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

The Nursing Inter Shift Handover: A Moment of Care for Patients and Their Family Caregivers

Precedents: The transfer between nursing shifts must guarantee the quality of care for patients and their families in the hospital. This study aimed to transform the handover between nursing shifts to strengthen the care capacity of patients and their family caregivers, and improve the care capacity of nursing staff, in a Latin American university hospital. Methods: This is a Nursing Methodology Research developed in the following phases: (a) identification of the best handover practices between nursing shifts to apply them within the institutional culture; (2) diagnosis of the transfer between shifts in the hospital; (3) design and validation of the transformation proposal; (4) measurement of transfer indicators; and (5) definition of a path to improve this transfer. Results: The proposal developed focuses on the patient and their family caregiver. The proposed protocol considered the perspective of the care recipients, the nursing staff, and the best available evidence. The overall transfer rating over 10 months went from 65% to 84%. Conclusions: The adjustment to the transfer process made it possible to strengthen the care capacity of patients and their family caregivers and improve the care capacity of the nursing staff.

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.

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.

Identifying and understanding benefits associated with return-on-investment from large-scale healthcare Quality Improvement programmes: an integrative systematic literature review

BACKGROUND

We previously developed a Quality Improvement (QI) Return-on-Investment (ROI) conceptual framework for large-scale healthcare QI programmes. We defined ROI as any monetary or non-monetary value or benefit derived from QI. We called the framework the QI-ROI conceptual framework. The current study describes the different categories of benefits covered by this framework and explores the relationships between these benefits.

METHODS

We searched Medline, Embase, Global health, PsycInfo, EconLit, NHS EED, Web of Science, Google Scholar, organisational journals, and citations, using ROI or returns-on-investment concepts (e.g., cost-benefit, cost-effectiveness, value) combined with healthcare and QI. Our analysis was informed by Complexity Theory in view of the complexity of large QI programmes. We used Framework analysis to analyse the data using a preliminary ROI conceptual framework that was based on organisational obligations towards its stakeholders. Included articles discussed at least three organisational benefits towards these obligations, with at least one financial or patient benefit. We synthesized the different QI benefits discussed.

RESULTS

We retrieved 10 428 articles. One hundred and two (102) articles were selected for full text screening. Of these 34 were excluded and 68 included. Included articles were QI economic, effectiveness, process, and impact evaluations as well as conceptual literature. Based on these literatures, we reviewed and updated our QI-ROI conceptual framework from our first study. Our QI-ROI conceptual framework consists of four categories: 1) organisational performance, 2) organisational development, 3) external outcomes, and 4) unintended outcomes (positive and negative). We found that QI benefits are interlinked, and that ROI in large-scale QI is not merely an end-outcome; there are earlier benefits that matter to organisations that contribute to overall ROI. Organisations also found positive aspects of negative unintended consequences, such as learning from failed QI.

DISCUSSION AND CONCLUSION

Our analysis indicated that the QI-ROI conceptual framework is made-up of multi-faceted and interconnected benefits from large-scale QI programmes. One or more of these may be desirable depending on each organisation's goals and objectives, as well as stage of development. As such, it is possible for organisations to deduce incremental benefits or returns-on-investments throughout a programme lifecycle that are relevant and legitimate.

Exploring nurses' perceptions of clinical handover in regional health care facilities: A exploratory qualitative study

AIM

This study sought to explore nurses' perceptions of clinical handover in a regional health care facility to better understand the local context and identify the most appropriate clinical handover models.

BACKGROUND

Clinical handover is an essential aspect of clinical care, and yet using accurate spoken and written communication can be neglected in nursing, potentially resulting in patient harm. Although much information is available on clinical handover in metropolitan settings, few studies have examined the regional context.

METHODS

This study was an exploratory qualitative study based at one small regional health care facility located 100 km from a metropolitan Australian centre. The study utilized an Appreciative Inquiry approach to identify how nurses perceive the use of standardized oral and written clinical handover. Focus groups were engaged to explore the perceptions of nurses "handing over" in the smaller regional facility.

RESULTS

Through focus group interviews with Registered and Enrolled Nurses, the data revealed that the cultural context of the ward influenced perceptions of clinical handover and that handover served as a light in the dark for all nursing staff; as an evolving communication tool illuminating patient care needs.

CONCLUSION

This study facilitated understanding of the handover needs of smaller Australian regional hospitals. This study identified gaps in perception about handover practices between junior and senior nurses. New graduate nurses develop confidence in supportive clinical environments. A transition to practice programme would need to address the challenges new graduates face in the regional setting.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers in regional facilities can champion supportive senior nurses to mentor new graduate nurses and enhance the transition to practice for the new nurse.

Do people living in rural and urban locations experience differences in harm when admitted to hospital? A cross-sectional New Zealand general practice records review study

OBJECTIVE

Little is known about differences in hospital harm (injury, suffering, disability, disease or death arising from hospital care) when people from rural and urban locations require hospital care. This study aimed to assess whether hospital harm risk differed by patients' rural or urban location using general practice data.

DESIGN

Secondary analysis of a 3-year retrospective cross-sectional general practice records review study, designed with equal numbers of rural and urban patients and patients from small, medium and large practices. Hospital admissions, interhospital transfer and hospital harm were identified.

SETTING

New Zealand (NZ) general practice clinical records including hospital discharge data.

PARTICIPANTS

Randomly selected patient records from randomly selected general practices across NZ. Patient enrolment at rural and urban general practices defined patient location.

OUTCOMES

Admission and harm risk and rate ratios by rural-urban location were investigated using multivariable analyses adjusted for age, sex, ethnicity, deprivation, practice size. Preventable hospital harm, harm severity and harm associated with interhospital transfer were analysed.

RESULTS

Of 9076 patient records, 1561 patients (17%) experienced hospital admissions with no significant association between patient location and hospital admission (rural vs urban adjusted risk ratio (aRR) 0.98 (95% CI 0.83 to 1.17)). Of patients admitted to hospital, 172 (11%) experienced hospital harm. Rural location was not associated with increased hospital harm risk (aRR 1.01 (95% CI 0.97 to 1.05)) or rate of hospital harm per admission (adjusted incidence rate ratio 1.09 (95% CI 0.83 to 1.43)). Nearly half (45%) of hospital harms became apparent only after discharge. No urban patients required interhospital transfer, but 3% of rural patients did. Interhospital transfer was associated with over twice the risk of hospital harm (age-adjusted aRR 2.33 (95% CI 1.37 to 3.98), p=0.003).

CONCLUSIONS

Rural patient location was not associated with increased hospital harm. This provides reassurance for rural communities and health planners. The exception was patients needing interhospital transfer, where risk was more than doubled, warranting further research.

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.

Identifying practical approaches to the normalisation of interprofessional collaboration in rural hospitals: A qualitative study among health professionals

This qualitative study explores the ideas and experiences of interprofessional collaboration (IPC) among health professionals in rural public hospitals and to propagate its normalization into practice by identifying existing or suggested solutions. The literature focuses largely on the barriers and facilitators to IPC in metropolitan areas and there is room to identify more practical responses for implementing solutions. Semi-structured interviews were conducted with 13 healthcare professionals (October 2018-March 2019). Interviews were audio-recorded, transcribed and underwent thematic analysis to identify themes derived from the dataset. Using the lens of the Normalization Process Theory (NPT) allowed for amalgamation of participant ideas and identification of solutions to implement IPC in practice. Participants' definitions of IPC and Interprofessional Teamwork were incongruous with the current literature, however when provided with formal definitions, participants agreed that they both participated and observed IPC with varying degrees of success. Factors influencing this success included good working relationships and positive workplace cultures, having an understanding of each professions' roles and needs and the hierarchy of professions in conjunction with attitudes of senior healthcare professionals. Solutions to improved IPC and its normalization included induction processes and informal introductions, formalized interprofessional interactions, interprofessional education and positive leadership, such as the 'assertive followership model'. Analyzed in the framework of the normalization process theory, this research shows that IPC is increasingly becoming a coherent, integrated aspect of the healthcare system but there is room for improvement, and cognitive participation in IPC varies across healthcare professionsals. In order to facilitate the normalization process, program and policy makers, hospital administrations and professional associations could consider formalized interprofessional team interactions, formalizing IPC through simple introductions, interprofessional education and positive leadership. Future research could explore through the NPT specific areas of care that benefit from IPC implementation such as community aged-care.

Ethical Challenges in Medical Community Internships: Perspectives from Medical Interns in the Philippines

The Philippine community internship program, originally created to supplement the country's thinning health workforce while providing training to student doctors, poses a legal and ethical challenge for medical interns. Inherent characteristics of the program-such as financial disparities and burdens, the lack of supervision by senior doctors, the competence of student doctors, and short rotation times-can predispose interns to cause harm to the patients and communities they serve. As currently designed, the internship program has the capacity to leave interns unsupervised, at risk of legal ramifications, constantly questioning the correctness of their interventions, and perpetually straddling conflicting role virtues. By failing to ensure that the community internship program has appropriate safeguards in place, the government not only jeopardizes the welfare of interns but also threatens the quality and continuity of care that patients and communities receive, potentially violating their right to the highest attainable standard of health. One medical school recently started a novel internship program that could address the issues mentioned.