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I need slide 7 and 8 of my article. I uploaded an example of the assignment Thank you very much for your thoughtful response to our article entitled, “Exploring Race in Nursing: Teaching Nursing Students about Racial Inequality Using the Historical Lens.” Certainly, this is a very large topic and indeed deserves our serious consideration. I could not agree with you more and am encouraged to find that young scholars are investigating diverse minority populations and addressing the gap that you so ably point out. Continue Reading... View all Letters... HomeANA PeriodicalsOJINTable of ContentsVol 21 2016No3 Sept 2016Enhancing Patient Safety Enhancing Patient Safety: Factors Influencing Medical Error Recovery Among Medical-Surgical Nurses ^ m d Bookmark and Share Theresa A. Gaffney, PhD, MPA, RN Barbara J. Hatcher, PhD, MPH, RN, FAAN Renee Milligan, PhD, RN, WHNP-BC, FAAN Amber Trickey, PhD, MS, CPH Abstract Keeping patients safe is a core nursing duty. The dynamic nature of the healthcare environment requires that nurses practice to the full extent of their education, experience, and role to keep patients safe. Research has focused on error causation rather than error recovery, a process that occurs before patient harm ensues. In addition, little is known about the role nurses play in error recovery. A descriptive cross-sectional, correlational study using a sample of 184 nurses examined relationships between nurse characteristics, organizational factors, and recovery of medical errors among medical-surgical nurses in hospitals. In this article, we provide background information to introduce the concept of error recovery, and present our study aims and methods. Study results suggested that medical-surgical nurses recovered on average 22 medical errors and error recovery was positively associated with education and expertise. The discussion section further considers the important role of medical-surgical nurses and error recovery to enhance patient safety. In conclusion, we suggest that creating a safer healthcare system will depend on the ability of nurses to fully use their education, expertise and role to identify, interrupt, and correct medical errors; thereby, preventing patient harm. Citation: Gaffney, T.A., Hatcher, B.J., Milligan, R., Trickey, A., (September 30, 2016) Enhancing Patient Safety: Factors Influencing Medical Error Recovery Among Medical-Surgical Nurses OJIN: The Online Journal of Issues in Nursing Vol. 21, No. 3, Manuscript 6. 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Making healthcare safer is a national mandate, yet little progress has been made to reduce the medical error rate in the past 15 years (Aranaz-Andrés et al., 2011; Landrigan et al., 2010). Since the focus on error prevention has not yielded expected results to make healthcare safer, it is reasonable to explore the notion of error recovery (Gaffney, Hatcher, & Milligan, 2016). Errors are actions that fail to meet their desired outcome (Institute of Medicine, 2000). The recovery process consists of identifying, interrupting, and correcting medical errors to mitigate patient harm. Safety conscious organizations must anticipate that errors will occur and incorporate error recovery strategies into patient safety efforts (Habraken & van der Schaaf, 2010; Helmreich, 2000; Reason, 1990). The dynamic nature of the healthcare environment requires that nurses practice to the full extent of their education, experience, and role in order to keep patients safe. Patient safety is a core nursing duty. The dynamic nature of the healthcare environment requires that nurses practice to the full extent of their education, experience, and role in order to keep patients safe (American Nurses Association, 2015). Although nurses play a key role in safeguarding patients, little is known about their role in recovering medical errors. Further examination of nurses’ role in the recovery process can provide important insight into positive recovery factors and the optimal utilization of registered nurses (RNs) in order to enhance patient safety. In this article, we will provide background information to introduce the concept of error recovery, and present our study aims, methods, and results. The discussion section will further consider our results in the context of the important role of medical-surgical nurses and error recovery to enhance patient safety. Background Patients interacting with healthcare organizations have an expectation of safety. Yet, the fundamental mission of the health profession has been challenged with widespread and persistent medical errors. An estimated 98,000 fatalities result from medical errors every year in the United States (IOM, 2000). In addition to causing loss of public confidence, these events have increased patient morbidity and mortality and raised healthcare costs (Pham et al., 2012). The past 10 years have demonstrated a national focus on reducing these adverse events, with an increase in research and prevention. Despite focused efforts on error prevention, minimal progress has been made to make healthcare safer (MacDonald, 2013). Error Recovery ...humans are the critical element of the error recovery process. Building on human factors theories, the Eindhoven Incident Causation Model suggested that errors result from technical, organizational, or human failures (van der Schaaf, 1992). Although the model is one of incident causation, it also proposes that errors can be prevented by adequate system defenses (van der Schaaf & Kanse, 2000). When built-in system defenses are unable to control failures, the flexibility, experience, and intuition of the human operator must stop the unintended chain of events before harm occurs. In this sense, humans are the critical element of the error recovery process (Reason, 2008). The phenomenon of error recovery as a critical defense against medical errors is relatively new, and the mechanisms involved in the recovery process are not well known (Gaffney et al., 2016). The recovery process is defined as the feature of the human system component to detect, localize, and correct system failures (van der Schaaf & Kanse, 2000). The recovery process consists of three sequential phases. First, an error must be detected. The identification or detection of the Create PDF in your applications with the Pdfcrowd HTML to PDF API PDFCROWD http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Aranaz http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Landrigan http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Gaffney2 http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Institute http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Habraken http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Helmreich http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Reason http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#ANA http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Institute http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Pham http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#MacDonald http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Schaaf http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Schaaf0 http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Reason8 http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Gaffney2 http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Schaaf0 https://pdfcrowd.com/doc/api/?ref=pdf https://pdfcrowd.com/?ref=pdf error is the process of knowing that an error occurred. Error detection can be facilitated by use of an attentional tool such as a checklist, a process (e.g., a double-checking protocol), or by failing to achieve an expected outcome (Jeffs, Lingard, Berta, & Baker, 2012). Familiarity with all aspects of the care plan allows nurses to anticipate and identify potential medical errors. The recovery process... emphasizes the importance of professional decision-making and clinical reasoning as an expected behavior of nurses.The second phase is intercepting and understanding the nature of the error. In this phase, the nurse attempts to gather an explanation of how the error occurred to prevent it in the future. Finally, the third phase is correcting or counteracting the error. In this phase, the focus is on initiating corrective action to suppress the error by revising the plan or initiating a new plan. Nurses rely on creativity and flexibility to select the most appropriate strategy to interrupt and correct medical errors. The recovery process is the unique difference between patient harm and a near miss and emphasizes the importance of professional decision-making and clinical reasoning as an expected behavior of nurses. Medical Error Recovery Among Nurses It is widely accepted that nurses have the most direct contact with patients (Leape, Bates, Cullen, & et al, 1995). When built-in system defenses do not automatically avert potentially dangerous situations, nurses are uniquely poised and possess competencies to identify, interrupt, and correct medical errors. Such instances are referred to as a near miss, preventable error, or recovered medical error. To date, a small body of research has provided evidence that nurses working in specialty areas successfully recover medical errors and prevent or mitigate patient harm. Dykes, Rothschild, and Hurley (2010a) estimated that critical care nurses recovered, on average, one error per week. Operating room nurses recovered an average of 11 errors per procedure (Yang et al., 2012). Further insight is needed into the nurse role in error recovery and factors that influence the recovery process. A substantial body of knowledge has indicated that nurses’ ability to provide safe and efficient care is influenced by individual characteristics, including expertise, experience, education, and personality traits (Aiken et al., 2011; Kendall-Gallagher, Aiken, Sloane, & Cimiotti, 2011; McHugh et al., 2013; Scott, Sochalski, & Aiken, 1999). Nursing expertise, comprised of years of nursing experience as well as experiential and practical knowledge, influences nurses’ clinical reasoning skills and quality of care (Benner, 1984; McHugh & Lake, 2010). Nurses gain experience as they are socialized into the profession. They may pursue additional formal education, seek additional training in a practice area, obtain certification, and become recognized experts in a specialty. Along this journey, nurses develop greater confidence and a capacity to recognize patterns and synthesize information. A variety of characteristics and conditions may strengthen or weaken a nurse’s ability to detect and correct errors, yet no studies have explored the relationship between individual characteristics and recovered medical errors. Personality has been cited as an important influence on general nursing performance (Ellershaw, Fullarton, Rodwell, & McWilliams, 2015; Scheepers, Lombarts, van Aken, Heineman, & Arah, 2014). Conscientiousness and openness are personality traits that have been linked to high performers. The trait of openness is comprised of creativity and adaptability. In turn, creativity and flexibility are strategies that nurses use to correct medical errors, yet no studies have explored the relationship between personality traits and recovered medical errors (Henneman, Blank, Gawlinski, & Henneman, 2006). Organizational factors, such as the presence of a safety culture and workload, have been demonstrated to influence patient safety (Aiken et al., 2011; Kane, Shamliyan, Mueller, Duval, & Wilt, 2007). The term safety culture is commonly used to describe employers or workers taking a committed, proactive approach toward safety problems to reduce patient harm (Clark, Belcheir, Strohfus, & Springer, 2012). In organizations with strong safety cultures, medical errors are recovered more readily (Kanse, van der Schaaf, Vrijland, & van Mierlo, 2006). The Magnet® Recognition Program offers a framework with established Create PDF in your applications with the Pdfcrowd HTML to PDF API PDFCROWD http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Jeffs http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Leape http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Dykes http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Yang http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Aiken11 http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Kendall http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#McHugh http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Scott http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Benner http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#McHugh0 http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Ellershaw http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Scheepers http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Henneman http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Aiken11 http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Kane http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Clark http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Kanse https://pdfcrowd.com/doc/api/?ref=pdf https://pdfcrowd.com/?ref=pdf effectiveness for the delivery of safe, high-quality nursing care (Aiken, Buchan, Ball, & Rafferty, 2008; McHugh et al., 2013; Valentine, Murphy, DeRoberts, & Lyman, 2012). For this study, we defined a safety culture as Magnet® designation. Medical-surgical nurses are challenged with complex workloads, managing five to six interventions for as many as 10 different conditions during a shift (Hanink, 2010). Workload, defined as nurse-to-patient ratio in this study, has been found to be one of the most consistent factors influencing patient outcomes (Aiken et al., 2011; de Cordova, Phibbs, Schmitt, & Stone, 2014; Dunton, Gajewski, Klaus, & Pierson, 2007). While examining medication error interception practices, however, Flynn and colleagues found no association between recovered medical errors and workload among medical-surgical nurses (Flynn, Liang, Dickson, Xie, & Suh, 2012). Research related to medical errors has grown in the past 15 years and has focused on causation rather than the phenomenon of recovery. Available information regarding the relationship between influencing factors and recovered medical errors is inherent in research focused more broadly on patient outcomes. While existing literature has indicated that nurses recover the majority of medical errors, as compared to other healthcare professionals, there is little information focusing on the nurse role in error recovery. No studies have examined the relationship among individual characteristics, organizational factors, and recovered medical errors (Rothschild et al., 2005). Further insight is needed into the nurse role in error recovery and factors that influence the recovery process. Aims Several research questions guided this study. For medical-surgical nurses in hospitals: 1. What is the relationship between individual nurse characteristics and recovered medical errors (age, experience, education, expertise, certification, and personality)? 2. What is the relationship between organizational factors and recovered medical errors (Magnet® designation and workload)? 3. Which individual nurse characteristics or organizational factors predict medical error recovery (age, experience, education, expertise, certification, personality, Magnet® designation, or workload)? Study Methods Design, Setting, and Sample This was a descriptive, correlational study with a cross-sectional design. We used survey data from medical-surgical nurses working in hospitals. Nurses were recruited through two mechanisms; a four-hospital healthcare system in a mid-Atlantic state and a professional nurses association. Inclusion criteria required current employment as a medical-surgical nurse in a hospital. Nurses who were unable to read and write in English were excluded. The sample size for the study was estimated based on regression analysis with 10 predictor variables (Tabachnick, 2007). We calculated a minimum sample size of 150 as sufficient to provide a medium effect size (R2 = 0.13) with a power of .80 and significance level of .05. Data Collection This study was reviewed by the University Office of Research Integrity and Assurance and the healthcare system Research Review Committee and categorized Create PDF in your applications with the Pdfcrowd HTML to PDF API PDFCROWD http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Aiken http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#McHugh http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Valentine http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Hanink http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Aiken11 http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Cordova http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Dunton http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Flynn http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Rothschild http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Enhancing-Patient-Safety.html#Tabachnick https://pdfcrowd.com/doc/api/?ref=pdf https://pdfcrowd.com/?ref=pdf as exempt from Institutional Review Board (IRB) review. Researchers collected data online from October 2014 to January 2015 using Qualtrics® web-based software and a self-report survey tool. Consent was considered completion of the survey. A link to the survey and follow-up reminders were emailed to nurses, using a modified Dillman method (Dillman, 2009). Measures and Variables Participants completed three items. These items include demographic questionnaire developed by the investigator, the Recovered Medical Error Inventory (RMEI) (Figure 1) and the Ten-Item Personality Inventory (TIPI) (Dykes, Rothschild, & Hurley, 2010b; Gosling, Renfrow, & Swann, 2003). Figure 1. Sample Questions from the Recovered Medical Error Inventory Medical record data were not reviewed to learn background information or recommendations about a patient’s treatment plan; e.g. not reading consultant’s suggestions or not knowing of a condition listed in the medical record that would contraindicate giving a typical medication used for presenting symptoms. Once (1) 2 to 5 times (2) More than 5 times (3) Electrolyte replacement was not ordered correctly. Once (1) 2 to 5 times (2) More than 5 times (3) A decision to transfer a patient to an environment lacking clinically required expertise was considered unsafe; e.g. an unstable patient from the CCU to a medical unit; not scheduling a patient for the surgical ICU after complicated surgery; ordering diagnostic testing to be done at a remote site. Once (1) 2 to 5 times (2) More than 5 times (3) (Dykes et al. 2010b) Outcome Variable. The dependent variable, recovered medical errors, was measured using the RMEI; a 25-item self-report survey (Dykes et al. 2010a). Participants were asked to report the frequency of medical errors recovered over the past three months as (1) none, (2) once, (3) 2-5 times, and (4) over 5 times. The higher the score, the more errors were recovered. The RMEI previously demonstrated an acceptable reliability (0.90) with subscale reliability ranging from 0.75 (Poor Judgment subscale) to 0.88 (Mistake subscale). 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Personality was measured using the Ten-Item Personality Inventory (TIPI). The 10-item, self-report survey measures broad personality domains (Gosling et al., 2003). Using a 7-point Likert scale, participants rated the extent they agreed or disagreed with statements concerning their personality. Possible responses ranged from 1) disagree strongly to (7) agree strongly. Reliability for the TIPI domains ranged as follows: (1) Extraversion (0.68), (2) Agreeableness (0.40), Conscientiousness (0.50), Emotional Stability (0.73), and Openness (0.45). The TIPI has been tested with undergraduate students in multiple countries and has an average correlation of 0.72 across the five domains (Jonason, Teicher, & Schmitt, 2011). Individual characteristics examined were age, hospital tenure, specialty tenure, education, expertise, certification, and personality. Individual characteristics examined were age, hospital tenure, specialty tenure, education, expertise, certification, and personality. Age, hospital tenure, and specialty tenure were measured on a continuous scale of years and collapsed for further analysis. Nurses reported their highest nursing education degree as a diploma, associate degree, baccalaureate, masters, or doctorate (DNP or PhD). These categories were collapsed for further analysis. Nurses self-reported their level of expertise as novice, competent, or expert. Organizational factors examined were culture of safety and workload. Participants were asked to indicate if they worked at a Magnet® designated organization. Further, participants reported workload by indicating their typical nurse-to-patient ratio over the past three months. These categories were collapsed for further analysis. Data Analysis Data analysis …  Improving Hand-off Report Student Names Team Name and First/Last Names of Participants Problem  Report (timing and hand off errors):  The unit manager of a medical surgical unit has observed that change of shift report takes greater than 45 minutes.  In addition, staff has complained that their peers do not include vital data (IV sites, dressing sites, DVT prevention measures….) in report leading to errors, leave patients in disarray, and leave tasks incomplete.  Our task is to propose a change that will address these issues.  Report (timing and hand off errors:  Unit managers observed that there was miscommunication between staff during shift report.  Often times leaving out important patient information as well as taking a significant amount of time to relay the information. Our goal it to offer a change that will address these issues.  Now here is our SWOT analysis starting off with Derrick talking about the strengths. Majka  Communication failures compromise patient treatment, care quality, and safety. It also leads to medical errors, the third leading cause of deaths in the United States (Ghosh, et all., 2015) The varying parties and large amount of complex information included in patient handoff reports frequently contribute to informational gaps and omissions in the handoff report that can lead to sentinel events and patient hard (Staggers & Blaz, 2013) Research has identifed handovers as a risky time in the care process, when information may be lost, distorted or misinterpreted (Borowitz et al 2008, Owen et al. 2009, Philibert 2009) Report (timing and hand off errors):  The unit manager of a medical surgical unit has observed that change of shift report takes greater than 45 minutes.  In addition, staff has complained that their peers do not include vital data (IV sites, dressing sites, DVT prevention measures….) in report leading to errors, leave patients in disarray, and leave tasks incomplete.  Your task is to propose a change that will address these issues.  Increase of errors during patient hand-off report leading to missed information and incomplete tasks  Hand-off report time is taking a greater deal of time  Our task is to implement the use of SBAR as the standard hand-off report between shifts in order to reduce errors and decrease the time spent giving report.  2 SWOT Strengths: Multidepartment focus addressing handoff report problems(Robins et al., 2017) Solutions shorten time taken in report while increasing quantity of pertinent information. (Stewart & Hand, 2017) SBAR is supported by the Joint Commision (Stewart & Hand, 2017) Proven error reduction due to use of SBAR tool. (Stewart & Hand, 2017) SBAR is an evidence-based hand-off tool (Eberhardt, 2014) Weakness Use of the tool requires education to reduce user error (Stacey Eberhardt 2014) Medical personnel have personal bias on giving report (Ghosh et al.,  2018) Some staff are unreceptive to change (Robins & Dai, 2017). Evaluating execution of report can be affected by observer bias (Robins & Dai, 2017) Opportunities SBAR is inexpensive as a tool and will earn its cost in education by the reduction of sentinel events (Stewart, 2017) Improve patient handoff by implementing an evidence-based handoff tool in SBAR format  (Eberhardt, 2014) For continued nursing education in standardizing hand-off report (Ghosh et al., 2018). Threats Due to the variety of the change-of-shift reporting process, the findings of the study may not be applicable across similar settings (Ghosh et at., 2018). Some staff are unreceptive to change (Robins et al., 2017). Evaluating execution of report is subject to observer bias (Drach-Zahavy, 2014)  Small sample sizes from 2 studies: only one randomized control study (Stewart, 2017) Strengths: Multidepartment focus on addressing problems with handoff report (Robins et al., 2017) Solutions manage to shorten time taken to give report while increasing the amount of pertinent information given in that time frame. (Stewart & Hand, 2017) SBAR is supported by the Joint Commision (Stewart & Hand, 2017) Error reduction due to use of SBAR tool. (Stewart & Hand, 2017) SBAR is an evidence-based hand-off tool (Eberhardt, 2014) Weakness (Wendy)  Use of the tool requires education for all staff to reduce user error (Stacey Eberhardt 2014) Medical personnel have personal bias on how they want to give report (Ghosh et al.,  2018) Healthcare worker disinterest in changing how they give report. (Robins et al., 2017). Subjective approach to measuring a handover’s strategies might be subject to bias, as participants may behave differently in the presence of an observer. Opportunities (ashley)  SBAR is inexpensive as a tool and will earn its cost in education by providers by the reduction of sentinel events (each of which carries a high expense). (Stewart, 2017) Improve patient handoff by implementing an evidence-based handoff tool in Situation Background Assessment Recommendation (SBAR) format  (Eberhardt, 2014) For continued nursing education in standardizing hand-off report (Ghosh et al., 2018). Threats (Alma) Due to the variety of the change-of-shift reporting process, the findings of the study may not be applicable across similar settings (Ghosh et at., 2018). The acuity of patient injury and medical history can increase the amount of time for patient hand-off (Robins, 2017). Small sample sizes from 2 studies: only one randomized control study (Stewart, 2017) and sample size of 200 handovers in 5 wards in another study(Drach-Zahavy, 2014) 3 Assessment  Inefficient communication during hand off report is a challenge to patient care. (Ghosh, et al., 2018)​ Communication error given during report increases risk of poor patient outcomes. (Stewart, 2017) ​ Hand off communication between medical personnel leads to an increase in medication errors, incomplete tasks, disorder, and eventually poor patient outcomes (Robins et al., 2015)​ According to The Joint Commission, communication errors have been among the top three leading root causes of reported sentinel events every year since 2004. (Stewart, 2017) The information we had gathered from our assessment on giving report overall was -  1. Poor communication leads to poor patient outcome  2. The Joint Commission has stated communication errors has been the top 3 leading root causes of unanticipated major events in the healthcare setting that results in death or serious physical or psychological injury to a client which require immediate investigation by the health care facility since 2004 3. And now we will be talking about our Diagnosis. Goal should comes from assessments (SMART (MEASURABLE)) Assessment will be bullet points of why is this a problem  Specific, measurable, attainable, realistic, timely All RNs and assistive personnel will attend 1 or more in-services on the use of SBAR handoff report within three weeks. During the same three week period, charge nurses and nursing management will include SBAR teaching in pre-shift meetings, encouraging staff to begin to practice using the SBAR template during report.  Following the three week introduction of SBAR to the staff, SBAR will be implemented on the unit for a trial period of 1 month with the goal of receiving ideas of how we can improve it from the staff at the end of the 1 month period.  At the end of the one month period, staff nurses and assistive personnel will be invited to discuss their experiences with SBAR, as well as any ideas they have to improve it, during pre-shift meetings, down-time during their shift, or via email with the nurse manager. 15 days into the trial month, as well as at the end of the trial month, the nurse manager will personally solicit input regarding SBAR from harvest nurses on the unit. At the end of the 1 month trial period, metrics on sentinel events, falls, nosocomial infections, and other communication errors will be compared with the month prior to SBAR implementation and to the same month in the previous year. During the second month, a new SBAR form that includes select suggestions from staff will be used by those staff members while other staff members continue to use the known SBAR report. Communication errors, sentinal events, falls, nosocomial infections, et al will be compared between the two systems.  Majka  4 Diagnosis Lack of standardization in report Communication Barriers (Stewart & Hand, 2017)  Communication practices learned by various career stages of nurses (promise, momentum, harvest)  Different individual communication styles Gaps in knowledge regarding lack of standardized reporting A lack of standardization in report increases risk of error and poor patient outcomes 5 S.M.A.R.T. Goal Use an evidence-based standardized hand-off report tool to reduce report times to less than 45 minutes while reducing report-based errors by 20\% within 6-month period.  Precontempemplation: Nurse manager goes to charge nurses, harvest nurses, and harvest support staff with the SBAR template and asks them to sit with it for one week. He or she will ask for feedback from these individuals about implementing it on the unit.  Contemplation: Harvest nurses and support staff, and charge nurses spend a week with the SBAR template and consider its strengths, weaknesses, and or simply form an opinion around it.   Preparation: nurse manager introduces in-services on SBAR and charge nurses begin introducing the template during pre-shift meetings.  Action: Nurses and support staff begin using the template during all hand-off reports for a one month period. Nurse manager seeks input from harvest staff on ways to improve the system and attempts to include their input on a trial period, thereby extending the practice of the original SBAR for another month with most staff, and offering a personalization to those interested in improving the system.  Maintenance: Nurse manager compares statistics from the same time period one year ago, to the same length of time prior to using the SBAR report, and the data from the SBAR report compared with the modified SBAR report and presents the data to the staff at a staff meeting. At the meeting the nurse manager encourages public input and opinions on the SBAR report. If there is resistance, the manager asks that SBAR be continued in practice for a 3 month period in which he or she will personally receive report from individuals on their patients – helping those nurses who need it with ways to be more succinct. At this point, the report will have been used in practice for 5 months and will have become habit for many of the staff.  Alma  6 Full-Range Leadership Model/Theory Definition: Focuses on the behavior of leaders towards the workforce in different work situations. (Marquis & Huston, 2011) Three sub-types Transactional Transactions between leaders and followers Leaders promote compliance to standard SBAR method through rewards and punishments Transformational Identifies needed change, inspires, and executes change Emphasize the importance of reducing errors in patient hand-off through application of SBAR. Our goal is to enhance quality of care and thorough communication. Laissez-faire No standard rules  Used when nursing staff and PCTs are efficient with and advocating use of SBAR Full Range Leadership: Promise, Momentum, Harvest Wendy Transactional: Promoting buy-in from nurses and PCTs through encouragement of ideas and discussion while also increasing of stakeholder support of the SBAR method Theory should apply to what we are trying to accomplish  this is how we plan to use this leadership style because.... Why is this theory important for our outcome? Using more then one theory, where is it applicable?  7 Plan Following the three-week introduction of SBAR to the staff, SBAR will be implemented on the unit for a trial period of one-month with the goal of receiving ideas of how we can improve it from the staff at the end of the one-month period.  At the end of the one-month period, staff nurses and assistive personnel will be invited to discuss their experiences with SBAR, as well as any ideas to improve it, during pre-shift meetings, down-time during their shift, or via email with the nurse manager. 15 days into the trial month, as well as at the end of the trial month, the nurse manager will personally solicit input regarding SBAR from harvest nurses on the unit. At the end of the one-month trial period, metrics on sentinel events, falls, nosocomial infections, and other communication errors will be compared with the month prior to SBAR implementation and to the same month in the previous year. During the second month, a new SBAR form that includes select suggestions from staff will be used by those staff members while other staff members continue to use the known SBAR report. Communication errors, sentinel events, falls, nosocomial infections, et al will be compared between the two SBAR report templates at the end of a one-month trial. 8 3 Weeks RNs and assistive personnel to attend 1 or more in-services on SBAR handoff report  Following in-service, SBAR teaching in pre-shift meetings, encouraging staff to begin to practice using the SBAR template during report.  1-month trial SBAR will be implemented on the unit for a trial period with the goal of receiving ideas of how we can improve it from the staff at the end of the one-month period.  15 days into the trial month/ after the trial month Nurse manager will personally solicit input regarding SBAR from harvest nurses on the unit. Post 1-month trail Staff invited to discuss their experiences with SBAR, to share ideas to improve it Second trial(1 – 3 months) New SBAR form that includes select suggestions from staff will be used. Communication errors, sentinel events, falls, nosocomial infections, et al will be compared between the two SBAR report templates at the end of a one-month trial. Then again at the end of three months.  Metrics on sentinel events, falls, nosocomial infections, and other communication errors will be compared with the month prior to SBAR implementation and to the same month in the previous year. References Drach-Zahavy A ; Hadid N. Nursing handovers as resilient points of care: linking handover strategies to treatment errors in the patient care in the following shift. J Adv Nurs. 2015; 71: 1135-1145 Ghosh, K., Curl, E., Goodwin, M., Morrell, P., & Guidroz, P. (2018). An Exploratory Study on how to Improve Bedside Change-of-Shift Process: Evidence from One Hospital Using Technology to Support Verbal Reporting. HICSS. Marquis, B.L., & Huston, C.  (2011). Leadership roles and management functions in nursing: Theory and application (9th ed).  Lippincott, Williams, Wilkins.  ISBN: 978-1-4963-4979-8 Robins, H., & Dai, F. (2015). Handoffs in the Postoperative Anesthesia Care Unit: Use of a Checklist for Transfer of Care. AANA journal, 83 4, 264-8. Stewart, Kathryn R., SBAR, communication, and patient safety: an integrated literature review (2016). Honors Theses. https://scholar.utc.edu/honors-theses/66