Running Head: CHANGE PROJECT

Change Project: Improving Change-of-Shift Handoff Report

Gaea Jamine Umali
Loma Linda University School of Nursing

Nursing 420
Kenneth Lard
May 29, 2015

CHANGE PROJECT
Introduction
Change is an essential part of the healthcare profession; especially with the constant
technological advancements and newfound evidence based practices. The change project
involved an opportunity for the student nurse to promote more effective nursing in the Loma
Linda University Behavioral Medicine Centers (BMC) Youth Services Department. In
collaboration with the unit director, nurse managers, preceptors, and unit educator, the student
nurse identified an ongoing issue and unfinished project. The issue addressed was the need to
improve the change-of-shift handoff report. The student nurse acted as a change agent by
researching the importance of a good quality change-of-shift handoff report on patient safety and
an evaluation tool to assess the handoff report. The normative-reeducative strategy and Rogers
Diffusion of Innovations Theory were used as a guide to implement the change project. A poster
was made by the student nurse to be placed on the unit as a reminder to the staff of the new and
improved way to do a change-of-shift handoff report. In addition, hand-off checklists, badge
buddies, instructional video, and an evaluation tool, were made to support the unit director, unit
educator, nurse managers, and nurses during the proposed change.
Background: Need for Change
The BMC Youth Services Department includes Child, (4-12 years old), and Adolescent,
(13-17 year old), units. The unit director brought up the issue regarding the need for change in
the way nurses do their change-of-shift handoff report. Currently, the handoff report is mostly
hand-written. Each nurse has his or her own way of making a brain or taking notes from the
report given. The nurse giving the report has his or her own way of reporting patient information.
Therefore this way of handoff report does not provide structure and is not supported by evidence-

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based practice. Consequently, amidst the handoff report, pertinent patient information can be
lost.
Ensuring accurate information is delivered during change-of-shift handoff report is
important in providing high-quality and safe care. According to the Joint Commission (2009),
approximately 70% of adverse medical events are due to problems with communication. To
reduce communication errors, the Associations of perioperative Registered Nurses (AORN)
performed a quasi-experimental design, which implemented a standardized communication stool
during handoff report, and decreased errors from 6.24 to 1.52 (P < 0.0001) per patient handoff
(Barry, 2014).
On the other hand, the World Health Organization established that handoff
communication would become their main focus in patient safety (Horwitz, et al., 2013).
Horwitz, et al, (2013), conducted a study using the Handoff CEX, (See figure 1), which is
derived from the American Board of Internal Medicine (ABIM) mini CEX assessment tool, to
evaluate change-of-shift handoff reports (Horwitz, et al., 2013). The study concluded that using a
standardized evaluation tool promoted good results (Horwitz, et al., 2013). Finally, Mattic,
Davidson, and Salomonson (2011), recommend on implementing an electronic system during a
handoff report to promote structure and improve communication.
Scope of Project, Stakeholders, & Implementation
The objective of the change project is to have a structured and systematic way of giving a
change-of-shift handoff report, which will encompass pertinent patient information, and
incorporate a standardized evaluation tool for assessment. To improve handoff report at the BMC
Youth Services Department, the unit director and student nurse promoted a variety of tools for
education and guidance. Also, a transition to an electronic handoff report will be implemented to

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endorse structure. Ultimately, the standardized tools used would decrease potential adverse
events, which in turn will provide a safer patient and staff outcomes. In addition, quality of care
and patient satisfaction would increase since nurses would be more equipped with pertinent
patient information. Thus, the planned change project will impact the nursing staff, nursing
managers, and patients.
To promote the transition to electronic change-of-shift handoff report, badge buddies,
detailed handoff report checklist, instructional video, and handoff evaluation form to the staff,
the student nurse created a poster board. Before the poster board was created, the student nurse
researched current evidence-based practices to support the change and educational tools
provided. The poster board included the importance of good handoff report, the barriers to
giving a good report, a sample of the handoff evaluation form, and a pocket with copies of the
detailed checklist free to take for any staff that needs a copy. The poster board was presented to
the educator first, then the unit director, and again during a meeting with the charge nurses. The
unit directors secretary is currently in the process of completing the badge buddies, and will be
given to the staff as soon as possible. Additionally, the transition to the electronic handoff report
will take place possibly in a few weeks, after the nurses have been sufficiently educated by their
designated charge nurses.
The tools promoted by the unit director and student nurse are as follows: First, moving
from hand-written notes to electronic notes, (See figure 2). A printed and laminated screenshot of
LLEAP was given to the charge nurses to show and educate the floor staff. The handout shows
where to type in the change-of-shift handoff report. The report will be similar to adding a sticky
note and is found under Hospital Course on LLEAP. Second, a badge buddy, (See figure 3),
was made and is to be distributed to all the nursing staff. The badge buddy is a concise checklist

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of patient information that needs to be addressed by the nurses during a handoff report. The
badge buddy checklist includes the following: patient name, status, (51/50, 52/50, voluntary),
hCG, (if applicable), allergies, medical conditions, medication consents, legal custody, (ward of
court, biological parents), labs, active orders, (MSP, 1:1, nutrition), daily behaviors, (changes in
condition), and treatment plant, (estimated length of stay, medication changes). Third, a detailed
handoff checklist, (See figure 4), was given to the charge nurses and is also available on the
poster board made by the student. The handoff checklist is for educational purposes and
describes into more details what should be included within each bullet point listed on the badge
buddy. Fourth, a handoff evaluation form, (See figure 1) is given to charge nurses to evaluate
change-of-shift handoff reports. The handoff evaluation form includes the following to be rated:
evaluatee level of experience, situation, (end of shift, transfer between services, admission),
setting, organization or efficiency, communication skills, content, clinical judgment, humanistic
properties or professionalism, overall sign-out competence, evaluator and evaluatee satisfaction
with evaluation, and comments or feedback. Lastly, an instructional video, (See figure 5),
performed by two nurses on how to successfully do a change-of-shift handoff report will be
shown to the staff.
Normative-reeducative Strategy & Rogers Diffusion of Innovations Theory
The charge nurses will implement the proposed plan to their nursing staff, making them
the designated change agent. Due to the charge nurses being integrated in the plan, the
normative-reeducative strategy was used for the change project. The normative-reeducative
strategy focuses on the transitional elements within the change and considers the perspective of
those who will be affected (Hewitt-Taylor, 2013). Rogers Diffusion of Innovations Theory is the
conceptual framework used for the change project; although only the first three steps were

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applied because the project is yet to be thoroughly implemented. Identifying the problem and
how it related to change-of-shift handoff reports, appraisal and systematical evaluation, (clinical,
theoretical, and empirical evidence), and using the evidence provided to implement a
standardized protocol for change-of-shift handoff report, are the first three steps of Rogers
Diffusion of Innovations Theory (Dufault, et al., 2010). The problem identified on the unit was
the lack of thorough patient report during change-of-shift handoff, (i.e. failing to mention lab
results). The standardized assessment and evaluation form was recommended by research as the
best-practice protocol for handoff report. On the Youth Services Department, (child and
adolescent units), the instructional video, detailed handoff checklist, and badge buddies can
provide structure and help with staff education.
Conclusion
Although current studies show that standardized evaluation tools increase patient safety
outcome, there is still plenty of room for research with improving change-of-shift handoff report.
It may be difficult to implement such a drastic change on the unit, but with adequate education,
positive outlook, and continuous support from the unit directors, unit educator, and nurse
managers, the staff will be more inclined to participate in the change. Overall, the BMC Youth
Services Department will be experiencing a transformation within the next few weeks, which
will promote better patient outcomes, and in turn, enhance nursing care.

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Appendix
Figure 1

Figure 2

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Figure 3

Figure 4

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Figure 5

Link: https://www.youtube.com/watch?v=X7tVHKDrIGs

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References
Barry, M., (2014). Hand-off communication: Assuring the transfer of accurate patient
information. American Nurse Today 9(1). 30, 34.
Dufault, M., Duquette, C., Ehmann, J., Hehl, R., Lavin, M., Martin, V., , Willey, C. (2010).
Translating an evidence-based protocol for nurse-to-nurse shift handoffs. Worldviews on
Evidence-Based Nursing, 7(2). 59-75.
Hewitt-Taylor, J. (2013). Planning successful change incorporating processes and people.
Nursing Standard. 27(38). 35-40.
Horwitz, L., Dombroski, J., Murphy, T., Farnan, J., Johnson, J., Arora, Vineet. (2013).
Validation of a handoff assessment tool:The handoff CEX. Journal of Clinical Nursing
22(9/10). 1477-1486.
Joint Commission Center for Transforming Healthcare. (2009). Project details: Hand-off
Communications. Retrieved from
http://www.centerfortransforminghealthcare.org/projects/detail.aspx?Project=1
Matic, J., Davidson, P., Salamonson, Y. (2011). Review: Bringing patient safety to the forefront
through structured computerisation during clinical handover. Journal of Clinical Nursing
20(1/2). 184-189.