Change-of-Shift Nursing Handoff Interruptions: Implications for Evidence-Based Practice

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.

Nursing Handoff Education Using Experiential and Virtual Innovations

BACKGROUND

Seventy percent of serious medical errors are the result of ineffective communication, including handoff errors.

PROBLEM

Nursing students have cited a need for more experience on how to give handoff; yet, handoff education remains variable.

APPROACH

Two innovative curricular approaches were implemented on the basis of Bloom's taxonomy to teach handoff education: experiential and virtual. The outcomes of the 2 curricular innovations were evaluated for handoff completion, handoff accuracy, and handoff quality, based on context.

OUTCOMES

During the experiential approach, students demonstrated average handoff completion rates of 84%. During the virtual approach, students' handoff completion rates rose from 25% to 63% and accuracy handoff rates rose from 13% to 31%.

CONCLUSIONS

Evaluations support that varying educational methods successfully teach nursing students how to give handoffs. Complementary innovations grant educators flexibility to tailor innovations to curriculum and course context, as supported by Bloom's taxonomy.

Standardized Change-of-Shift Handoff: Nurses' Perspectives and Implications for Evidence-Based Practice

BACKGROUND

Nursing handoff is a communication activity with a high risk for loss or omission of information. Efforts to improve handoffs include standardization of the processes and content of handoff communications.

OBJECTIVES

To examine nurses' perspectives on the structure and organization of change-of-shift handoffs.

METHODS

A qualitative descriptive approach was used to conduct a secondary analysis of focus group data. Thirty-four nurses from 4 critical care units participated in focus groups.

RESULTS

Three themes emerged: handoff elements are defined by practice and culture; a clear, consistent, identified structure supports handoff; and personal preferences can disrupt handoff.

CONCLUSIONS

A standardized approach to handoff based on unit and organizational needs will be more successful than a broad mandate of content and organization. Individual preference is prevalent and strongly influences the information conveyed and the structure of handoff communication.

Interruption in the work of nursing professionals: conceptual analysis

OBJECTIVES

to analyze the concept of "interruption in the work of nursing professionals".

METHODS

conceptual study according to the method proposed by Walker and Avant through integrative literature review. The study searched the databases using the descriptors: "Attention", "Attention Bias", "Health Personnel", "Nurses", "Patient Safety" and "Medical Malpractices". The sample consisted of 36 studies.

RESULTS

the antecedents were alarms, answering phone calls, providing patient care, and lack of material/medicine. The defining attributes were pause, suspension, breakage, and intrusion. In relation to the consequences, the study highlighted the increase in frequency and severity of medication errors and change of focus.

FINAL CONSIDERATIONS

theconceptual analysis identified the attributes, antecedents, and consequences and allowed to build an operational definition for "interruption in the work of nursing professionals". It will contribute to the improvement of the work process and the creation of strategies that ensure safer care for the patient.