Elements of Safe Client Transfers
A recent study initiated by CNO examined the challenges nurses face when the care of clients is transferred from one health care provider to another, and between health care teams. CNO wanted to learn if the existing practice standards support current practice-setting realities, and whether enough is being done from a regulatory perspective to support safe client transfers.
The study found that the risk of harm to clients and breaches of client safety are most likely to occur during the transfer of client care from one caregiver to another. Transfers can also be complex and context-specific, so adhering to a set of rigid procedures can be difficult. Nurses should use critical thinking skills, consider any unique factors relating to a particular transfer or client, and consider whether those factors could affect her or his ability to care for the client.
To conduct the study, CNO collaborated with the College of Physicians and Surgeons and the Ontario College of Pharmacists, as well as Sunnybrook Health Sciences Centre St. Michael’s Hospital and York University’s School of Nursing. The research involved interviews with 85 health care professionals and themes about what constitutes a successful transfer (such as information needs, flexibility and collaboration) arose. The study also examined accountability and overcoming obstacles in the transfer process.
The study found that health care teams are addressing challenges that transfers of care present by developing policies about face-to-face transfers at the client’s bedside, or systems in which in-person communication is reinforced by written documentation. Face-to-face transfers with written documentation support client-focused care, and consider the environment and the needs of the nurse.
Because the study found that health care teams were already using good clinical judgment when conducting client transfers, participants felt that it is unnecessary to develop guidelines for all settings and practitioners. For this reason, CNO has discontinued its Transferring Clients practice guideline.
Nurses can access other CNO resources such as the Medication, Revised 2008, Infection Prevention and Control, Documentation, Revised 2008 and Professional Standards, Revised 2002 practice documents by visiting www.cno.org/publications. Read the report, Transferring Clients Safely: Know Your Client and Know Your Team, at www.cno.org/transferring_clients.