What is Transition of Care and How to do it Safely

Care transition is an important part of the continuum of care. It occurs when care recipients move across the healthcare system such as between different health units, specialists, care settings or systems. As they move from one healthcare setting to another or within units they will experience changes to physical setting, healthcare providers and to the care they require. This can be a stressful situation for care recipients, leading to vulnerability of workers.

The transition of care from one setting to another has been identified as a major contributor to employee exposure to hazards and can cultivate poor and unsafe care. This is mainly attributed to a lack of a structured process to communicate risks to employee and care recipient safety.

Three major topics within care transitions

Prevention of musculoskeletal disorders (MSD) during client handling

MSDs are common workplace injuries affecting the back, shoulders, neck, and arms, often caused by strain from awkward postures, repetitive tasks, or heavy lifting. These disorders represent one of the leading causes of disability and pain in workers and a significant source of employers’ compensation claims. When MSDs go unaddressed, the cycle of physical discomfort and mental stress can impact overall wellbeing, productivity, and workplace morale. That’s why early intervention and support—both physical and psychological—are key to a healthy, safe work environment.

Client handling is the lifting, transferring and repositioning of a care recipient and commonly leads to MSDs due to:

• The gradual and cumulative wear and tear on the body due to repetitive client handling
• A one-time exertion due to high forces or awkward postures

According to the Occupational Health and Safety Act (OHSA), employers must make sure the equipment, materials and protective devices they provide are maintained in good condition. For example, if client handling equipment, including slings, is in disrepair, a worker might need to use extra physical force to operate it, therefore, potentially leading to an MSD.

Employers must also provide workers with information, instruction and supervision to protect their health and safety. This includes proper use of equipment and techniques for client handling as well as recognition of MSD hazards.

Safe client handling and MSD prevention during care transition is achievable with techniques, equipment, knowledge and communication.

Violence prevention during transition of care

Fear, uncertainty and loss of control can quickly lead care recipients, or their loved ones, to act violently towards healthcare workers which may result in physical and/or psychological injuries. The impact can be damaging and affect all involved in many ways. Workplace violence in healthcare is a serious issue that demands attention and action and can be prevented by planning, proactively sharing information and having the right resources.

As a part of our violence, aggression and responsive behaviour (VARB) tools and resources for the healthcare sector, the workplace violence during care transition toolkit provides information on sound practices for planning a course of action, gathering resources and collaborating with workplace parties and other care organizations to transition care recipients with a risk of violence. The toolkit provides guidance and information on:

• Care Transition Basics
• Roles and Responsibilities
• The Phases of Care Transition
• Training

So that employers can ensure the safety of both care recipients and workers.

Communication and care

Failure to communicate critical information about a transitioning care recipient places not only employee safety but also care recipient safety at risk and may lead to negative outcomes for both employees and care recipients.

Collaboration and teamwork is the foundation for building safer care and gaps in communication can lead to issues which are preventable.

Information that needs to be communicated during transfers include:

• Care recipient demographics
• Care recipient medical information (diagnosis, allergies, adverse drug reactions, procedures, test results, medications)
• Safety concerns:
  • History and risk of violence/aggression
  • Risk of musculoskeletal injury to employees while providing care and other assistance
  • Risk of exposure to infectious disease
  • Risk of slips, trips and falls
  • Additional physical hazards in the home care environment
• Responsible physician/health care provider
• Plan of care
• Strategies to prevent injuries and illness and control hazards (e.g. risk management, employee safety)

In summary, communication is key:

• Employer to identify all possible transition of care points
• Identify, assess and control employee and care recipient hazards and risks and communicate information at each transition point
• Employer to raise staff awareness about transition of care points and the hazards involved
• Develop all measures, procedures and training in consultation with the Joint Health and Safety Committee/Health and Safety Representative
• Standardize the language and information exchange process by developing a standard tool to share and receive transition of care information
• Avoid relying solely on electronic communication tools
• Facilitate verbal communication between providers, in addition to written
• Integrate employee and care recipient safety into existing communication tools
• Ensure confidentiality and privacy of personal health Information when communicating hazards and risks To frontline staff in the transition of care process
• Use visuals to portray information, e.g., pictograms, color coding
• Include strategies for prevention and risk management