Nurses work together to smooth the transfer of new mothers and newborns from L&D to postpartum care
TEAM: Labor & Delivery and Couplet Care/Postpartum
ENTRY SUBMITTED BY: Cheryl Roth, PhD, WHNP-BC, RNC-OB, RNFA, nurse practitioner
Handoffs between Labor & Delivery and Couplet Care/Postpartum nurses are traditionally fraught with communication issues. Common complaints from staff include that the L&D nurses are trying to push their patients to Couplet before they are ready and/or that Couplet nurses don’t want to accept their transferred patients in a timely manner.
At HonorHealth Scottsdale Shea Medical center, the Handoff Team was formed, utilizing staff nurses from in L&D and Couplet Care and Unit Supervisors. The Handoff Team, led by the Nurse Practitioner, initially established the team goal and “must-haves” for each department. The goal was to “work together to develop a transfer process for mothers and babies from Labor & Delivery to Couplet Care in a manner that promotes optimal patient safety, a smooth transfer process, and teamwork that enhances staff relationships in both departments.”
The “must-haves” defined by the team members established the groundwork for their discussions. These were enlightening for all team members, as they learned about each other’s limitations and needs. For instance, the L&D nurses were surprised to find that the Couplet Nurses cannot call a physician directly. They are required to go through the answering service, sometimes waiting hours for a return call. During this time, patients may be waiting for pain meds because the physician did not input their postpartum orders. If the L&D nurse ensured those orders were entered prior to transfer, it made the process much smoother for the patient and could increase patient satisfaction.
The team worked on three key concepts: Development of a checklist to ensure all elements of the handoff were accomplished; development of transfer criteria to ensure consistency with conditions of transfer; and logistical and practical elements of the process. A checklist was developed and completed on each patient transferred during the three month trial of the new process. Logistical questions such as “What do we do if the unit is crazy and we need to move patients out of L&D as soon as possible for other patients who need the bed?” or “What do we do at change of shift?” presented the toughest challenges. These questions demanded careful thought and planning with input from the Clinical Directors.
There were previously unidentified bumps in the road, as with all change, but overall the trial went well. L&D nurses learned how to notify Couplet nurses and plan for them to come to the bedside during the recovery period, and Couplet nurses learned how to plan their time so they were available to come to L&D for a 10-15 minute report. Following the initial handoff, the L&D nurse completes the patient’s recovery, then transfers the mother and baby to the postpartum room, where a very brief handoff, which includes a check of the patient’s bleeding, bladder, IV’s, identification bands and vital signs and update on the newborn status is performed with the Couplet nurse.
Following the trial, nurses filled out a survey containing Likert-scale questions comparing the old process and new process. Results were significantly positive for the change in practice. Patients and families found the process satisfying, as reflected in increased patient satisfaction scores, especially with HCAHPS questions related to nurse communication.
Overall, nurse satisfaction with the handoff process has improved and one year later, the new process continues. The initiative of the Handoff Team to investigate, prioritize, and design a new system to improve communication and patient satisfaction is a stellar example of how effective change can be made in the nursing process