Handing Off Safety at the Bedside

Implementing IPASS Handoff to Improve Patient Safety in Pediatric Critical Care Transport

INTRODUCTION

The aim of this study was to implement a standardized, hospital-based bedside handoff report (IPASS [Illness severity, Patient summary, Action items, Situational awareness, and Synthesis]) in prehospital pediatric critical care transport to increase patient safety by eliminating the risk of misreporting or omitting critical patient care information received before arrival at a tertiary care center. The setting for this project was a level 1 pediatric trauma center in the Southern United States.

METHODS

Pre- and postsurveys were used to assess staff perception of clinical handoff comprehensiveness and satisfaction with the use of a standardized IPASS handoff tool.

RESULTS

Improvement was identified in 6 of 8 survey items. Team members were better able to hear all the information provided in the handoff, the format was functional, and physical transfers of patients from the transport team to the ED went more smoothly. Overall, satisfaction of the handoff process increased by 80%.

CONCLUSION

Many factors contribute to patient safety events and errors in health care, with communication failures contributing to the majority. Overall, findings support the use of standardized IPASS handoffs in pediatric critical care transport to promote patient safety, increase comprehension of patient information, and increase staff satisfaction.

Influencing Factors of Nurses' Practice during the Bedside Handover: A Qualitative Evidence Synthesis Protocol

Nursing Bedside Handover (NBH) is acknowledged as a nursing practice implemented at the patient's bedside to improve communication safety during the shift change, but it is vulnerable due to inconsistent application among nurses. This synthesis of qualitative evidence aims to review and synthesize the perceptions and experiences of nurses regarding the factors that, in their perspective, influence NBH practice. We will follow the thematic synthesis methodology of Thomas and Harden and the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) Statement guidelines. A search will be conducted through the databases of MEDLINE, CINAHL, Web of Science, and Scopus, and we will follow the three-step search process to identify primary studies with qualitative or mixed-method research designs and projects of quality improvement. The screening and selection of the studies will be carried out by two independent reviewers. We will use the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) to report the screening, search, and selection of studies. To assess its methodological quality, two reviewers will independently use the CASM Tool. The extracted data will be reviewed, categorized, and summarized in tabular and narrative formats. The findings obtained will allow us to inform future research and change management led by nurse managers.

Benefits and Challenges of Clinical Nurse Educator Roles: A Qualitative Exploratory Study

BACKGROUND: The nurse will successfully apply high quality of care if maintaining their comptencies. The quality of nursing care is dynamic, and competency is needed to be adapted. Besides, The presence of clinical nurse educator (CNE) able to strengthen nurses’ knowledge and skill in the clinical setting. AIM: This study aimed to explore the benefits and challenges of CNEs. METHODS: A qualitative exploratory design was used in this study. Data were collected by focus group discussion with eight CNEs at Sanglah General Hospital Bali. Content analysis was used for analyzing the data. RESULTS: The findings of this study suggest certain advantages for the hospital, such as continuing professional education and becoming a role model. Greater incentive to learn, as well as personal rewards such as increased self-confidence, being appreciated, and trust. A lack of support from management related to educational preparation for this function, the ambiguous role, the necessity to continue giving direct care, and the CNE ratio with the number of nurses is not equal were some of the challenges that arose. CONCLUSION: CNEs serve a critical role in the clinical context. They help nurses with ongoing education and competency maintenance. While numerous excellent outcomes have developed for hospitals and CNEs personally, many of them confront several obstacles in fulfilling their work properly.

Apply the SERVQUAL Instrument to Measure Service Quality for the Adaptation of ICT Technologies: A Case Study of Nursing Homes in Taiwan

The adoption of information and communication technology by elderly care organizations is an inevitable trend. Most empirical studies on e-Health service quality have focused predominantly on the general population rather than on the elderly. Thus, the generalizations are rather problematic. In addition, in the planning stage, pre-implementation analysis is considered critical but seldom performed. In this research, an instrument to evaluate the e-Health service quality in nursing homes was developed based on the SERVQUAL model. Furthermore, a pre-implementation analysis combining the SERVQUAL questionnaire and importance performance analysis was performed. Dissatisfactory factors were identified as follows. Regarding the physical environment quality, the residents expressed that the nursing homes did not provide well-maintained rooms and that the temperature in the rooms was unsuitable. Regarding the outcome quality, the elderly residents replied that the medical treatments and doctor visits were not well scheduled. Regarding the interaction quality, the residents indicated that the staff did not solve their problems sincerely or clearly understand their needs. Health care informatics (HCI) such as an electronic shift system (ESS) and electronic health records (EHR) are proposed to eliminate these problems. Given current resource limitations, our instrument and methodology proposed in this research could be extremely meaningful in practical application.

Impact of Patient Census and Admission Mortality on Pediatric Intensive Care Unit Attending Electronic Health Record Activity: A Preliminary Study

BACKGROUND

Physicians may spend a significant amount of time using the electronic health record (EHR), but this is understudied in the pediatric intensive care unit (PICU). The objective of this study is to quantify PICU attending physician EHR usage and determine its association with patient census and mortality scores.

METHODS

During the year 2016, total EHR, chart review, and documentation times of 7 PICU physicians were collected retrospectively utilizing an EHR-embedded time tracking software package. We examined associations between documentation times and patient census and maximum admission mortality scores. Odds ratios (ORs) are reported per 1-unit increase in patient census and mortality scores.

RESULTS

Overall, total daily EHR usage time (median time [hh:mm] [25th, 75th percentile]) was 2:10 (1:31, 3:08). For all hours (8 a.m.-8 a.m.), no strong association was noted between total EHR time, chart review, and documentation times and patient census, Pediatric Index of Mortality 2 (PIM2), or Pediatric Risk of Mortality 3 (PRISM3) scores. For regular hours (8 a.m.-7 p.m.), no strong association was noted between total EHR, chart review, and documentation times and patient census, PIM2, or PRISM3 scores. When patient census was higher, the odds of EHR after-hour usage (7 p.m.-8 a.m.) was higher (OR 1.262 [1.135, 1.403], p < 0.0001), but there were no increased odds with PIM2 (OR 1.090 [0.956, 1.242], p = 0.20) and PRISM3 (OR 1.010 [0.984, 1.036], p = 0.47) scores. A subset of physicians spent less time performing EHR-related tasks when patient census and admission mortality scores were elevated.

CONCLUSION

We performed a novel evaluation of physician EHR workflow in our PICU. Our pediatric critical care physicians spend approximately 2 hours (out of an expected 10-hour shift) each service day using the EHR, but there was no strong or consistent association between EHR usage and patient census or mortality scores. Future larger scale studies are needed to ensure validity of these results.

A systematic review on the structured handover interventions between nurses in improving patient safety outcomes

AIM

This review aimed to elucidate the effectiveness of structured handovers in improving patient outcomes in the wards.

BACKGROUND

Studies have reported that the lack of quality handovers is one of the main causes of adverse effects.

EVALUATION

A search over six electronic databases: MEDLINE; CINAHL; Web of Science; EMBASE; Scopus; and CENTRAL via Ovid concluded nine studies and synthesized by two independent reviewers based on the Cochrane Handbook for Systematic Reviews of Interventions. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used to guide the undertaking of this review and meta-analysis. All studies published up to February 2019 were considered in this review.

KEY ISSUES

This review has demonstrated that structured handovers reduced the incidences of patient complications, medication errors and general adverse events. However, the results were not statistically significant.

CONCLUSION

Current structured handover formats were effective in reducing problematic handovers such as omission of information, inaccurate information and documentation errors.

IMPLICATIONS FOR NURSING MANAGEMENT

Although there is limited high-quality and rigorous research conducted to gain a clearer understanding of the impacts on patient-related outcomes in nursing care, structured handovers remained effective in reducing the number of mistakes in information transfer.

Improved patient satisfaction 2 years after introducing person-centred handover in an oncological inpatient care setting

AIMS AND OBJECTIVES

To investigate patients' satisfaction with care, 2 years after the introduction of person-centred handover (PCH) in an oncological inpatient setting, and to describe patients' perceptions of individualised care.

BACKGROUND

To obtain higher levels of patient satisfaction, bedside nursing handovers have been evaluated with positive results. One such model is PCH, which blends aspects of person-centred care with the bedside report and provides the opportunity for nursing staff and patients to perform the handover together.

DESIGN

A survey-based design was used with one data collection period. Patient satisfaction scores were compared with baseline data from a previous study that has been conducted in the same wards.

METHOD

Patient satisfaction was measured with the EORTC IN-PATSAT32 questionnaire, and individualised care was assessed with the Individualized Care Scale. A total of 120 adult patients with cancer were invited to participate from August 2017-March 2018. Of these, 90 chose to participate. The STROBE checklist for cross-sectional studies was used when preparing the paper.

RESULTS

Compared to the previous study, statistically significant improvements in patient satisfaction were observed in the subscales "Exchange of information between caregivers" and "Nurses' information provision" postimplementation of PCH. Regarding patients' perceptions of individualised care, the highest scores were in the ICS-A subscale "Clinical situation" and ICS-B "Decisional control," while "Personal life situation" scored the lowest overall.

CONCLUSIONS

Person-centred handover seems to have sustainable positive effects on important outcomes regarding patient satisfaction. A novel finding is the positive impact on nurses' information provision, indicating that PCH can facilitate effective information exchange between patients and nurses.

RELEVANCE TO CLINICAL PRACTICE

Person-centred handover seems to improve patients' satisfaction with nurses' provision and exchange of information. Nurses and managers should carefully consider the implementation process of PCH and evaluate its long-term effects. PCH can be recommended in the oncology inpatient setting.

Exploring the Hidden Functions of Nursing Bedside Shift Report: A Performance, Ritual, and Sensemaking Opportunity

BACKGROUND

Implementing Nursing Bedside Shift Report (NBSR) is challenging for nurse leaders. Before implementing or improving NBSR, nurse leaders need a clear understanding of the process and functions of nursing shift report. However, the social-cultural latent functions (unrecognized or unintended uses) of NBSR are poorly understood.

PURPOSE

The purpose of this qualitative study was to describe the latent functions of NBSR from the perspectives of frontline nurses.

METHODS

Thematic analysis of previously collected semistructured interviews with nurses (n = 13) about NBSR was used to explore NBSR's latent functions.

RESULTS

Three latent functions emerged; nurses used bedside shift report as a performance, ritual, and sensemaking opportunity. The latent functions are described, and corresponding recommendations for successful implementation of NBSR are provided.

CONCLUSIONS

Nurse leaders can use this study's findings to inform the development or improvement of an efficient, effective, and sustainable NBSR process at their local institution.