Successfully reducing communication error
within the complex adaptive health care
system requires both an understanding of potential
sources of error within the process
and developing appropriate interventions.3
Individual nurse factors influencing handoff
report include providing lengthy or irrelevant
content, inability to accurately recall information,
poor peer relationships, language
barriers,4 stress, fatigue, faulty information
processing, flawed decision making, eagerness
to complete the shift,5 and failure of the
recipient to document information provided.6
Organizational and/or environmental factors
contributing to communication error include
alarms, interruptions,7 and the lack of a predetermined
process to guide shift report.8 Furthermore,
in today’s data-rich technological
environment, it is possible that too muchinformation may be provided, resulting in
cognitive overload and the inability to make
decisions.