I-PASS as a Nursing Communication Tool
Background: The Joint Commission reports that hand-offs are one of the most complex communication processes, and despite mandating a standardized approach, there are still gaps and a lack of consistency, ultimately resulting in medical and nursing errors. Nurses in a large children's hospital had poor compliance on the implementation of standardizing hand-off using the I-PASS mnemonic (illness severity, patient summary, action list, situational awareness, and synthesis by receiver) hand-off tool, interfering with patient safety objectives.
Purpose: I-PASS is a standardized shift report process, studied and validated in the United States and Canada, instituted in 2015 in this children's hospital. Investigating and addressing the barriers to use of I-PASS process were the goals of this project.
Methods: A quality improvement (QI) initiative was used to engage nurses working on two inpatient pediatric units to identify barriers to the use of the I-PASS hand-off tool and determine evidence-based recommendations to improve compliance. A survey was disseminated to all nurses working on these units; responses were collected, and data were analyzed.
Findings: Seventy-two percent of nurses completed the survey, with a mean of working at this hospital for seven years. Despite 94% of nurses knowing where to find the tool in the medical record and 98% feeling there was time to ask questions, nurses agreed that interruptions during shift change were prominent barriers to use of I-PASS; admissions, phone calls, and families asking for assistance represented some common distractions.
Conclusion: Standardized hand-off communication can assist in preventing health care-related errors. Development of an I-PASS toolkit, giving nurses tools to decrease the barriers, and having I-PASS champions on each unit allowed for better adherence to using the I-PASS hand-off tool. These data were included in a hospital-wide continuous improvement initiative, intending to improve compliance, ultimately affecting patient outcomes.