Verbal Hand-off Reports - Are they no longer necessary?

Nurses General Nursing

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I work as an acute care Med-Surg float nurse and my hospital has implemented a new process where patients are being transferred to units from other units, ie. the ED to the floor, ICU to the floor, and from affiliate hospitals to our hospital without having to call and give a verbal report. I find this practice outrageous and an accident waiting to happen.

The reason behind this new policy is to expedite patient transfers and open beds faster. All I ever learned is how important patient the hand-off is, and now we are actually no longer required to give report to the next nurse who will be taking care of the patient.

Apparently now that we have the EPIC system to do our patient charting, the decision-making people feel that verbal reports are no longer needed. However, I have had several instances where EPIC contained very little patient information and virtually no history, so I literally had to ask the female patient, who was busy vomiting, why she was even admitted to the hospital. The fact that she was a stage 4 CKD patient with only one remaining kidney was nowhere to be found on EPIC. She needed pain meds, but her current medication reconciliation had not been completed, delaying her receiving any medications.

And I must also stress the last Magnet hospital I worked at did the same thing by getting rid of verbal report for patient transfers. Has anyone else been experiencing this practice, and if so, how do you deal with the huge safety risk? What happened to placing patient safety first?

Specializes in Med-Tele; ED; ICU.
Do you have an example of how "a lawsuit waiting to happen" would come from not getting a verbal report?

Several people including myself have already responded to this.

I'm sure that I've missed a few posts but I haven't seen any concrete examples of an adverse outcome that was attributable to the lack of *verbal* report.

The posts either talk about:

+ patients having been dropped off without the nurse knowing that they were coming (this isn't about verbal report, it's about the floor not having a reliable system in place to accept patients)

+ presumptions that information not found in the chart would have been available verbally

+ few if any adverse outcomes

I think this thread has run its course; either you insist that it's unsafe or you believe that proper charting and summary reports can work... I doubt anybody is changing their mind.

In support of the latter view I can simply say that the large health system at which I work routinely makes changes for the nurses when adverse outcomes occur and they have a robust mechanism for finding them and analyzing them. If EMR-based handoff were leading to adverse events, they wouldn't be doing it.

Specializes in Med Surg, Specialty.

So KindaBack, you quoted me, where I said that I had just responded to this issue in my last post. That post (#153) quoted/responded to you specifically and gave specific examples. So I guess you are saying instead of doing a chart(thread) review, you'd like a verbal report? ;) Sure, I'll go over it again.

I'm sure that I've missed a few posts but I haven't seen any concrete examples of an adverse outcome that was attributable to the lack of *verbal* report.

The portion you quoted from SC wasn't the one I quoted. Report itself doesn't have to be verbal, BUT, it can not be just a chart review. You have additional information that is important to be handed off.

For example, you can fax over a report and then call in with additional information and see if there are questions. This technique might not technically be considered verbal report but you still have the nurse-nurse final handoff which is key. So I guess to be technical, what I'm saying is a verbal report (of basic information like iv gauge) is not needed but a verbal handoff is. The whole point of handoffs (and of nursing itself on a wider scale), is to catch/prevent issues and keep the patient's care managed appropriately and smoothly.

Patients being dropped off without the nurse's knowledge is absolutely an issue connected to verbal handoff as it simply wouldn't have happened with verbal report/handoff in place! You want to assign the responsibility to 'some other system'(but you give no alternative suggestion for solution) but transfer issues happen in every single hospital and you already have a solution(verbal handoff) that's basically 100%.

As a previous poster mentioned, she had a patient who was airborne precautions in a room which was not set up for that, and because of lack of verbal handoff, many people were placed at risk. Others have talked about inappropriate floor admissions which I personally have experienced, which can be stopped at verbal handoff stage. I remember one patient in particular where the charge nurse told me to not accept report from the ER if they tried to call it in to me as it was inappropriate for our floor. A few minutes later ER did try to give report to me. I would have been screwed if the patient was simply brought up and we had to try to sort this mess out on the floor. Not good for patients and not good for nurses. Verbal report saved the day again!

presumptions that information not found in the chart would have been available verbally

In my last post I gave specific examples of important information which can not be placed in the chart, such as that the husband who's wife my patient killed was being admitted to the same floor. Other social or police related information (I gave an example that I was getting a shooting victim, and the shooter was threatening to come back to finish the job which is very important for me to know), or concerns/suspicions such as abuse, can be important to know which is not written in the chart either.

And again, as I said in my last post, when reviewing a chart you are more likely to miss a random piece of important information which can be easily highlighted and elaborated upon with verbal handoff. Muno had previously written about a patient on Revatio - this important information can be highlighted during a verbal handoff to prevent the nitro issue. In addition, any other unusual information such as strange HIPAA issues can be highlighted. I had one young adult non English speaking patient who had no idea what her birthday was. Thankfully her family was there at the time and could reassure me that was normal for her. Night shift was grateful for me to highlight that information to them. Little tips to manage dementia patients are also very common to be passed along in report and can give a clearer picture of what is 'normal' for a patient. It happens so often that just a minute of extra verbal information can make the care so much smoother.

There are also things which can be stated so much more bluntly and clearly verbally, than in the chart. You can't write "her breathing sounds terrible" but you can say it on verbal report. I had one patient where it was her norm that her breathing sounded awful. I was grateful to hear this from the offgoing nurse so that I could give her appropriate care.

Bottom line there are things which are important to know which can not be written in the chart, and important things which are in the chart but can be emphasized so as to not be overlooked. Verbal handoff can be a quick thing to do and can be very helpful to the care the patient receives and the safety of both the patient and nurse. Many problems can be prevented with verbal handoff and clarification of issues. So with all the good that verbal report/handoff can do... instead of trying to remove it and assign blame for the multiple holes it leaves on other things, why not instead assign focus on the one issue of why someone can't give report in a reasonable amount of time? Perhaps say that if report/handoff can't be given within 30 minutes then it can be given to the floor charge?

Specializes in Med-surg, telemetry, critical care..

Is there a way to send a printout with an H&P, medications, allergies, symptoms, etc that can go with the patient to the next unit and handed off to the receiving nurse? So many units are so busy and crazy, I wouldn't feel comfortable taking that patient without that information, along with the Drs transfer orders. Sometimes you might not see those orders for hours. If the facility expects a nurse to stop and receive a patient with only a screen to look at, they need so staff accordingly.

And therein lies the problem. Many nurses do not document sufficiently, nor do patients coming from the ED have all of their information presented in EPIC. I just had a patient transported from one of our hospital ED's with no report and very little warning. She showed up with a diagnosis in EPIC of "headache." Turns out the patient had a MEWS score of 9 (over 5 we call an RRT), and she was septic. Not one mention of that in EPIC. Patient was sent to the ICU almost immediately. She should not have ever been made floor status to begin with. SO.. if verbal had been given I am quite certain I would have been given a clearer picture of what was happening, and I could have questioned their decision to make her floor status.

The hospital I worked at tried this a few years ago. They faxed an SBAR to the floor. It didn't speed up anything. They called to get the bed, when the SBAR was faxed and when they were bringing up the patient. It didn't contain a lot of the information a nurse wants and didn't speed up the process at all. They went back to verbal report. If a nurse is busy the charge takes report and settles them in. ER works with the floor when they are busy and the floors works with ER. It is a team.

Specializes in SCI/TBI, Hospice, Legal Nurse Consulting.

So do you just print out the SBAR form? Or is there a,way to print out a Kardex like report for each of my patients? I just started with EPIC but need something to write on.

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