Integrating Verbal Handoffs into Nursing Education: A Quality Improvement Project

Michelle A. Stimson, MSN-S, BSN, RN, CEN, CCRN

Ferris State University

Background Study Discussion

•Problem: Numerous students were observed delivering
ineffective verbal handoffs to various members of the
healthcare team.
•Communication failures are the root cause of approximately
70% of sentinel events.
•Delivering effective verbal handoffs requires practice; ample
•Verbal handoffs are fraught with risk.
Self-efficacy increased in all domains:
Delivery at the Bedside •Student nurses need ample opportunities to practice the
skill of delivering verbal handoffs in the clinical setting.
•Delivery using the SBAR technique
•Delivery at the patient’s bedside •Proficiency is best achieved through hands-on practice
•Delivery to a Registered Nurse paired with frequent, structured feedback.

practice tends to be in short supply in many nursing programs.
•Adopting standardized verbal handoff practices such as the
SBAR communication technique can mitigate communication
failures.
•Solution: Provide systematic opportunities for student nurses
to practice the skill of delivering verbal handoffs in the clinical
setting with the goal of improving self-efficacy and proficiency.
Confidence
•Delivery to a Physician
•Delivery to a member of the Interdisciplinary Team •The process of conducting verbal handoffs has the
potential to become laborious and time consuming; staff
Most notable increase: mentors may be necessary.
Delivery at the Patient’s Bedside Pre Confidence Survey Post Confidence Survey •Principles derived from Experiential Learning Theory and
Mostly Confident and Extremely Confident
Social Learning Theory can assist academic nurse educators
in ensuring future nurses develop the essential skill of
communicating effectively during transitions in care.

Plan Proficiency increased in all domains:

•Organization References
•Sixteen students enrolled in an advanced medical-surgical •Professionalism
course were randomly assigned to one of two clinical groups. •Content
•Judgment & Critical Thinking Costedio, E., Powers, J., & Stuart, T. (2013). Change-of-shift report:
•Each student underwent education on best practices regarding From hallways to the bedside. Nursing, 43(8), 18-19.
verbal handoffs, specifically on the proper use of the SBAR Most notable increase:
communication technique. Davis, J., Roach, C., Elliott, C., Mardis, M., Justice, E., & Riesenberg,
Judgment & Critical Thinking L. (2017). Feedback and assessment tools for handoffs: A
•During the clinical practicum, students conducted four verbal systematic review. Journal of Graduate Medical Education, 9(1),
handoffs using the SBAR communication technique. 18-32. doi: 10.4300/JGME-D-16-00168.1

•Student progress was measured via an evaluation tool and self- De Meester, K., Verspuy, M., Monsieurs, K. G., & Van Bogaert, P.
efficacy ratings were captured through confidence surveys. (2013). SBAR improves nurse-physician communication and
reduces unexpected death: A pre and post intervention study.
Resuscitation, 84, 1192-1196. doi: http://dx.doi.org/
Tools 10.1016/j.resuscitation.2013.03.016
Do Lee, J., Mast, M., Humbert, J., & Bagnardi, M. (2016). Teaching
•A confidence survey was issued to each student prior to the handoff communication to nursing students. Nurse Educator,
For Example: Patient is a ___ y/o M/F, admitted on ___ with c/o ___, and diagnosed with
41(4), 189-193.
S
start of the clinical rotation; the survey was reissued eight weeks ____ (OR: rule/out ____). Patient is a ___ code with allergies to ___.

later.
Situation:
When was your patient admitted
and what is the admitting
Manojlovich, M., Kerr, M., Davies, B., Squires, J., Mallick, R., &
•An evaluation tool measured handoff proficiency in the areas of
diagnosis?
What is happening right now? Rodger, G. L. (2014). Achieving a climate for patient safety by

B
organization, content, professionalism, and critical thinking.
For Example: Significant PMH/PSH includes ___. (If in precautions for history of infection,
list here). focusing on relationships. International Journal for Quality in
Background: What is the
Healthcare, 26(6), 579-584.
patient’s relevant past medical

•Over the course of eight weeks each student conducted four

history?

A
verbal handoffs using the SBAR communication technique:
Assessment:
•The first handoff occurred with a peer
Identify subjective and objective
assessment findings pertinent to
priority issues, or that are
significant for other reasons.
Physical Assessment:
Pertinent Labs/Tests:
Analysis
What is the current status of
your patient?
Quality and Safety Education in Nursing [QSEN]. (n.d.). Pre-
Pertinent medications/IV soln: What is your analysis of the
assessment findings?
Improving? Declining?
licensure KSAs. Retrieved from
Trends?
http://qsen.org/competencies/pre-lisensure-ksas/

•The second handoff occurred with the clinical instructor

Include labs according to the
following format. Also include any
other pertinent labs/diagnostic

•The final two handoffs occurred with the clinical instructor at

tests
Include other things important for
Wojciechowski, E., Pearsall, T., Murphy, P., & French, E. (2016). A
nursing to know, such as: activity,

the patient's bedside.

IV, telemetry, diet, fall risk,
Braden risk, etc. case review: Integrating Lewin’s theory with lean’s system
For Example: Pt is/is not stable. Upcoming labs/tests include ___. Patient is receiving approach for change. Online Journal of Nursing Issues, 21(2).
R
____ (treatments/medications). Continue to monitor ___. Plan for dc is ___. I would

• Students were expected to complete an SBAR tool prior to

recommend __. doi: 10.3912/OJIN.Vol21No02Man04
Recommendation

delivering each verbal handoff. What is the needed or desired

outcome?
What will you recommend to the
provider?
What do you recommend to the
Zigmont, J. J., Kappus, L. J., & Sudikoff, S. N. (2011). Theoretical
•Education on the proper use of the SBAR communication
next shift to optimize care?
foundations of learning through simulation. Seminars in
technique was facilitated by the project leader in the post- Perinatology, 35, 47-51. doi:10.1053/j.semperi. 2011.01.002
conference setting using didactic and role-play methods.