460 October 2013 Volume 39 Number 10 The Joint Commission Journal on Quality and Patient Safety N ursing intershift handoff is a daily process that takes place at the beginning of every shift, and involves communicat- ing essential patient information between the outgoing and the oncoming nurses. 1 Any information omission, misinterpretation, or incongruence may lead to deficient or inappropriate patient care. 2–4 The Joint Commission has identified communication failures as the leading cause of sentinel events in the United States, and lists shift reports as a contributing factor. 5 The Insti- tute of Medicine reported that the first shortfall of safety lies in inadequate nursing handoffs. 6 The Canadian Ontario Hospital Association stated that approximately 70% of all sentinel events are linked to communication breakdown. 7 In a 2009 assessment of patient safety culture in 68 hospitals in Lebanon, 57% of the 6,807 responding hospital employees (including hospital-em- ployed physicians, nurses, and clinical and nonclinical staff ) agreed that pertinent patient information, such as abnormal vital signs, laboratory values or radiology test findings, pain manage- ment, allergy, fall risk, and functional status, is often lost during shift change. 8 At Labib Medical Center (LMC), one of the 68 hospitals, 17 (23%) of the 76 nurses were concerned about the adequacy of communication during shift changes. 9 A subsequent review of reported patient safety incidents at LMC showed that medication errors, delay in treatment, wrong treatment, dupli- cation of laboratory tests, and near-miss events were caused by patient information omissions during intershift handoffs. 10 In response, LMC initiated a quality improvement (QI) project using a multifaceted intervention to improve the quality of nurs- ing intershift handoffs, as we describe in this article. Methods SETTING Labib Medical Center is a 130-bed hospital (Saida, Lebanon), approximately 27 miles (43 kilometers) south of Beirut. It ad- mits approximately 8,000 inpatients and 2,000 outpatients yearly. Lina A. Younan, RN, MSN, DNP; Maryann F. Fralic, DrPH, RN, FAAN Teamwork and Communication Using “Best-Fit” Interventions to Improve the Nursing Intershift Handoff Process at a Medical Center in Lebanon Article-at-a-Glance Background: Nursing intershift handoff involves commu- nicating essential patient information between the outgoing and the oncoming nurses during shift changes. A subsequent review of reported patient safety incidents at Labib Medical Center (LMC), Saida, Lebanon, showed that medication errors, delay in treatment, wrong treatment, duplication of laboratory tests, and near-miss events were caused by patient information omissions during intershift handoffs. In re- sponse, LMC initiated a quality improvement project using a multifaceted intervention to improve the quality of nursing intershift handoffs. Methods: The barriers to effective intershift handoff iden- tified in the literature that best fit the current context of in- tershift handoffs at LMC showed that the following three issues needed to be addressed: (1) the absence of a standard- ized intershift communication tool, (2) inadequate training of RNs on intershift handoff communication, and (3) the interruptions during the shift reports. Accordingly, a three- faceted intervention was constructed, entailing (1) introduc- tion of a standardized intershift handoff tool, (2) training RNs about effective handoff communication, and (3) de- creasing interruptions. Results: The mean number of omissions per handoff across the three units decreased from 4.96 to 2.29 (t = 6.29, p = .000), as did the mean number of interruptions per in- tershift report—from 2.17 to 1.26 (t = 2.7, p = .008). RNs’ knowledge of the criteria to be communicated suggested a greater appreciation of their own role in patient safety. Conclusion: The intershift handoff communication process can be improved using evidence-based strategies that target internal barriers where the shift report occurs. Regular monitoring and follow-up are essential to maintain the improvement. Copyright 2013 © The Joint Commission