Hospital offers helping HAND

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South Carolina facility implements variant of SBAR

In 2005, Pam Stodghill, MS, RN, director of performance improvement and risk management at Shriners Hospital for Children in Greenville, SC, decided to develop a new process to improve patient handoffs at her facility.

SBAR—Situation, Background, Assessment, and Recommendation—was what the staff at the Greenville location previously used for handoffs. “SBAR had a lot of really good components, but the process was not a natural way to look at all the information [at the facility],” Stodghill says. “There is a lot of flip-flopping between existing information, background information, and current assessment.”

Stodghill reexamined the SBAR process and saw an opportunity to improve the facility’s handoffs from shift to shift. She then looked at literature related to the SBAR process to see whether there was any information she could use in developing the new program.

“I was sitting at home thinking of the assessments I did in the ICU and how I had to think of what was going on, what was going to happen tomorrow and in the future, and then go through all the medications,” says Stodghill. “I thought, wouldn’t it be cool to do a play off of ‘hands’ or ‘handoff?’ ”

Stodghill created the following acronym for HAND:

  • History
  • Assessment
  • Next care
  • Drug review

The history part of the model includes reviewing the patient’s name, age, development level, gender, reason for admittance, illnesses, and allergies.

The assessment is a current overview of the patient from head to toe. It includes assessments of the patient’s cardiovascular, respiratory, and muscular functions, fall risk, and pain levels.

Next care identifies any further treatment the patient needs. This includes any treatment involving other disciplines, further medical care, any scheduled surgeries, and a schedule for the staff to determine what needs to be done for this patient to be discharged.

Finally, drug review includes an analysis of any current medication the patient is on, when the next dose is scheduled, and the home list of medications if the patient is being transferred.

Stodghill took this idea and consulted three nurses on staff at the Greenville location. The nurses described the daily procedures each went through to hand off a particular patient, without taking into consideration the SBAR process. All of them agreed that there was a more natural flow when a patient was examined and handed off.

In 2006, the HAND process was introduced to staff members without running a pilot, says Stodghill.

To give staff members a better understanding of the HAND model, they were shown a PowerPoint presentation that discussed how poor communication is one of the leading causes of sentinel events.

Posters displaying the HAND model were also put up throughout the facility, including a picture of a hand, an explanation of the acronym, and the slogan “Let me give you a hand.” They were hung on walls in report rooms and throughout the various departments.

“The staff was very welcoming of the HAND model,” Stodghill says. “The current staff members were able to gain more guidance, while the HAND model helped us to orient the new staff on how to report handoffs.”

Stodghill is always looking for ways to improve to the HAND model but believes that due to the model’s general format, anything added would be more of a change to the policy, not the model.



Adapted from Briefings on The Joint Commission, March 2009, HCPro, Inc.