Developing a minimum dataset for nursing team leader handover in the intensive care unit: a prospective interventional study

Abstract

Since the World Health Organization listed clinical handover as a top five priority area for patient safety, the evidence-base and resources generated to improve handover communication has increased. But literature specific to the intensive care unit (ICU) handover, particularly handover from shift-to-shift by the ICU nurse Team Leader (TL) remains limited. The aims of this three-phase interventional study focused on understanding current TL handover practices and implementing a handover strategy to improve this practice. The aim of Phase 1 was to determine the content of ICU nursing TL handover. The aim of Phase 2, was to identify the key components for inclusion in a handover minimum dataset (MDS) and, the aim of Phase 3 was to implement and evaluate an electronic minimum dataset (eMDS) for nursing TL handover. A modified version of the Knowledge-to-Action framework guided each phase of this research. The study was conducted in a 21-bed ICU, at a tertiary referral hospital in Brisbane, Australia. Senior nurses working in TL roles were sampled for this study. Phase 1 involved audiotaping TL handovers to identify the content discussed during handovers. Audio recordings were transcribed and content analysis was used to analyse the data. A quantitative approach was used to identify the frequency of a priori categories and subcategories. Phase 2 consisted of focus groups with TLs to determine the content to include in an MDS for handover. Descriptive statistics were used to analyse responses from focus groups. In Phase 3, TLs were given surveys to complete to determine the barriers and facilitators to eMDS use prior to implementation. Survey results were analysed using descriptive statistics and the frequency of recurring responses to dichotomous and open-ended questions were summarised. Three months post eMDS implementation, TLs’ use of the eMDS was assessed by auditing and evaluating nurses’ perceptions through the distribution of surveys to TLs. Descriptive statistics were used to summarise audit and survey data. Phase 1 findings revealed that TL handovers contained variable content, and that aspects of handover did not meet the Australian National Standards (e.g. handovers were conducted at the desk rather than bedside). In Phase 2, TLs identified the content to include in an MDS for handover. The content of the MDS was structured using the ISBAR (Identify-Situation-Background-Assessment-Recommendations) schema and included additional items specific to ICU nursing TL handover. In Phase 3, the barriers and facilitators to eMDS use were identified prior to implementation. These focused on usability, content and efficiency of the eMDS, and informed implementation strategies adopted to implement the eMDS. Implementation strategies included education, champions, reminders and ad hoc audit and feedback. Three months post implementation, audit results revealed TLs had relocated handovers to the bedside, and TLs were using the eMDS. Some key content items were discussed frequently while others showed no improvement or were absent from handovers. Results also highlighted that additional documentation was required alongside the eMDS to conduct handovers. Surveys of TLs’ perceptions identified benefits and disadvantages to eMDS use. Benefits were: improved patient content and time saved updating the tool. Disadvantages were: irrelevant patient content included, with pertinent content missing from handovers, and difficulties navigating the tool. Shortcomings of the eMDS were a result of limitations within the clinical information system (CIS) to filter and draw relevant data required into the tool. Nurses suggested eMDS modifications were needed to increase usability. This is the first study to examine nursing TL handover, and to implement and evaluate an evidence-based eMDS for nursing TL shift-to-shift handover in the ICU. While the eMDS requires further testing and modifications, it is the first evidence-based handover tool developed for the MetaVision CIS that can be utilised and adapted by other ICUs. Continual iterations of the eMDS should occur in collaboration with vendors, information technology teams, and in alignment with national guidelines, to increase patient safety. The use of simulation in education and training, is the next step to informing relevant changes to the eMDS and optimising ICU nursing TL handover practices. Organisations need to recognise the value of practice improvements by investing funds to successfully implement and sustain the use of evidence-based practices. Evidence-based practices that are embedded in healthcare settings will ensure patients receive quality care and will improve patient outcomes.