body language and non-verbal behaviors play an important role

• Understand that the receiver must have an opportunity to seek clarification

• Understand that multiple modes of communication are needed

• Understand that tone and reflection must be heard to sense urgency

• Understand that organizational and unit culture has a direct impact on communication

Now, one of the best outcomes from reading this month’s blog post is that your hand-off communication process is reviewed in your organization and you work with your nursing leadership to improve the process and quality of every hand-off every time. Here are a few ideas to get you started on reducing legal risk for all nurses, physicians, and care providers:

• Implement team huddles twice daily

• Required hand-off communication to be face to face

• Designate hand-off communication locations and tape them off with yellow or red tape so others know you may not be disturbed during hand-off

• If you have bedside reporting processes consider a change to include a nurse to nurse report just prior to the bedside report

• Use a standardized reporting tool such as ISBARR or I-PASS and assure the use of this tool is written into your hand-off communication policy and procedure

• Require annual hand-off communication training using role-play

Individually, as nurses, there are many ways we can improve our own level and quality of communication during hand-off reports that will decrease our individual risk for law suit as well. Some of these are as follows:

• Assure that you give a face to face report. If your organization uses a phone system assure that you talk to the nurse you are handing off to directly instead of leaving a message

• Assure you provide opportunity for the receiving nurse to ask questions and clarify your report

• Assure your report sticks to objective and patient subjective fact data and not your opinion or judgement

• Assure your report is systematic to enhance clarity

• Assure you use an organizational tool to keep your information organized and shred this tool when your hand-off report is over

• Assure you use multiple methods for data discussion. For example, use the computer to pull up and discuss the patient’s labs together. This addresses the need to actively learn through doing, listening, and seeing

• Assure that you communicate to other clinical staff that you are in report and you may not be disturbed unless there is an emergency. Be clear to outline what an emergency is and for what you may be interrupted for

• Assure that you are clear and direct about what still needs to be done for the patient and any follow-up necessary

• Assure that you have accurately and thoroughly documented your care and your patient’s response to your care in the charting system so there is an excellent resource to refer to when needed

• Assure that you document the hand-off and who you handed-off too

Thank you for taking the time to engage in this month’s Ownership Series for Nurses: Arming yourself against Civil or Criminal Prosecution. If you have not yet signed up to automatically receive my Talk Tuesday monthly blog please do so before you leave my website.

If you are liking what you are reading and you are interested in having me present to your group please contact me for a free consultation regarding your needs.

I look forward to our time next month for a discussion on the legal risk of long working hours for nurses.

Talk Tuesday,

The Legal Nurse