IHI.org - A resource from the Institute for Healthcare Improvement
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Develop a Culture of Safety:
Relay Safety Reports at Shift Changes

Certain situations increase the risk of adverse events and should prompt staff to be even more safety-conscious than usual. Examples include patients with the same last name, trials of new equipment, and research protocols. Identifying these higher-risk situations and bringing them to the attention of all staff members at the start of each shift decreases the likelihood of errors and adverse events.


Tips
  • Make the person in charge of the department or unit responsible for collecting and relaying the information for each shift. If there is no regular person in charge on a shift, appoint a member of the department or unit staff to take care of collecting and relaying the information.
  • Share safety information with staff from other departments who work with patients on the unit, e.g., physical therapists and respiratory therapists.
  • Monitor for common issues across departments; they may be alerts to system-wide issues.