Perspectives of clinical handover processes: a multi-site survey across different health professionals

Analysis of Nurses' Perceptions of Handover Practices: A Comparative Study in Different Medical Settings

This article reports a comparative prospective study aimed to explore and compare nurses' perceptions of bedside clinical handover in 3 different settings (emergency unit, ICU, and medical ward). Results revealed that the participant nurses' perceptions varied significantly for different aspects of the handover process. Our data demonstrate department-specific variations in perceptions related to the adequacy, organization, relevance, availability of charts, use of charts for review, ease of following the information, and timeliness of the information.

Intrahospital Handovers before and after the Implementation of ISBAR Communication: A Quality Improvement Study on ICU Nurses' Handovers to General Medical Ward Nurses

BACKGROUND

Research finds a lack of structure as well as varying and incomplete content in intrahospital handovers. This study aimed to improve intrahospital handovers by implementing structured ISBAR communication (identification, situation, background, assessment and recommendation).

METHODS

This quality improvement study was conducted observing 25 handovers given by nurses from the intensive care unit to nurses from general medical wards at baseline and after the implementation of the ISBAR communication tool. The 26-item ISBAR scoring tool was used to audit the handovers. In addition, the structure of the ISBAR communication and time spent on the handovers were observed.

RESULTS

There were no significant improvements from baseline to post-intervention regarding adherence to the ISBAR communication scoring tool. The structure of the handovers improved from baseline to post-intervention (p = 0.047). The time spent on handovers declined from baseline to post-intervention, although not significantly.

CONCLUSIONS

The items in the ISBAR communication scoring tool can act as a guide for details that need to be reported during intrahospital handovers to strengthen patient safety. Future research calls for studies measuring satisfaction among nurses regarding using different handover tools and studies using multifaceted training interventions.

Implementing a ward-level intervention to improve nursing handover communication with a focus on bedside handover-A qualitative study

AIM

To improve the effectiveness of nursing clinical handover through a qualitative, tailored communication intervention.

DESIGN

A multisite before and after intervention using qualitative ethnography combined with discourse analysis of nursing handover interactions.

METHODS

We implemented a tailored ward-based intervention to redesign nursing handover practice with co-constructed recommendations for organisational and cultural change on seven wards across three affiliated metropolitan hospitals between February 2020 and November 2022. The intervention was informed by pre-implementation interviews and focus groups with nursing, medical and allied health staff and patients (n = 151) and observed and/or audio-recorded handover events (n = 233). Post-intervention we conducted interviews and focus groups (n = 79) and observed and/or audio-recorded handover events (n = 129) to qualitatively evaluate impact.

RESULTS

Our translational approach resulted in substantial changes post-intervention. Nurses conducted more shift-to-shift handovers at the bedside, with greater patient interaction and better structured and more comprehensive information transfer, supported by revised handover documentation. Redesigned group handovers were focused and efficient, communicating critical patient information.

CONCLUSION

Contextualised training combined with changes to ward-level systemic factors impeding communication results in improved nursing handovers. Practice change requires strong executive leadership and project governance, combined with effective ward-level leadership, collaboration and mentoring. The speed and degree of change post-intervention demonstrates the power of interdisciplinary collaborative research between hospital executive, ward leadership and communication specialists.

RELEVANCE TO CLINICAL PRACTICE

Nurses are more likely to conduct efficient group handovers and informative, patient-centred bedside handovers in line with policy when they understand the value of handover and have practical strategies to support communication. Communication training should be combined with broader ward-level changes to handover practice tailored to the ward context. A multilevel approach results in more effective practice change.

REPORTING METHOD

We adhered to the COREQ guidelines.

PATIENT OR PUBLIC CONTRIBUTION

We interviewed patients on study wards pre and post intervention.

Decision-making about changing medications across transitions of care: Opportunities for enhanced patient and family engagement

BACKGROUND

Older patients often have complex medication regimens, which change as they move across transitions of care. Engagement of older patients and families in making medication decisions across transitions of care is important for safe and high-quality medication management.

AIMS

To explore decision-making between health professionals, older patients and families about medication changes across transitions of care, and to examine how patient and family engagement is enacted in the process of decision-making in relation to these medication changes.

METHODS

A focused ethnographic design was undertaken with semi-structured interviews, observations, and reflective focus groups or interviews. Reflexive thematic analysis was conducted on transcribed data. The study was undertaken at a public teaching acute care hospital and a public teaching community hospital in Australia.

RESULTS

In all, 182 older patients, 44 family members and 94 health professionals participated. Four themes were conceptualised from the data: different customs and routines, medication challenges, health professional interactions, and patient and family involvement. Environments had differences in their customs and routines, which increased the potential for medication delays or the substitution of unintended medications. Medication challenges included health professionals assuming that patients and families did not need information about regularly prescribed medications. Patients and families were informed about new medications after health professionals had already made decisions to prescribe these medications. Health professionals tended to work in disciplinary silos, and they had views about their role in interacting with patients and families. Patients and families were expected to take the initiative to participate in decision-making about medication changes.

CONCLUSIONS

Patient movements across transitions of care can create complex and chaotic medication management situations, which lacks transparency, especially for older patients and their families. A greater focus on pre-emptive and planned discussions about medication changes will contribute to improving patient and family involvement in medication decision-making.

Don't interrupt me! development of a handoff education bundle to simulate the real world

OBJECTIVES

Ineffective nurse-to-nurse handoff communication is associated with information omissions, diagnostic errors, treatment errors, and delays. New nurses report a lack of confidence and ability in handoff communication, which may stem from inadequate training in prelicensure nursing programs. Our objective was to introduce prelicensure nursing students to a standardized, theory-based method for handoff, including behavioral strategies employed by nurses during interrupted handoff.

METHODS

A handoff education bundle (HEB) was developed. Kern's six-step curriculum model was utilized to design, implement, and evaluate the handoff curriculum.

RESULTS

Student feedback highlighted the importance of integrating multiple, varying distractors during learning cycles and recognition of the impact of distractors on handoff.

CONCLUSIONS

Implementing a HEB at the prelicensure nursing level could promote competency in handoff communication for new graduate nurses.

IMPLICATIONS FOR INTERNATIONAL AUDIENCE

Handoff is an international patient safety priority, as inadequate communication has been linked to adverse patient events.

Improving the handover of complex trauma patients by implementing a standardised process

BACKGROUND

Patient handover continues to be an international health priority in the prevention of patient harm. Transitioning patients from the intensive care unit (ICU) to the ward is complex, particularly for trauma patients, due to the multifaceted aspects of their care requirements as a result of multiple injuries and different speciality teams.

OBJECTIVES/AIM

To design, implement, and evaluate the efficacy of a standardised handover process and tool for the transfer of ICU trauma patients.

METHODS

A multimethod before/after study design was used. This included observations before and after an implemented transfer process and semistructured interviews with ICU and ward nurses caring for trauma patients. Comparisons were made of data before and after the intervention.

RESULTS

Eleven patient handovers were observed, and 21 nurses (11 from the ICU and 10 from the ward) were interviewed. Patients and family members were included during the handover following the intervention (n = 0/10 [0%] vs n = 4/11 [36%]) and the ward nurses were asked if they had any concerns (n = 5/10 [50%] vs n = 10/11 [91%]). Improvements in patient observations handed over were reported following the intervention. However, omissions remained in some key areas including patient introduction, patient identity, fluid balance, and allergies/alerts. Thematic analysis of interviews revealed that the new handover process was perceived advantageous by both ICU and ward nurses because of its structured and comprehensive approach. Identified future improvements included the need for hospital service managers to ensure integration of ICU and ward electronic health record systems.

CONCLUSION

Precise, accurate, and complete handover remains a patient safety concern. Improvements were achieved using a standardised process and handover tool for the transfer of complex trauma patients. Further improvements are required to reduce the failure to hand over essential patient information.

Predictors and outcomes of patient safety culture at King Abdulaziz Medical City, Jeddah, Saudi Arabia. A nursing perspective

BACKGROUND

Patient safety culture assessment is viewed as the starting point from which action planning begins and helps hospitals get a good idea of the patient safety features that need immediate attention, identify the strengths and weaknesses of their safety culture, help units find their most common patient safety problems, and compare their scores to those of other hospitals. This study aimed to assess nurses' perceptions of patient safety culture composites in a Saudi hospital in the Western region and to explore the association between patient safety culture predictors and outcomes, taking into consideration nurses' characteristics.

METHODS

This study employed a cross-sectional descriptive design with a convenience sample of 184 nurses who are working at inpatient care units at King Khaled Hospital- King Abdulaziz Medical City in Jeddah, Western region, Saudi Arabia. The data were collected through a structured questionnaire consisting of nurses' demographics and work characteristics, and the Patient Safety Culture Hospital Questionnaire (HSOPSC), which proved valid and reliable. Descriptive status, correlation, and regression analysis were applied to patient safety culture composites for statistical analysis.

RESULTS

The overall positive response rate of the predictors of patient safety culture in the HSOPSC survey was 63.46%. The mean percent score for predictors ranged from 39.06% to 82.95%. "Teamwork within units" (82.95%) was the highest mean, followed by "organizational learning" (81.88%) and "feedback and communication about errors" (81.25%). In addition to the overall perceived patient safety (59.0%), safety grade, frequency, and number of events are also reported as safety outcome measures.

CONCLUSIONS AND RECOMMENDATIONS

Regardless of the percentage of the safety culture domains, this study agrees that all the domains should be considered high-priority and focused areas for continuous improvement. The results confirmed the need for continuous staff safety training programs to improve their perception and performance of the safety culture.

Sixth Annual Enhanced Recovery After Surgery Symposium highlights: work in progress or standard care?

Enhanced Recovery After Surgery (ERAS) protocols have demonstrated effectiveness in accelerating patient recovery and improving outcomes. Since the systemwide implementation of ERAS protocols at Baylor Scott & White Health, an annual multidisciplinary conference has provided a review of outcomes and advancements in the ERAS program. This meeting, coined the ERAS symposium, allows providers who utilize recovery protocols to collaborate with national and international leaders in the field to improve the clinical care of patients. The sixth annual ERAS symposium was held on February 10, 2023, and provided key presentations that discussed the latest results from ERAS efforts across multiple surgical specialties along with updates in anesthesia, nursing, and nutrition. A summary of those presentations, which included perioperative glycemic control, misconceptions in pain management, and emerging ERAS protocols in different surgical specialties, is provided to document the system progress.

Shift handover quality in Saudi critical care units: determinants from nurses' perspectives

BACKGROUND

Nurses' effective handover communication is vital for patient safety and quality of care. Few studies have empirically tested how certain factors influence the quality of handover in the Saudi context.

METHODS

A descriptive correlational design was used with a convenience sample of all nurses (N = 201) working in Saudi hospital CCUs in 2022. Demographics and handover quality instruments were used to collect the necessary data in addition to two open-ended questions that asked about perceived barriers and facilitators to handover. The analysis was conducted using descriptive statistics and regression analysis.

RESULTS

The majority of nurses reported good-quality handover. The regression analysis showed that staffing, cognitive capacity, the focus of attention, relationships, and safety climate factors contributed positively to the variance of handover quality. In contrast, intrusions, distractions, anxiety, time stress, and acute and chronic fatigue factors negatively affected the prediction of handover quality (p < 0.05). Nurses added types of shifts and languages as barriers to handover while emphasizing training and the use of standardized tools for handover as facilitators.

CONCLUSION AND RECOMMENDATIONS

Nursing handover is a multidimensional phenomenon. By understanding the determinants that contribute to or hinder handover quality, it is possible to develop targeted interventions aimed at improving communication and the quality of shift handover in CCUs. The current study's findings highlight the need for nurses to work in a more supportive environment, receive better training, and follow a standardized handover protocol. Additionally, nurse managers should pay more attention to nurses' well-being to control or mitigate the effect of psychological precursors on the quality of nurses' handover. Future research should investigate handover practices and outcomes on units that have both good and bad practice environments.

Midwives' experiences with a safe childbirth checklist: A grounded theory study

OBJECTIVE

The aim of this study was to explore midwives' experiences with a safe childbirth checklist used in handover situations from birth to hospital discharge. Quality of care and patient safety is highly recognised and a priority within health services globally. In handover situations, checklists have proven to reduce unwanted variation by standardising processes, which in turn contribute to increased quality of care. To improve the quality of care, a safe childbirth checklist was implemented at a large maternity hospital in Norway.

DESIGN

We conducted a Glaserian grounded theory (GT) study.

SETTING AND PARTICIPANTS

A total of 16 midwives were included. We included three midwives in one focus group and conducted 13 individual interviews. Years of experience as midwives ranged from one to 30 years. All included midwives worked in a large maternity hospital in Norway.

FINDINGS

The main concern faced by the midwives who used the checklist included no common understanding of the purpose of the checklist nor consensus on how to use the checklist. The generated grounded theory, individualistic interpretation of the checklist, involved the following three strategies that all seemed to explain how the midwives solved their main concern: 1) not questioning the checklist, 2) constantly evaluating the checklist, and 3) distancing oneself from the checklist. Experiencing an unfortunate event concerning the healthcare of both mother or newborn was a condition that could alter the midwives understanding and use of the checklist.

KEY CONCLUSIONS

The findings in this study showed that a general lack of common understanding and consensus on the rationale for implementing a safe childbirth checklist led to variations between midwives in how and whether the checklist was used. The safe childbirth checklist was described as long and detailed. It was not necessarily the midwife who was expected to sign the checklist who had carried out the tasks signed for. To ensure patient safety, recommendations for future practice include securing that separate sections of a safe childbirth checklist are limited to a specific time-point and midwife.

IMPLICATIONS FOR PRACTICE

Findings emphasise the importance of implementation strategies supervised by the leaders of the healthcare services. Further research should explore the understanding of organisational and cultural context when implementing a safe childbirth checklist to clinical practice.

Nursing handoff education: An integrative literature review

AIM

This integrative review aimed to identify nursing students' experiences of handoff practices and the effects of handoff education in the curriculum on nursing student learning outcomes.

BACKGROUND

Appropriate handoff communication skills are essential for nursing students to maintain patient safety and prevent adverse events.

METHOD

A systematic literature search was conducted with keywords related to nursing, student, and handoff in April 2020. Articles should focus on nursing students' handoff education published in English in 2015-2020. Eight articles met the inclusion criteria and were included in this review.

RESULTS

Nursing students reported discrepancies in handoff experiences; diverse factors influenced their handoff experiences, such as knowledge, anxiety, confidence, and type of student supervision. Various handoff educations were implemented across studies. Some handoff educations significantly improved nursing students' attitudes toward other disciplinary providers, satisfaction, confidence, quality, and clarity in handoff communication; some did not substantially affect their selected outcomes.

CONCLUSION

This review identified that there are still limited handoff experiences among nursing students and many factors affecting opportunities for their handoff experience. Some handoff education (e.g., structured handoff formats, role-play, simulated scenarios) effectively improved students' communication clarity, confidence levels, and handoff education satisfaction. More handoff education is needed for nursing students to learn safe and quality handoff practices.

Quality and efficiency of a standardized e-handover system for pediatric nursing: A prospective interventional study

AIM

This study examined the effect on pediatric nursing handover quality and efficiency when a standardized e-handover system was implemented.

BACKGROUND

Handover quality is an important aspect of nursing quality management; however, handover quality among nursing staff is poor.

METHODS

A prospective interventional study was carried out in a general pediatrics ward from December 2019 to November 2020. The tools included a standardized e-handover system. The intervention strategies included workflow remodeling and employee training on oral handover using the standardized e-handover system.

RESULTS

The omission frequency of critical handover elements decreased from 47.32% to 2.94% (p < .01), among which the omission frequencies of nine out of 16 key elements significantly decreased. Integrity also showed improvement. Specifically, the integrity of five types of critical information was significantly improved, including vital signs, signs and symptoms, laboratory test results, radiologic examination results, and treatment regimen (2.00 vs. 5.00, p < .01; 3.00 vs. 5.00, p < .01; 3.00 vs. 5.00, p < .01; 5.00 vs. 5.00, p = .009; 3.00 vs. 4.00, p < .01, respectively). Information accuracy was 100%. Workflow and efficiency significantly improved, communication duration with patient/family during work hours significantly increased (24.00 vs. 56.00, p < .01), and prehandover preparation duration significantly decreased (32.00 vs. 2.50, p < .01). Nurse handover satisfaction showed improvement (56.88 ± 15.08 vs. 74.31 ± 9.22, p < .01).

CONCLUSION

The standardized e-handover system effectively improved nurse handover quality, optimized workflow, increased work efficiency, and promoted teamwork.

IMPLICATIONS FOR NURSING MANAGEMENT

Standardized e-handover systems have great potential for ensuring the safety of pediatric patients and improving the quality of handover.

Information flow as reproductive governance. Patient journey analysis of information barriers and facilitators to abortion care in the republic of Ireland

Background

Information flow - information communication and transmission pathways and practices within healthcare systems - impacts patient journeys. Historically, regulating information flow was a key technology of reproductive governance in the Republic of Ireland. Pre-2018, law and the State sustained informational barriers to and through abortion care in Ireland. An expanded abortion service was implemented in January 2019.

Method

Patient Journey Analysis (PJA) interrogates informational facilitators and barriers to/through post-2019 abortion care in Ireland. We focus on information flow at the interfaces between the 'public' sphere and 'point of entry', 'point of entry' and primary care, and primary and secondary care.

Materials

The paper uses data from a mixed-method study. A tool for assessing online abortion service information (ASIAT), desktop research, and qualitative data from 108 in-depth interviews with providers, policy-makers, advocacy groups, and service users informed the analysis.

Results

Abortion patient journeys vary. Information flow issues, e.g. communication of how to access services, referral systems, and information handover, act as barriers and facilitators. Barriers increase where movement from primary to secondary is needed.

Applications

The article identifies good practice in information flow strategy, as well as areas for development. It illustrates the significance of information flow in accomplishing reproductive governance.

Teaching and Assessment of Medical Students During Complex Multifactorial Team-Based Tasks: The "Virtual on Call" Case Study

Abstract

Although considerable efforts have been made to incorporate simulation-based learning (SBL) in undergraduate medical education, to date, most of the medical school curricula still focus on pure knowledge or individual assessment of objective structured clinical examination skills (OSCE). To this end, we designed a case study named "iG4 (integrated generation 4) virtual on-call (iVOC)". We aimed to simulate an on-call shift in a high-fidelity virtual hospital setting in order to assess delegates' team-based performance on tasks related to patient handovers (prioritisation, team allocation).

Methods

A total of 41 clinical year medical students were split into 3 cohorts, each of which included 3 groups of 4 or 5 people. The groups consisted of a structured mix of educational and cultural backgrounds of students to achieve homogeneity. Each performing group received the handover for 5 patients in the virtual hospital and had to identify and deal with the acutely unwell ones within 15 minutes. We used TEAMTM tool to assess team-based performances.

Results

The mean handover performance was 5.44/10 ± 2.24 which was the lowest across any performance marker. The overall global performance across any team was 6.64/10 ± 2.11. The first rotating team's global performance for each cycle was 6.44/10 ± 2.01, for the second 7.89/10 ± 2.09 and for the third 6.78/10 ± 1.64 (p = 0.099 between groups).

Conclusion

This is one of the first reported, high-fidelity, globally reproducible SBL settings to assess the capacity of students to work as part of a multinational team, highlighting several aspects that need to be addressed during undergraduate studies. Medical schools should consider similar efforts with the aim to incorporate assessment frameworks for individual performances of students as part of a team, which can be a stepping-stone for enhancing safety in clinical practice.

Healthcare professional perspectives on barriers and enablers to falls prevention education: A qualitative study

In hospitals, patient falls prevention education is frequently delivered by nurses and allied health professionals. Hospital falls rates remain high globally, despite the many systems and approaches that attempt to mitigate falling. The aim of this study was to investigate health professional views on the enablers and barriers to providing patient falls education in hospitals. Four focus groups with 23 nursing and allied health professionals were conducted at 3 hospitals. Three researchers independently coded the data and findings were analysed thematically with a descriptive qualitative approach to identify and develop themes according to barriers and enablers. Barriers included (i) limited interprofessional communication about patient falls; (ii) sub-optimal systems for falls education for patients and health professionals, and (iii) perceived patient-related barriers to falls education. Enablers to providing patient falls education included: (i) implementing strategies to increase patient empowerment; (ii) ensuring that health professionals had access to effective modes of patient education; and (iii) facilitating interprofessional collaboration. Health professionals identified the need to overcome organisational, patient and clinician-related barriers to falls education. Fostering collective responsibility amongst health professionals for evidence-based falls prevention was also highlighted.

Safe handovers: Safe patients-why good quality structured handovers in the transfusion laboratory are important

BACKGROUND

Effective transfer of information relating to patient care is vital in healthcare. In the UK formal handover is an established and well reported process in the clinical setting but less so in transfusion laboratories. Blood transfusions occur within many hospital specialities and across clinical and laboratory staff shifts, making robust handover critical for safe practice. Failure to adequately transfer information relating to pending or ongoing provision of blood components during shift handover in the laboratory can have an adverse impact on patient care.

AIMS

To identify transfusion errors where laboratory handover was considered a contributory factor.

MATERIALS AND METHODS

Serious adverse events and reactions reported to the UK haemovigilance scheme, Serious Hazards of Transfusion (SHOT), involving handover in the transfusion laboratory were reviewed for a 6-year period.

RESULTS

Laboratory incidents involving handover were mainly associated with incorrect blood component transfused-specific requirements not met (IBCT-SRNM) and delays in provision of blood components transfusion, with 16.6% of these cases involving major haemorrhage situations. Handover was found to be insufficient in most cases, no handover was completed in 29.5% of cases, inadequate written handover accounted for 14.8% cases, and inadequate verbal for 5.7% of cases.

DISCUSSION

Poor handover can lead to laboratory errors, particularly delays in provision of blood components. Embedding effective handover processes in the laboratory and including handover time within the shift working pattern, may help reduce errors and ensure continuity of care.

CONCLUSION

Handover should be considered a task that is built into laboratory routine practices, ensuring effective transfer of information and appropriate follow up actions are taken. SHOT have created a handover template which can be adopted in laboratories to formalise this process.

Improving the handover process in a psychiatry liaison setting

Efficient handover of patient care is integral to clinical safety. Barriers in communication can lead to adverse outcomes. The Integrated Liaison Assessment Team (ILAT) has a daily handover meeting which presents several challenges to the multidisciplinary liaison team (MDT including high patient turnover, differing staff shift-work patterns, presence of visitors/students and lack of a unified approach to structured discussion at times. Areas identified for improvement included optimising efficiency, structure and handover documentation. Lack of teaching and learning opportunities were also identified. The primary aim was to reduce handover time to 30 min. The secondary aims were to improve communication by introducing the Situation-Background-Assessment-Recommendation (SBAR) tool, improve team satisfaction and introduce a teaching programme in the time saved. The Model for Improvement methodology was used with MDT focus groups and questionnaires to explore change ideas. This informed our 'Plan, Do, Study, Act' cycles to design a structured handover. Daily measures looked at handover length and individual team member satisfaction. Weekly measures included semiqualitative questionnaires highlighting areas for improvement. Feedback was gathered from emails and MDT discussions. A structured handover format incorporating SBAR, key task allocation and a shift handover lead was introduced. A regular MDT teaching programme was initiated. Over 4 weeks, 'Good' handover ratings increased from 22% to 65%; 'Poor' ratings decreased from 25% to 8%. Mean handover time decreased from 47 min to 31.25 min; a decrease of 33.5%. Overall, the team viewed SBAR positively as an efficiency-promoting tool. Structured handover has promoted staff competencies, team morale and information sharing practices among ILAT. MDT teaching improved team communication and confidence. Sustaining motivation to keep up interventions and documentation of handover were identified as key areas for sustained improvement.

Improving patient-centred care through a tailored intervention addressing nursing clinical handover communication in its organizational and cultural context

Aims

To increase the quality and safety of patient care, many hospitals have mandated that nursing clinical handover occur at the patient's bedside. This study aims to improve the patient‐centredness of nursing handover by addressing the communication challenges of bedside handover and the organizational and cultural practices that shape handover.

Design

Qualitative linguistic ethnographic design combining discourse analysis of actual handover interactions and interviews and focus groups before and after a tailored intervention.

Methods

Pre‐intervention we conducted interviews with nursing, medical and allied health staff (n = 14) and focus groups with nurses and students (n = 13) in one hospital's Rehabilitation ward. We recorded handovers (n = 16) and multidisciplinary team huddles (n = 3). An intervention of communication training and recommendations for organizational and cultural change was delivered to staff and championed by ward management. After the intervention we interviewed nurses and recorded and analyzed handovers. Data were collected from February to August 2020. Ward management collected hospital‐acquired complication data.

Results

Notable changes post‐intervention included a shift to involve patients in bedside handovers, improved ward‐level communication and culture, and an associated decrease in reported hospital‐acquired complications.

Conclusions

Effective change in handover practices is achieved through communication training combined with redesign of local practices inhibiting patient‐centred handovers. Strong leadership to champion change, ongoing mentoring and reinforcement of new practices, and collaboration with nurses throughout the change process were critical to success.

Impact

Ineffective communication during handover jeopardizes patient safety and limits patient involvement. Our targeted, locally designed communication intervention significantly improved handover practices and patient involvement through the use of informational and interactional protocols, and redesigned handover tools and meetings. Our approach promoted a ward culture that prioritizes patient‐centred care and patient safety. This innovative intervention resulted in an associated decrease in hospital‐acquired complications. The intervention has been rolled out to a further five wards across two hospitals.

Examining the meaning of the language used to communicate the nursing hand-off

The miscommunication and inconsistent recall of patient information due to cognitive lapses that occur during the hand-off between healthcare providers account for 80% of sentinel events in acute care. Cognitive lapses are a consequence of the nurse experiencing cognitive overload, which impedes the nurse's ability to recall relevant information during and after the hand-off communication. The primary cognitive and human factor contributing to cognitive overload in the hand-off is language. The purpose of this study was to examine the meaning of the language used to communicate the nurse-to-nurse change of shift hand-off occurring at bedside and nonbedside on a medical-surgical unit in an urban medical center. A qualitative descriptive design was used. The sample was 10 audio-recorded hand-offs (five bedside and five nonbedside), with a total of 19 nurses participating. A natural language process program was used to analyze the data. The hand-off is a narrative story centered on communicating patient information delivered with a high degree of confidence. The hand-off is focused on past and current events with minimal focus on future or anticipated events. The drive to communicate is minimally based on concern, fear, or danger. There is a difference in the language used to communicate the nursing hand-off message at bedside as compared to the nonbedside hand-off.

Enhancing the verbal handover process for nurses in inpatient orthopedic wards: a best practice implementation project

OBJECTIVES

This evidence-based quality improvement project aimed to evaluate the effectiveness of a handover guide in improving handovers from registered nurses to enrolled nurses.

INTRODUCTION

Nursing handover involves the transfer of the responsibility of care for a patient from one nurse to another. Handover techniques vary in different healthcare organizations. Non-standardized, incomplete handovers can lead to delays or errors in treatment, increased lengths of stay, and poor health outcomes.

METHODS

This project was conducted in two orthopedic wards of a tertiary hospital, and occurred in four phases over 12 months. The project utilized the JBI Practical Application of Clinical Evidence System (PACES) and the Getting Research into Practice (GRiP) tools.

RESULTS

The baseline audit in March 2017 revealed a poor compliance in handover of essential patient information. The post-intervention audit showed a significant increase (P < 0.001) in the compliance of handover of essential patient information. Registered nurses' handovers of patient information to enrolled nurses improved from 11% to 27% (P < 0.000). Verbal face-to-face handovers occurred throughout the implementation. Eighty-two per cent of the nurses felt that the handover guide had reduced the number of monitoring errors and delays in treatment.

CONCLUSION

The project has successfully improved nurses' clinical handovers and contributed to safe patient care. Further audits are required to sustain the evidence-based practice change. Nursing leaders play a significant role in supporting the project and building a positive evidence-based practice environment.

Rural family physician perspectives on communication with urban specialists: a qualitative study

OBJECTIVE

Communication is a key competency for medical education and comprehensive patient care. In rural environments, communication between rural family physicians and urban specialists is an essential pathway for clinical decision making. The aim of this study was to explore rural physicians' perspectives on communication with urban specialists during consultations and referrals.

SETTING

Newfoundland and Labrador, Canada.

PARTICIPANTS

This qualitative study involved semistructured, one-on-one interviews with rural family physicians (n=11) with varied career stages, geographical regions, and community sizes.

RESULTS

Four themes specific to communication in rural practice were identified. The themes included: (1) understanding the contexts of rural care; (2) geographical isolation and patient transfer; and (3) respectful discourse; and (4) overcoming communication challenges in referrals and consultations.

CONCLUSIONS

Communication between rural family physicians and urban specialists is a critical task in providing care for rural patients. Rural physicians see value in conveying unique aspects of rural clinical practice during communication with urban specialists, including context and the complexities of patient transfers.

Translating evidence-based nursing clinical handover practice in an acute care setting: A quasi-experimental study

Effective transfer of information during the nursing handover contributes to patient safety. This study aimed to translate the best practice nursing shift handover recommendations in an acute care setting using the Ottawa Model for Research Use and to explore its effect on patient adverse outcomes (falls, pressure injuries, and medication errors). Using a quasi-experimental design, the study was conducted in four internal medicine wards in a major tertiary hospital. A total of 88 nurses and 110 patients participated in 152 handover observations. The findings showed clinically important increases in percentages and odds of nurses' compliance with shift handover recommendations after the intervention. The patient adverse outcomes after the intervention were compared to the corresponding period of previous year. A reduction was observed for all adverse patient outcomes with incident rate ratios of 0.762 (p = 0.027) for falls, 0.624 for pressure injuries (p = 0.010), and 0.782 for medication errors (p = 0.023). Replicating this study's methodology across multiple clinical settings will increase the generalizability of findings and provide further evidence to inform nursing practice and policy.

Visual mapping of team dynamics and communication patterns on surgical ward rounds: an ethnographic study

BACKGROUND

The effect of team dynamics on infection management and antimicrobial stewardship (AMS) behaviours is not well understood. Using innovative visual mapping, alongside traditional qualitative methods, we studied how surgical team dynamics and communication patterns influence infection-related decision making.

MATERIALS/METHODS

Between May and November 2019, data were gathered through direct observations of ward rounds and face-to-face interviews with ward round participants in three high infection risk surgical specialties at a tertiary hospital in South Africa. Sociograms, a visual mapping method, mapped content and flow of communication and the social links between participants. Data were analysed using a grounded theory approach.

RESULTS

Data were gathered from 70 hours of ward round observations, including 1024 individual patient discussions, 60 sociograms and face-to-face interviews with 61 healthcare professionals. AMS and infection-related discussions on ward rounds vary across specialties and are affected by the content and structure of the clinical update provided, consultant leadership styles and competing priorities at the bedside. Registrars and consultants dominate the discussions, limiting the input of other team members with recognised roles in AMS and infection management. Team hierarchies also manifest where staff position themselves, and this influences their contribution to active participation in patient care. Leadership styles affect ward-round dynamics, determining whether nurses and patients are actively engaged in discussions on infection management and antibiotic therapy and whether actions are assigned to identified persons.

CONCLUSIONS

The surgical bedside ward round remains a medium of communication between registrars and consultants, with little interaction with the patient or other healthcare professionals. A team-focused and inclusive approach could result in more effective decision making about infection management and AMS.

Newly graduate nurse perception and experience of clinical handover

BACKGROUND

Clinical handover is challenging for newly graduated nurses. Previous studies have showed that many new graduates perform handover ineffectively and unsystematically; however, our knowledge of newly graduated nurse perceptions of handover, including barriers and challenges to handover, is incomplete.

OBJECTIVES

The study aimed to explore newly graduated nurse experience of clinical handover in Hong Kong public hospitals.

DESIGN

This was a descriptive phenomenological study.

SETTING

Participants were recruited from 11 public acute care hospitals in Hong Kong.

PARTICIPANTS

The participants were a convenience sample of 20 nurses who had graduated within the previous 12 months.

METHODS

Individual semi-structured interviews were conducted, and the data were analysed using content analysis.

RESULTS

Three themes emerged from the data: 'significance of clinical handovers,' 'feelings of frustration about clinical handover,' and 'perceived barriers to handover.' Participants perceived clinical handover as an essential nursing practice in the provision of continuous patient care. Further, some new graduates experienced stress and anxiety in clinical handover, which severely affected their quality of life. Perceived barriers to handover included inadequate professional judgement, poor ability to synthesize the important information, and unsystematic reporting.

CONCLUSIONS

Newly graduated nurses face challenges and encounter difficulties in performing clinical handover. Handover theory and, in particular, skills training should be introduced into the undergraduate nursing curriculum, to arm students with the confidence and competence to perform appropriate clinical handover.

Patient safety culture and handoff evaluation of nurses in small and medium-sized hospitals

Objectives

This study was conducted to investigate the current status of handoffs, perception of patient safety culture, and degrees of handoff evaluation in small and medium-sized hospitals and identified factors that make a difference in handoff evaluation.

Methods

This is a descriptive study. 425 nurses who work at small and medium-sized hospitals in South Korea were included in our study. They completed a set of self-reporting questionnaires that evaluated demographic data, handoff-related characteristics, perception of patient safety culture, and handoff evaluation.

Results

Results showed that the overall score of awareness of a patient safety culture was 3.65 ± 0.45, the level was moderate. The score of handoff evaluation was 5.24 ± 0.85. Most nurses experienced errors in handoff and most nurses had no guidelines and checklist in the ward. Handoff evaluation differed significantly according to the level of education, work patterns, duration of hospital employment, handoff method, degree of satisfaction with the current handoff method, errors occurring at the time of handoff, handoff guidelines, and appropriateness of handoff education time (P < 0.05).

Conclusion

For handoff improvement, guidelines and standards should be established. It is necessary to develop a structured handoff education system. And formal handoff education should be implemented to spread knowledge uniformly.

Critical care nurses' communication challenges during handovers: A systematic review and qualitative meta-synthesis

AIMS

To review and synthesize qualitative studies to gain a deeper understanding of critical care nurses' inter-departmental and shift-to-shift handover challenges.

BACKGROUND

Good-quality nurse-to-nurse handover promotes patient safety, while poor handover has been associated with medical errors. However, systematic reviews of qualitative approaches for better understanding the handover experiences of critical care nurses are lacking.

EVALUATION

Systematic review methods incorporating meta-synthesis were used. A comprehensive search of seven databases was conducted. Two independent reviewers performed data extraction and evaluated ten studies using the Critical Appraisal Screening Program. Findings were analysed and synthesized using thematic analysis. The transactional model of communication was used to guide the analysis.

KEY ISSUES

A total of 10 qualitative studies were included. Seven major handover themes were identified: (a) expectations of perfection, (b) need for partnership, (c) unilateral communication, (d) obstacles to information acquisition, (e) lack of pertinent patient information, (f) need for a structured handover and (g) interruptions/distractions.

CONCLUSIONS

Handovers should be considered an essential part of patient-centred care for ensuring continuity of care.

IMPLICATIONS FOR NURSING MANAGEMENT

Poor communication during a handover could increase the nurse's burden or stress and adversely affect patient care. Therefore, training should be provided on explicit handover communication.

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.

Referrals to a pediatric emergency department of a tertiary care teaching hospital before and after introduction of a referral education module - a quality improvement study

BACKGROUND

Provision of timely care to critically ill children is essential for good outcome. Referral from smaller peripheral hospitals to higher centers for intensive care is common. However, lack of an organized referral and feedback system compromises optimal care. We studied the quality of referral letters coming to our Emergency Department (ED) with respect to their demography, association with severity of illness and mortality before and after referral education.

METHODS

Our study was completed in three phases in the Pediatric ED; Pre-intervention, Intervention and Post intervention phases. Quality of referral letter was matched with a quality checklist proforma and graded as 'good', 'fair' and 'poor' if it scored > 7, 5-7 and < 5 points respectively. A peer reviewed referral education module was prepared using case studies, expert opinions, and lacunae observed in the first phase and administered to health care providers (HCP's) of referring hospitals. Quality of referral letter was compared between pre and post intervention phases.

RESULTS

Most referrals belonged to the neighboring states of Punjab (48.2%) and Haryana (22.4%). Major referring hospitals were from public sector (80.9%), of which the teaching hospitals topped the list (53.6%). Government run ambulance services (85.5%) was commonest mode of transport used and need for a PICU bed and/or mechanical ventilation (50.4%) was the commonest reason for referral. The post intervention phase saw a significant decline in the proportion of poor (93.2 vs.78.2%; p = 0.001) and a significant increase in the proportion of fair (6.1 vs 18%; p = 0.001) and good referral letters (0.7 vs 18%; p = 0.001). The proportion of children with physiological decompensation at triage had reduced significantly in the post intervention phase [513 out of 1403 (36.5%) vs. 310 out of 957 (32.3%); p = 0.001].

CONCLUSION

Referral education had significantly improved the quality of referral letters. Proportion of children with physiological decompensation at triage had decreased significantly after referral module. This change suggests sensitization of the peripheral hospitals towards a better referral process. Continued multifaceted approach will be required for sustained and increased benefits.

Information concerning ICU patients' families in the handover-The clinicians' «game of whispers»: A qualitative study

AIMS AND OBJECTIVES

To explore how information concerning ICU patients´ families is included in the ICU clinicians' daily handover.

BACKGROUND

Handover refers to the transfer of information and care responsibility between clinicians. An effective and precise handover are of great importance to ensure quality of care. Although improvements in handovers have received increasing attention in recent decades, little is known about how information about ICU patients' family members is included in handovers.

DESIGN

A qualitative study using Charmaz' constructivist grounded theory approach.

METHODS

Data were gathered through participant observation, focus groups, dyadic and individual interviews of physicians and nurses from four ICUs in different Norwegian hospitals. The data consist of 270 observation hours, seven focus groups, three dyadic interviews and two individual interviews. Field notes and transcribed interview data were analysed using constructivist grounded theory approach. COREQ checklist was applied as reporting guideline for this study.

FINDINGS

"A game of whispers" emerged as the core category, representing missing information about the patient's family during the handover. Together with three subcategories: "documentation dilemmas," "being updated" and "talking together," the core category explains how transfer of family-related information between clinicians is continually processed and resolved.

CONCLUSIONS

This study indicates challenges related to appropriate and high-quality handover concerning ICU patients´ families. Oral handovers are essential in terms of clinicians' need to elaborate on written information and update each other. However, oral transmission involves a high risk of information loss during the handover. Written documentation about the family seems to be inadequate and poorly structured.

RELEVANCE TO CLINICAL PRACTICE

The study findings suggest a need for increased awareness in practice and research of the importance of transferring appropriate and reliable information about patients' families between ICU clinicians. User-friendly handover tools and patient records that include information on patients' family members should be developed.

Transition in Care from EMS Providers to Emergency Department Nurses: A Systematic Review

Background: Transitions in care between emergency medical services (EMS) providers and emergency department (ED) nurses are critical to patient care and safety. However, interactions between EMS providers and ED nurses can be problematic with communication gaps and have not been extensively studied. The aim of this review was to examine (1) factors that influence transitions in care from EMS providers to ED nurses and (2) the effectiveness of interventional strategies to improve these transitions. Methods: We conducted a mixed-methods systematic review that included searches of electronic databases (DARE, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, Joanna Briggs Institute EBP), gray literature databases, organization websites, querying experts in emergency medicine, and the reference lists cited in included studies. All English-language studies of any design were eligible for inclusion. Two reviewers independently screened titles/abstracts and full-texts for inclusion and methodological quality, as well as extracted data from included studies. We used narrative and thematic synthesis to integrate and explore relationships within the data. Results: In total, 8,348 studies were screened and 130 selected for full text review. The final synthesis included 20 studies. Across 15 studies of moderate-to-high methodological quality, 6 factors influenced transitions: different professional lenses, operational constraints, professional relationships, information shared between the professions, components of the transition process, and patient presentation and involvement. Three interventions were identified in 6 methodologically weak studies: (1) transition guideline (DeMIST, Identification, Mechanism/Medical complaint, Injuries/Information related to the complaint, Signs, Treatment and Trends - Allergies, Medication, Background history, Other information [IMIST-AMBO]) with training, (2) mobile web-based technology (EMS smartphone and geographic information system location data), and (3) a new clinical role (ED ambulance off-load nurse dedicated to triaging and assessing EMS patients). There were mixed findings for the effectiveness of transition guidelines and the new clinical role. Mobile technology was seen positively by both EMS providers and ED nurses as helpful for better describing the pre-hospital context and for planning flow in the ED. Conclusion: While multimedia applications may potentially improve the handoff process, future intervention studies need to be rigorously designed. We recommend interdisciplinary training of EMS and ED staff in the use of flexible structured protocols, especially given review findings that interdisciplinary communication and relationships can be challenging.

What is the effect of electronic clinical handovers on patient outcomes? A systematic review

Handover between physicians is a high-risk event for communication errors. Using electronic handover platforms has potential to improve the quality of informational transfer and therefore minimise this risk. This systematic review sought to compare the effectiveness of electronic handover methods on patient outcomes. Articles were identified by searching MEDLINE, EMbase, Scopus and CINAHL databases. Studies involving electronic handover between two healthcare personnel or teams, and which described patientspecific outcomes, were included. This search yielded 390 articles, with a total of nine publications included in the analysis. Outcomes reported in studies included length of stay, adverse event rates, time to procedure and handover completeness. This review suggests that e-handover may improve the handover completeness; however, it is unclear at this time if that translates to an improvement in patient care. The lack of reliable evidence highlights the need for further research exploring the effect of e-handovers on patient care.

The critical care nurse's perception of handover: A phenomenographic study

OBJECTIVE

To describe variations in critical care nurses' perceptions of handover.

RESEARCH METHODOLOGY

Phenomenographic design using individual interviews for data-collection.

SETTING

The critical care nurses participating in the study were recruited from critical care units in three hospitals in Sweden.

FINDINGS

Five descriptive categories were identified: Communication between staff, Opportunity for learning, Patient-centred information gathering as a basis for continuous care, Responsibility for transfers, and Patient safety and quality of care.

CONCLUSION

Nursing handover is a complex phenomenon, which is understood in various ways. Handover is mediated through communication and marks a shift in responsibility. Handover seems to be related to patient safety and quality of care. There is potential for improvement in the quality of nursing handover in clinical praxis, but further research is needed to determine ways of improving quality of handover.

Mental health nurses' attitudes towards consumer involvement in nursing handover pre and post an educational implementation

Involving mental health consumers in nursing handover is a recent introduction to practise in acute mental health units. However, implementation must recognize that mental health care is complex and the approach needs to include recovery-focused philosophies of practice. Evidence shows that nurses and other health professionals consider poor handover practices may be the source of adverse events; however, the views of mental health nurses about involving consumers in nursing handover have not been previously reported. The aim of this study was to identify nurses' attitudes towards consumer involvement in handover and to measure the effect of a training programme upon these attitudes. A single-group pre-post-test intervention study was undertaken. The study was conducted on the adult acute mental health inpatient unit of a major metropolitan hospital in Victoria, Australia, 2016-2017. Questionnaires were developed to capture the views of the nurses about proposed changes in the afternoon nursing handover process. A questionnaire was administered before and after the training intervention, an innovative, multi-media education handover package. We found that training had a significant influence on mental health nurses' attitudes towards involving consumers in the handover. Therapeutic engagement improved following training and miscommunication reduced when all players are informed and have the opportunity to engage with the information. This study has demonstrated that well-planned education can influence nurses' attitudes about involving consumers in the nursing handover processes.

Nursing students' involvement in shift-to-shift handovers: Findings from a national study

BACKGROUND

Effective performance of clinical handovers should be one of the priorities of nursing education to promote efficient communication skills and ensure patient safety. However, to date, no studies have explored to what extent nursing students are involved in handovers.

OBJECTIVE

To explore nursing students' handover involvement during their clinical rotations and associated factors.

METHOD

This was a secondary analysis of a large national cross-sectional study that involved 9607 undergraduate nursing students in 27 universities across 95 three-year Italian baccalaureate nursing programs. The involvement in the clinical handovers was the end point (from 0, never, to 3, always). A path analysis was performed to identify variables directly and indirectly affecting students' handover involvement.

RESULTS

Handover involvement was reported as 'only a little', 'to some extent', and 'always' by 1739 (18.1%), 2939 (30.6%), and 4180 (43.5%) students, respectively; only 749 (7.8%) of students reported never being involved. At the path analysis explaining the 19.1% of variance of nursing students' involvement, some variables emerged that directly increased the likelihood of being involved in handovers. These were being female (β = 0.115, p < 0.001); having children (β = 0.107, p = 0.011); being a 3rd-year student (β = 0.142, p < 0.001) and being a 2nd-year student as compared to a 1st-year student (β = 0.050, p = 0.036); and having a longer clinical rotation (β = 0.015, p < 0.001) in units with high 'quality of the learning environment' (β = 0.279, p < 0.001). Moreover, students who were supervised by the nurse teacher (β = -0.279, p < 0.001), or by a nurse on a daily basis (β = -0.253, p = 0.004), or by the staff (β = -0.190, p < 0.001) reported being less involved in handovers as compared to those students supervised by a clinical nurse. Variables with indirect effects also emerged (model of student's supervision adopted at the unit level, and number of previous clinical rotations attended by students). Moreover, handover involvement explained 11.5% of students self-reported degree of competences learned during the clinical experience.

CONCLUSIONS

Limiting students' opportunity to be involved in handover can prevent the development of communication skills and the professional socialization processes. Strategies at different levels are needed to promote handover among undergraduate nursing students.

Handover of Patients From Prehospital Emergency Services to Emergency Departments: A Qualitative Analysis Based on Experiences of Nurses

BACKGROUND

During the transfer of patients, both ambulance and hospital emergency service professionals need to exchange necessary, precise, and complete information for an effective handover. Some factors threaten a quality handover such as excessive caseload, patients with multiple comorbidities, limited past medical history, and frequent interruptions.

PURPOSE

To explore the viewpoint of nurses on their experience of patient handovers, describing the essential aspects of the process and areas for improvement, and establishing standardized elements for an effective handover.

METHODS

A qualitative research method was used.

RESULTS

Nurses identified the need to standardize the patient transfer process by a written record to support the verbal handover and to transmit patient information adequately, in a timely manner, and in a space free of interruptions, in order to increase patient safety.

CONCLUSIONS

An organized method does not exist. The quality of handovers could be enhanced by improvements in communication and standardizing the process.

The impact of patient safety culture on handover in rural health facilities

BACKGROUND

Effective handover is crucial for patient safety. Rural health care organisations have particular challenges in relation to handover of information, placing them at higher risk of adverse events. Few studies have examined the relationship between handover and patient safety in rural contexts, particularly in Australia. This study aimed to explore the effect of handover on overall perceptions of patient safety and the effect of other patient safety dimensions on handover in a rural Australian setting.

METHODS

A cross-sectional online survey using The Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture was implemented across six rural Local Health Districts in NSW, Australia and resulted in 1587 respondents. Hierarchical multiple linear regression analysis was conducted to account for the nested nature of the data. Models were developed to assess the effect of handover on patient safety perceptions, and the effect of other patient safety culture composites on handover variables. Open-ended questions about patient safety were inductively analyzed for themes. Quotes from the handover theme are presented.

RESULTS

All models were significant overall (p < .001), with explanatory powers ranging from 29 to 48%. Within rural health settings, effective handover is significantly related to patient safety perceptions (R2 = .29). A strong teamwork culture and management support culture was found to enhance effective handover of patient information (R2 = .47), and effective handover of personal responsibility (R2 = .37). A strong teamwork, management support, and open communication culture enhances handover of department accountability (R2 = .41). Despite the implementation of standardised communication tools and frameworks for handover, patient safety is compromised by inadequate coordination, poor or absent documentation between departments, between other health care agencies and in transfer of care from acute facilities to primary/community care.

CONCLUSION

Approaches to handover need to consider the particular challenges associated with rurality and strengthening elements found to be associated with increased safety, such as a strong teamwork and management culture and good reporting practices. Research is required to examine how communication at transition of care, particularly between facilities, is conducted and ways in which to enhance patients' and families' participation.

A tool for assessing the quality of nursing handovers: a validation study

AIM

Handover, in particular between two shifts, is a crucial aspect of nursing for patient safety, aimed at ensuring continuity of care. During this process, several factors can affect quality of care and cause errors. This study aimed to assess quality of handovers, by validating the Handoff CEX-Italian scale.

METHOD

The scale was translated from English into Italian and the content validity index was calculated and internal consistency assessed. The scale was used in several units of the San Paolo Teaching Hospital in Milan, Italy.

RESULTS

A total of 48 reports were assessed (192 evaluations). The median score was 6, interquartile range (IQR) [5;7] and was not influenced by specific (p=0.21) or overall working experience (p=0.13). The domains showing the lowest median values (median=6, IQR [4;8]) were context, communication, and organisation. Night to morning handovers obtained the lowest scores. CVI-S was 0.96, Cronbach's alpha was 0.79.

DISCUSSION

The Handoff CEX-Italian scale is valid and reliable and it can be used to assess the quality of nurse handovers.

Nurses’ perceptions of bedside clinical handover in a medical-surgical unit: An interpretive descriptive study

Background:

Clinical handover is the transfer of relevant and important information and responsibility for patient care from one healthcare provider to another. An effective clinical handover is determined by the transition of critical information and the continuity of quality care for the patient. In the inpatient settings, bedside clinical handover mainly occurs during shift changes (morning to afternoon shift, afternoon to night shift and night to morning shift). Bedside clinical handover can take place in a cohort room of up to six patients or a single-bedded room with only one patient. Various nurses in the nursing hierarchy are involved in the handover, each contributing to ensure patients’ safety and continuity of quality care.

Aim:

To explore nurses’ perceptions of bedside clinical handover in an inpatient acute-care ward in Singapore.

Methodology:

An interpretive, descriptive, qualitative study was conducted using focus group interviews with semi-structured questions. The interviews were conducted with 20 nurses from an acute-care hospital in Singapore. The interviews were audiotaped and transcribed verbatim. Data collected were analyzed using thematic analysis.

Results:

Nurses described that bedside clinical handover could potentially compromise patient’s confidentiality and that the patient and/or their family members and the environment were sources of constant interruptions and distractions. Bedside clinical handover also acted as a platform for communication amongst nurses and between nurses and patients.

Conclusion:

This study provided an insight into nurses’ perceptions of bedside clinical handover and offered a foundation for nurses to improve the handover process.