Evaluating the Influence of a Standardized Bedside Handoff Process in a Medical-Surgical Unit

Handoff Education Interventions: A Scoping Review Focused on Sustaining Improvements

Handoffs involve the transfer of patient information and responsibility for care between health care professionals. The purpose of the current scoping review was (1) to describe handoff studies with education as part of the intervention and (2) to explore the role of handoff educational interventions in sustaining handoff improvements. This scoping review utilized previously published systematic reviews and a structured, systematic search of 5 databases (January 2006-June 2020). Articles were identified, and data were extracted by pairs of trained, independent reviewers. The search identified 74 relevant articles, most published after 2015 (70%) and conducted in the United States (76%). Almost all of the studies (99%) utilized instruction, 66% utilized skills practice, 89% utilized a memory aid, and 43% utilized reinforcement. However, few studies reported using education theory or followed accepted tenets of curriculum development. There has been a substantial increase over time in reporting actual handoff behavior change (17%-68%) and a smaller but important increase in reporting patient outcomes (11%-18%). Thirty-five percent of studies (26/74) had follow-up for 6 months or more. Twelve studies met the criteria for sustained change, which were follow-up for 6 months or more and achieving statistically significant improvements in either handoff skills/processes or patient outcomes at the conclusion of the study. All 12 studies with sustained change used multi-modal educational interventions, and reinforcement was more likely to be used in these studies than all others (75%, 9/12) versus (37%, 23/62), P = 0.015. Future handoff intervention efforts that include education should use education theory to guide development and include needs assessment and goals and measurable objectives. Educational interventions should be multi-modal and include reinforcement. Future research studies should measure actual handoff behavior change (skills/process) and patient outcomes, include follow-up for more than 6 months, and use education reporting guidelines.

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.

Use of Theory in Quality Innovations: Shift Change Protocol in the Emergency Department

BACKGROUND

Inconsistent and nonstandardized patient handoffs can increase the risk of adverse events. Using change theory may promote adoption of effective handoff processes.

LOCAL PROBLEM

A Midwest emergency department (ED) had no standardized practice for shift change handoffs. Previous handoff quality improvement efforts had been unsuccessful.

METHODS

A pre/postintervention pilot project design was used. Nurses' compliance with the new handoff protocol was evaluated.

INTERVENTIONS

Using Diffusion of Innovation (DOI) theory, an evidence-based shift change protocol was designed and implemented, which included a comprehensive handoff tool specific to the ED.

RESULTS

Four elements in the new shift change process saw statistically significant improvements after implementation, including discussion of the patient's illness severity ( P = .001), synthesis of the patient's care ( P < .001), completing a bedside safety checklist ( P < .001), and providing a formal transition-of-care process ( P < .001).

CONCLUSIONS

Using DOI theory may improve the adoption of new shift change practices.

Improving Communication From Hospital to Skilled Nursing Facility Through Standardized Hand-Off: A Quality Improvement Project

Background: Inadequate hand-off communication from hospital to skilled nursing facility (SNF) hinders SNF nurses’ ability to prepare for specific patient needs, including prescriptions for critical medications, such as controlled medications and intravenous (IV) antibiotics, resulting in delayed medication administration. This project aims to improve hand-off communication from hospital to SNF by utilizing a standardized hand-off tool. This project was conducted in an inpatient, 50-bed, post-hospital skilled nursing care unit of a local SNF. The participants included all 32 staff nurses employed by the SNF. Methods: Lewin’s change management theory (CMT) guided this quality improvement (QI) project. Baseline assessment included a one-month chart review of 76 patient charts that was conducted to assess the disparities related to ineffective hand-off and medication delays in the SNF before intervention. The wait time for the availability of prescriptions for controlled medications and IV antibiotics, and delays in medication administration were assessed. Intervention: Multiple randomly selected hospital-to-SNF hand-offs were observed. Semistructured interviews with all staff nurses were conducted using open-ended questions about hand-off structure and process matters. Data gathered from observation and interviews were used to create the standardized hand-off tool used in this project. In-service training on hand-off tool utilization for SNF nurses was conducted. Champions for each shift were cultivated to assist with project implementation. Results: After six weeks of implementation, a chart review of 101 patient charts was conducted to evaluate the effects of the hand-off tool on the wait time on the availability of prescriptions for controlled medications and IV antibiotics, and medication administration. The wait time of prescriptions availability during the hospital-to-SNF transition was decreased by 79% for controlled medications, with an associated 52.9% reduction in late administration, and decreased by 94% for IV antibiotics, with a 77.8% reduction in late administration. Conclusion: The use of standardized hand-off resulted in improved communication during the hospital-to-SNF hand-off and significantly decreased the wait time for the availability of prescriptions for controlled medications and IV antibiotics. Integrating standardized hand-off into the SNF policies can help sustain improved communication, medication management, and patient transition from hospital to SNF.

Nursing bedside handover in an intensive care unit with a mixed structure: Nursing professionals' perception

AIM

The main objective is to determine if the infrastructure of critical care units influences the perception of professionals using this handover method.

BACKGROUND

Nursing bedside handover is considered a safe information transfer method that can help reduce communication errors; however, it has some disadvantages expressed by health professionals and patients, related to confidentiality, stress and less rest.

METHODS

Qualitative descriptive study. The perception of nursing professionals who work in a critical care unit with a mixed structure (open and closed boxes) in a tertiary care hospital was evaluated through a semi-structured interview with a battery of common questions (prepared after literature review) and spontaneous questions according to the objectives of the study.

RESULTS

Five thematic areas related to the study objectives were observed: patient safety, message content, confidentiality/privacy, intimacy/rest/noise, and patient participation.

CONCLUSIONS

Nursing bedside handover improves safe communication between professionals, because it avoids errors or distractions by double or triple checking (if we include the patient) as well as empowering the patient and including him in his recovery. Carrying it out in closed boxes increases confidentiality and improves intimacy as there are no other patients or relatives nearby who can hear the message. However, the place or shift where the handover is performed does not interfere with the effectiveness of the communication of the message. The morning shift is the busiest, which could affect the patient's rest, a fact that could be solved if it is carried out in a closed box.

IMPLICATIONS FOR NURSING MANAGEMENT

Carrying out the handover in individual boxes in intensive care units would provide greater privacy to the patient and reduce the perception of external noise, contributing to the reduction of interruptions and the increase of the patient's rest. It is also a key element in patient safety through verification by double or triple check-up, the structuring of the message and the visualization of devices presented by the patient. In addition, it will allow the professional to start a process of early humanization and participation of the patient in the health process.

Informing the standardising of care for prolonged stay patients in the ICU: A scoping review of quality improvement tools

OBJECTIVES

To inform design of quality improvement (QI) tools specific to patients with prolonged intensive care unit (ICU) stay, we determined characteristics (format/content), development, implementation, and outcomes of published multi-component QI tools used in ICU irrespective of length of stay.

RESEARCH METHODOLOGY

Scoping review searching electronic databases, trial registries and grey literature (January 2000 to January 2022).

RESULTS

We screened 58,378 citations, identifying 96 studies. All tools were designed for use commencing at ICU admission except 3 tools implemented at 3, 5 or 14 days. We identified 32 studies of locally developed checklists, 28 goal setting/structured communication templates, 23 care bundles, and 9 studies of mixed format tools. Most (43 %) tools were designed for use during rounds, fewer tools were designed for use throughout the ICU day (27 %) or stay (9 %). Most studies (55 %) reported process objectives i.e., improving communication, care standardisation, or rounding efficiency. Most common clinical processes QI tools were used to standardise were sedation (62, 65 %), ventilation and weaning (55, 57 %), and analgesia management (58, 60 %). 44 studies reported the effect of the tool on patient outcomes. Of these, only two identified a negative effect - increased ICU length of stay and increased ICU days with pain and delirium.

CONCLUSION

Although we identified numerous QI tools for use in ICU settings, few were designed to specifically address actionable processes of care relevant to the unique needs of prolonged ICU stay patients. Tools that address these needs are urgently required.

SYSTEMATIC REVIEW REGISTRATION

The review protocol is registered on the Open Science Framework, https://osf.io/, DOI 10.17605/OSF.IO/Z8MRE.

Systematic Review of Quality Improvement Projects Related to Intershift Nursing Handover

BACKGROUND

Nursing handover is a real-time process in which patient-specific information is passed between nurses to ensure the continuity and safety of patient care.

PURPOSE

The purpose of this study was to determine the effects of quality improvement (QI) projects in improving the intershift nursing handover process.

METHODS

A computerized search was performed of electronic databases for articles published during 2009-2019 in English or Korean for which the full texts were available. The included studies involved QI projects, handover between nurses, and intershift handover. The QI-MQCS (Quality Improvement Minimum Quality Criteria Set) was used to appraise the quality of QI strategies.

RESULTS

The handover methods used in the 22 QI projects could be broadly divided into 2 types: (1) using a standardized communication tool; and (2) involving patient-participation bedside handover.

CONCLUSIONS

The published research on intershift handover-related QI projects employed standardized communication tools and the patient-participation bedside handover method to reduce adverse events and handover times and increase the satisfaction of patients and nurses. Future studies should measure the changes in patient safety-related outcomes.

Impact of Structured Clinical Handover Protocol on Communication and Patient Satisfaction

The Handover process is an essential aspect of patient care in daily clinical practice to ensure continuity of patient care. Standardization of clinical handover may reduce sentinel events due to inaccurate and ineffective communication. Single arm experimental trial was conducted to assess the effect of standard Situation, Background, Assessment, Recommendation (SBAR) protocol implementation in overall bedside nursing handover process, patient satisfaction, and nurses’ acceptance. As a sample, all nursing staff of specified unit, all handover process performed by them, and patients admitted during study the period were included. Initially, the prevailing handover process and patient satisfaction regarding nursing handover was assessed using a structured observation checklist. During the implementation phase, nurses were trained on an SBAR handover protocol. After implementation, nursing handovers were again assessed and data regarding patient satisfaction and nurses’ acceptance were collected. There was a statistically significant difference (P < .05) in median scores between the pre and post-intervention group on overall nursing handover and patient satisfaction regarding nursing handover. Standardization of patient’s handover process is effective in terms of improving nursing handover process, patient satisfaction, and health professionals’ acceptance.

Innovation in Education With Acute Care Nurses

As health care is continuously changing, it is important that nurses are continually learning to promote evidence-informed practice. eLearning has gained prominence to gain information and enhance learning within time and space constraints. Innovation such as gamification within and outside of eLearning has also risen in interest to increase engagement in the learning process. In this article, we discuss the usefulness of innovation such as gamification via an ePlatform for continuing education of acute care nurses. Although innovative methods using an ePlatform have the potential to meet nurses' desires for continuing education that is flexible and applicable to their work, more research is needed to understand its effectiveness among acute care nurses. [J Contin Educ Nurs. 2020;51(9):420-424.].

Preliminary Psychometrics of the Knowledge and Attitudes Toward SBAR Instrument (KA-SBAR)

BACKGROUND

When measuring new practice approaches for improving patient safety in the clinical setting, researchers need instruments with evidence of reliability and validity.

OBJECTIVE

The purpose of this analysis was to examine the reliability and validity of an instrument to assess knowledge and attitudes toward communication using situation-background-assessment-recommendation (SBAR; KA-SBAR).

METHODS

This psychometric analysis was conducted with data from an interprofessional simulation-based learning experience with doctor of nursing practice students (n = 19) and physical therapy students (n = 52). Internal consistency reliability and construct validity tests including factor analysis for the KA-SBAR were conducted.

RESULTS

The KA-SBAR instrument had adequate internal consistency reliability and evidence of construct validity, including identification of two factors that explained 70% of the instrument's variance. However, there may be a ceiling effect of scores, making it difficult to show change.

CONCLUSIONS

The KA-SBAR instrument may be useful in assessing clinicians' perceptions of SBAR communication in education and practice settings.

IMPLICATIONS FOR NURSING

When selecting data collection measures, nurses need to carefully consider the purpose of the measure and evidence of the instrument's reliability and validity. Educators need to consider the clinical expertise of the students in designing challenging simulations to advance learning.