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Kaiser Permanente used an innovation model to
develop and test a structured handoff system in the
inpatient care setting known as “Nurse Knowledge
Exchange” (NKE). Early data showed promising trends
in reduced number of falls on general care units. Now,
working in partnership with IHI’s faculty on spread, this
nurse designed JCAHO compliant change-of-shift
handoff process is being spread across 21 inpatient
care sites. This session will describe the essential
workflow and technology changes that make NKE a
better system for change-of-shift communication, the
strategy to spread NKE to 21 sites in nine months, and
data to show how well implementation has progressed.
After this presentation you will be able to:
- Identify key safety elements of a structured system of handoffs in the inpatient care setting.
- Apply concepts used in designing and testing the system of handoffs to different care settings.
- Describe the elements of NKE that make it a good strategy for spreading improvements throughout a system.
Cory Sevin, RN, MSN, NP, Director, Institute for Healthcare Improvement;
Lisa Schilling, RN, MPH, Patient Safety Practice Leader, Kaiser Permanente;
Linda J. Fahey, RNP, Manager Quality and Patient Safety, Kaiser Permanente |
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