An observational study of patient handover communications among nurses on an oncology critical care unit

Nurse-to-nurse handoff with distractors and interruptions: An integrative review

AIM

An integrative review of the literature was conducted to explore perceptions of distractors and interruptions during nurse-to-nurse handoff.

BACKGROUND

Handoff distractors and interruptions are recognized as barriers to effective nurse handoff and may lead to preventable and costly medical errors. However, little is known about the perception of these barriers to nurses and strategies to mitigate distractors and interruptions during nurse-to-nurse handoff.

METHODS

Using the framework of Whittemore and Knafl, four electronic databases were searched for articles written in English and published in the last five years. Inclusion criteria included: qualitative, quantitative, mixed-methods or quality improvement papers focused on distractors/interruptions during nurse handoff. A multi-author independent review of articles was completed with a rigorous process of data extraction and quality assessment.

RESULTS

A total of 17 articles were reviewed with findings categorized into the following themes: perceptions of handoff, characteristics of handoff, or logistics of handoff. Nurses reported that interruptions and distractions were a limitation in handoff quality and handoff efficiency, occurring during inter-shift and unit-to-unit handoff. The two most common types of interruptions and distractions were people (patient, family) and environmental factors (equipment alarms). An organized and standardized approach to handoff was recommended, but few specific examples were reported.

CONCLUSION

Despite recent research related to interruptions and distractions in nurse handoff, few evidence-based strategies have been identified that effectively mitigate these patient safety problems. More evidence is needed to determine best practice methods for handoff training for nurses and nursing students.

Effective nursing shift handover in critical care: A concept analysis

To explore the concept of effective shift handover in critical care settings. Ineffective handover is one of the leading causes of adverse events in healthcare settings. Nursing shift handover in the intensive care unit (ICU) is more complex and detailed than in other in-patient wards due to the complexity of medical issues experienced by ICU patients. It is, therefore, critical that nurses be able to conduct handover effectively. Despite the importance of handover, the definition and attributes of effective handover are not clearly understood. Walker and Avant's eight-step approach to concept analysis. Effective handover in nursing is an interactive process between two nurses, resulting in the direct transfer of adequate patient-specific recent information in a manner that creates a shared understanding of information. Its defining attributes are (1) content-related and (2) process-related attributes. The antecedents of effective handover are organizational support, interpersonal relationship, and work environment. Its consequences include patient and nurse satisfaction, improved care, and continuity of care. Empirical referents include several tools developed to measure some of the effective handover attributes. The definition provides a connotative meaning and is the first step toward concept validation and instrument development to measure effective handover practice in the ICU.

Communication between pre-hospital and intra-hospital emergency medical services: literature review

OBJECTIVES

to analyze, according to the scientific literature, communication strategies in the transfer of cases between pre-hospital and in-hospital services and their contributions to patient safety.

METHODS

this is a literature review study, that is, one that aims to gather and synthesize research results on the subject in a systematic and orderly manner.

RESULTS

ten articles were published, published between 2010 and 2018, and two points of discussion emerged: use of mnemonics; and barriers to transferring a case.

CONCLUSIONS

studies point to the need to standardize the case transfer process, as well as integrative training of professionals, regular assessment of the teams involved in emergency medical services and the need for research on the subject.

Clinical nursing handovers for continuity of safe patient care in adult surgical wards: a best practice implementation project

OBJECTIVES

The objective of this evidence-based quality improvement project was to improve clinical nursing handovers between registered nurses.

INTRODUCTION

Clinical nursing handovers transfer critical information about the patient's care to oncoming shift nurses. Nurses use structured handover tools to handover patient information. In three adult surgical wards of a Singapore tertiary hospital, a lack of consistency was found in the local handover process when shifts changed. These resulted in ineffective handovers and compromised the patient's safety. Thus, evidence-based interventions were needed so that patient handovers and continuity in safe patient care could improve.

METHODS

This project was implemented in three phases from January 2017 to November 2017 at three adult surgical wards of a tertiary hospital, utilizing the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRiP) module. The pre- and post-implementation audits were conducted using JBI PACES audit criteria. An evidence-based four-pronged approach was employed, including adequate human resource coverage during handovers, a structured and standardized handover, visual cues and a teaching video.

RESULTS

The results of the post-implementation audit of nurses performing handovers (n = 33) showed that handovers using standardized documentation improved from 0% to 21.0% (p = 0.005), which was statistically significant. However, handovers of detailed observations of patients improved from 72.7% to 87.9% (p = 0.215) and handovers of relevant history of patients improved slightly from 93.9% to 97.0% (p = 1.000) but was not statistically significant. Medication error incidents related to handovers was reduced by 72% over a six-month period.

CONCLUSION

The multi-modal approach improved the comprehensiveness and completeness of clinical nursing handovers. These strategies had a significant effect on reducing medication errors related to handovers.