Sher Michael Graan1, Mari Botti2, Beverley Wood3, Bernice Redley4. 1. Deakin University, School of Nursing and Midwifery, Burwood Highway, Burwood 3125, Australia; Epworth Healthcare, 89 Bridge Road, Richmond 3121, Australia. Electronic address: bashirgran@hotmail.com. 2. Deakin University, School of Nursing and Midwifery, Burwood Highway, Burwood 3125, Australia; Epworth Deakin Centre for Clinical Nursing Research, 185-87 Hoddle Street, Richmond, Victoria 3121, Australia. Electronic address: mari.botti@deakin.edu.au. 3. Deakin University, School of Nursing and Midwifery, Burwood Highway, Burwood 3125, Australia; Epworth Deakin Centre for Clinical Nursing Research, 185-87 Hoddle Street, Richmond, Victoria 3121, Australia. Electronic address: beverley.wood@deakin.edu.au. 4. Deakin University, School of Nursing and Midwifery, Burwood Highway, Burwood 3125, Australia; Epworth Deakin Centre for Clinical Nursing Research, 185-87 Hoddle Street, Richmond, Victoria 3121, Australia. Electronic address: Bernice.redley@deakin.edu.au.
Abstract
BACKGROUND: Standardising handover processes and content, and using context-specific checklists are proposed as solutions to mitigate risks for preventable errors and patient harm associated with clinical handovers. OBJECTIVES: Adapt existing tools to standardise nursing handover from the intensive care unit (ICU) to the cardiac ward and assess patient safety risks before and after pilot implementation. METHODS: A three-stage, pre-post interrupted time-series design was used. Data were collected using naturalistic observations and audio-recording of 40 handovers and focus groups with 11 nurses. In Stage 1, examination of existing practice using observation of 20 handovers and a focus group interview provided baseline data. In Stage 2, existing tools for high-risk handovers were adapted to create tools specific to ICU-to-ward handovers. The adapted tools were introduced to staff using principles from evidence-based frameworks for practice change. In Stage 3, observation of 20 handovers and a focus group with five nurses were used to verify the design of tools to standardise handover by ICU nurses transferring care of cardiac surgical patients to ward nurses. RESULTS: Stage 1 data revealed variable and unsafe ICU-to-ward handover practices: incomplete ward preparation; failure to check patient identity; handover located away from patients; and information gaps. Analyses informed adaptation of process, content and checklist tools to standardise handover in Stage 2. Compared with baseline data, Stage 3 observations revealed nurses used the tools consistently, ward readiness to receive patients (10% vs 95%), checking patient identity (0% vs 100%), delivery of handover at the bedside (25% vs 100%) and communication of complete information (40% vs 100%) improved. CONCLUSION: Clinician adoption of tools to standardise ICU-to-ward handover of cardiac surgical patients reduced handover variability and patient safety risks. The study outcomes provide context-specific tools to guide handover processes and delivery of verbal content, a safety checklist, and a risk recognition matrix.
BACKGROUND: Standardising handover processes and content, and using context-specific checklists are proposed as solutions to mitigate risks for preventable errors and patient harm associated with clinical handovers. OBJECTIVES: Adapt existing tools to standardise nursing handover from the intensive care unit (ICU) to the cardiac ward and assess patient safety risks before and after pilot implementation. METHODS: A three-stage, pre-post interrupted time-series design was used. Data were collected using naturalistic observations and audio-recording of 40 handovers and focus groups with 11 nurses. In Stage 1, examination of existing practice using observation of 20 handovers and a focus group interview provided baseline data. In Stage 2, existing tools for high-risk handovers were adapted to create tools specific to ICU-to-ward handovers. The adapted tools were introduced to staff using principles from evidence-based frameworks for practice change. In Stage 3, observation of 20 handovers and a focus group with five nurses were used to verify the design of tools to standardise handover by ICU nurses transferring care of cardiac surgical patients to ward nurses. RESULTS: Stage 1 data revealed variable and unsafe ICU-to-ward handover practices: incomplete ward preparation; failure to check patient identity; handover located away from patients; and information gaps. Analyses informed adaptation of process, content and checklist tools to standardise handover in Stage 2. Compared with baseline data, Stage 3 observations revealed nurses used the tools consistently, ward readiness to receive patients (10% vs 95%), checking patient identity (0% vs 100%), delivery of handover at the bedside (25% vs 100%) and communication of complete information (40% vs 100%) improved. CONCLUSION: Clinician adoption of tools to standardise ICU-to-ward handover of cardiac surgical patients reduced handover variability and patient safety risks. The study outcomes provide context-specific tools to guide handover processes and delivery of verbal content, a safety checklist, and a risk recognition matrix.
Authors: Sami Alsolamy; Atheer Al-Sabhan; Najla Alassim; Musharaf Sadat; Eman Al Qasim; Hani Tamim; Yaseen M Arabi Journal: BMC Emerg Med Date: 2018-01-18
Authors: Mojtaba Vaismoradi; Susanna Tella; Patricia A Logan; Jayden Khakurel; Flores Vizcaya-Moreno Journal: Int J Environ Res Public Health Date: 2020-03-19 Impact factor: 3.390