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Patient Safety Tip
of the Week
September
29, 2020
ISHAPED for Nursing Handoffs
We’ve covered just
about every type of handoff in healthcare in our previous columns (see the full
list below) and touched upon almost every one of the mnemonics for those
handoffs. But one we have never discussed is ISHAPED.
ISHAPED stands for Introduction,
Story, History, Assessment, Plan, Error-Prevention, and Dialogue. It is a
format that has been used in shift-to-shift nursing handoffs at the bedside. At
Seattle Children’s Hospital shift-to-shift handoffs were not considered to be
problematic but anecdotal concerns had been raised regarding handoffs
between departments (intensive care to acute care, emergency department to
acute care, etc.). A prior systematic review (Ong 2011) had also found that exposure of handoffs at
patient transfers presented challenges that are not experienced in inter-shift
handoffs. So, clinicians and researchers at Seattle Children’s Hospital (Stimpson 2020) implemented a modified ISHAPED (m-ISHAPED)
tool to align the content shared and the expectations for interdepartmental
handoffs. Their quality improvement team and relevant stakeholders studied
multiple handoff tools and ultimately chose ISHAPED as the one to use for
interdepartmental handoffs.
The original ISHAPED tool was developed by
the Inova Health System (Friesen
2013). The original
ISHAPED tool from Inova Health is available on the IHI
(Institute for Healthcare Improvement) website. Because the original tool was
intended for shift-to-shift bedside handoffs, the Seattle Children’s team
modified it for interdepartmental handoffs and pediatric patients. The
resultant m-ISHAPE Form is available on the web: http://links.lww.com/JNCQ/A671.
Their implementation
plan included 4 key elements:
- Creation of a job aid, intended to be used
as a reference at the time of handoff
- Creation of an education plan that
leveraged preexisting annual nurse education time. The education consisted
of a short didactic section, a video demonstrating the process in action,
and time for the nurses to practice using it with short scenarios;
- Creation of a superuser support plan for
the first week of go-live. Nurses who were involved in the project
received additional training to support the new practice change;
- K-card audit and coaching, which
included realtime coaching, and collection of feedback
from the nurses.
cardiac,
and neonatal), rehabilitation unit, postanesthesia
care unit (PACU), inpatient psychiatric unit, and ambulatory infusion area.
The authors note that some nursing units and
departments have begun using the tool for shift-to-shift handoffs as well.
We note that the tool conveys a tremendous
amount of information. Hence, some of the important considerations for any
handoff apply, such as allowing ample time, doing the handoff in a quiet
environment devoid of interruptions and distractions, and allowing the receiver
to ask questions and seek clarification. Importantly, the tool emphasizes the
use of “repeat-back”. When Inova originally developed ISHAPED they also
identified multiple best practices for handoffs, including use of face-to-face
communication, use of written documentation, and importance of read-back. They
also emphasized that handoffs involve not only the transfer of information but
also the unambiguous transfer of responsibility.
So go ahead and add
ISHAPED as one more option to choose from when you are looking at improving
your handoffs, particularly your interdepartmental handoffs.
Read
about many other handoff issues (in both healthcare and other industries) in
some of our previous columns:
May 15, 2007 “Communication,
Hearback and Other Lessons from Aviation”
May 22, 2007 “More
on TeamSTEPPS™”
August 28, 2007 “Lessons
Learned from Transportation Accidents”
December
11, 2007 “Communication…Communication…Communication”
February 26, 2008 “Nightmares….The
Hospital at Night”
September 30, 2008 “Hot
Topic: Handoffs”
November 18, 2008 “Ticket
to Ride: Checklist, Form, or Decision Scorecard?”
December 2008 “Another
Good Paper on Handoffs”.
June 30, 2009 “iSoBAR: Australian Clinical Handoffs/Handovers”
April 25, 2009 “Interruptions,
Distractions, Inattention…Oops!”
April
13, 2010 “Update on Handoffs”
July
12, 2011 “Psst! Pass it on…How a kid’s game can mold good
handoffs”
July
19, 2011 “Communication Across Professions”
November
2011 “Restricted Housestaff
Work Hours and Patient Handoffs”
December
2011 “AORN Perioperative Handoff Toolkit”
February 14, 2012 “Handoffs
– More Than Battle of the Mnemonics”
March
2012 “More on Perioperative Handoffs”
June
2012 “I-PASS Results and Resources Now Available”
August
2012 “New Joint Commission Tools for Improving
Handoffs”
August
2012 “Review of Postoperative Handoffs”
January
29, 2013 “A Flurry of Activity on Handoffs”
December
10, 2013 “Better Handoffs, Better Results”
February
11, 2014 “Another Perioperative Handoff Tool: SWITCH”
March
2014 “The “Reverse” Perioperative Handoff: ICU to
OR”
September
9, 2014 “The Handback”
December
2014 “I-PASS Passes the Test”
January
6, 2015 “Yet Another Handoff: The Intraoperative
Handoff”
March
2017 “Adding
Structure to Multidisciplinary Rounds”
August
22, 2017 “OR to
ICU Handoff Success”
October
2017 “Joint
Commission Sentinel Event Alert on Handoffs”
October
30, 2018 “Interhospital
Transfers”
April
9, 2019 “Handoffs for Every Occasion”
November
2019 “I-PASS Delivers Again”
August 2020 “New
Twist on Resident Work Hours and Patient Safety”
Some
of our prior columns on intrahospital transports and the “Ticket to Ride”
concept:
- April
8, 2008 “Oxygen
as a Medication”
- November
18, 2008 “Ticket
to Ride: Checklist, Form, or Decision Scorecard?”
- August
11, 2009 “The
Radiology Suite…Again!”
- March
13, 2012 “Medical
Emergency Team Calls to Radiology”
- August 25, 2015 “Checklist for Intrahospital Transport”
- September 1, 2015 “Smarter Checklists”
- November 2016 “Oxygen
Tank Monitoring”
- February 2018 “Oxygen
Cylinders Back in the News”
- May 22, 2018 “Hazardous
Intrahospital Transport”
- October 30, 2018 “Interhospital
Transfers”
- March 31, 2020 “Intrahospital Transport
Issues in Children”
- June 23, 2020 “Telemetry Incidents”
- July 14, 2020 “A Thesis on
Intrahospital Transports”
- August 4, 2020 “Intravenous Issues”
References:
Ong MS, Coiera E. A
systematic review of failures in handoff communication during intrahospital
transfers. Jt Comm J Qual Patient Saf
2011; 37(6): 274-284
https://www.jointcommissionjournal.com/article/S1553-7250(11)37035-3/fulltext
Stimpson M, Carlin K, Ridling
D, Implementation of the m-ISHAPED Tool for Nursing Interdepartmental Handoffs,
Journal of Nursing Care Quality 2020; 35(4): 329-335
Friesen MA, Herbst A, Turner JW, Speroni KG, Robinson J. Developing a patient-centered
ISHAPED handoff with patient/family and parent advisory councils. J Nurs Care Qual 2013; 28(3): 208-216
Inova Health System. ISHAPED Patient-Centered
Approach to Nurse Shift Change Bedside Report. IHI (Institute for Healthcare
Improvement). 2012; Accessed September 2, 2020
http://www.ihi.org/resources/Pages/Tools/ISHAPEDPatientCenteredNurseShiftChangeBedsideReport.aspx
m-ISHAPE Form. Seattle Childrens’
Hospital.
http://links.lww.com/JNCQ/A671
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