Handover Practice Research Articles

474 Audit of ENT Department Handover Practice: An Improved Patient Safety Outcome

Abstract Aim To analyse the comprehensiveness and reliability of e-handover sheets in a district hospital ENT unit, and to compare the departmental standards in line with Royal College England Guidance on Safe Handover (2007). Method Retrospective analysis of e-handover sheets were analysed over two periods (31 days and 16 days). To improve standards, we distributed the Royal College of Surgeons England guidance, junior doctors received regular feedback and emphasise the importance of handover to the ENT doctors during clinical governance and induction sessions. Results The reaudit cycle demonstrated data transfer improved from morning handover information were present and complete on 70 per cent of days, present but incomplete 30 per cent of days, and absent on 0 per cent of days; evening handover information were complete 75 per cent of days, present but incomplete 25 per cent of days, and absent on 0 per cent of days. Conclusions Following our first and second audit cycle results, the quality and standards of e-handover information showed significant improvement.

Safe handoff practices and improvement of communication in different paediatric settings

Inadequate information management, especially during patient handoff, contributes to a large part of health care-related adverse events. The Committee for Quality of Care and Patient Safety of the Asociación Española de Pediatría has developed this document to provide an overview of handover practices in different paediatric care settings (emergency, inpatient, intensive care, neonatal and primary care). It describes resources to achieve safe and effective communication in all these settings, such as standardised handoff tools. It also proposes recommendations for the prevention of medication errors during the handover process, to improve safety in interhospital and intrahospital patient transfer, and to optimise communication and continuity of care in chronically ill and medically complex children.

The ACCELERATE Plus (assessment and communication excellence for safe patient outcomes) Trial Protocol: a stepped-wedge cluster randomised trial, cost-benefit analysis, and process evaluation

BackgroundNurses play an essential role in patient safety. Inadequate nursing physical assessment and communication in handover practices are associated with increased patient deterioration, falls and pressure injuries. Despite internationally implemented rapid response systems, falls and pressure injury reduction strategies, and recommendations to conduct clinical handovers at patients’ bedside, adverse events persist. This trial aims to evaluate the effectiveness, implementation, and cost–benefit of an externally facilitated, nurse-led intervention delivered at the ward level for core physical assessment, structured patient-centred bedside handover and improved multidisciplinary communication. We hypothesise the trial will reduce medical emergency team calls, unplanned intensive care unit admissions, falls and pressure injuries.MethodsA stepped-wedge cluster randomised trial will be conducted over 52 weeks. The intervention consists of a nursing core physical assessment, structured patient-centred bedside handover and improved multidisciplinary communication and will be implemented in 24 wards across eight hospitals. The intervention will use theoretically informed implementation strategies for changing clinician behaviour, consisting of: nursing executive site engagement; a train-the-trainer model for cascading facilitation; embedded site leads; nursing unit manager leadership training; nursing and medical ward-level clinical champions; ward nurses’ education workshops; intervention tailoring; and reminders. The primary outcome will be a composite measure of medical emergency team calls (rapid response calls and ‘Code Blue’ calls), unplanned intensive care unit admissions, in-hospital falls and hospital-acquired pressure injuries; these measures individually will also form secondary outcomes. Other secondary outcomes are: i) patient-reported experience measures of receiving safe and patient-centred care, ii) nurses’ perceptions of barriers to physical assessment, readiness to change, and staff engagement, and iii) nurses’ and medical officers’ perceptions of safety culture and interprofessional collaboration. Primary outcome data will be collected for the trial duration, and secondary outcome surveys will be collected prior to each step and at trial conclusion. A cost–benefit analysis and post-trial process evaluation will also be undertaken.DiscussionIf effective, this intervention has the potential to improve nursing care, reduce patient harm and improve patient outcomes. The evidence-based implementation strategy has been designed to be embedded within existing hospital workforces; if cost-effective, it will be readily translatable to other hospitals nationally.Trial registrationAustralian New Zealand Clinical Trials Registry ID: ACTRN12622000155796. Date registered: 31/01/2022.

Perceived Quality of Postoperative Handover by Saudi Nurses: A Single-Center Cross-Sectional Study.

Handover is considered a basic nursing practice in which a patient's care information is moved to another nurse. Handover of patients after surgery is critical due to a number of care transitions, the presence of a surgical procedure, and the influence of anesthesia. High-quality postoperative handover is essential to safe patient care. Few studies have been conducted to evaluate the quality of current postoperative handover practices and the factors contributing to the quality of such processes, especially in Saudi Arabia. The present research aimed at evaluating nurses' perceptions of postoperative handover quality and assessing factors impacting this process.This cross-sectional study targeted registered nurses with at least one year of professional experience who were actively involved in the conduction of postoperative handovers across various surgical departments. A total sample of 143 nurses was selected via a convenient sampling technique. Study instruments included Handover Quality Rating Form, patient status, and nurses' background characteristics. Overall, postoperative handover quality was perceived as high by handing over and receiving nurses. Generally, 55.2% of nurses agreed on the different items supporting the positive circumstance for handover, and 92.3% agreed on the good conduct of handover compared to only 7.69% disagreement (p˂0.001). Significant agreements were observed for teamworking (p˂0.001), as well as four indicators (out of five) measuring the overall handover quality (p<0.001). The type of involved departments impacted significantlythe handover quality perception(p=0.004). The respondents' age had asignificant effect onquality (p=0.036), as well as circumstances of postoperative handover (p=0.046). Moreover, significant statistical differences were found for the circumstance of handover (p=0.031), as well as teamwork (p=0.019) according to the nurses' roles.Finally, the patient's blood circulation and respiration had a significant effect (p=0.023, p=0.033, respectively), as did the patient's level of consciousness (p=0.006) in the nurses' perception of the overall postoperative handover quality. Postoperative handover quality was highly perceived by nurses. This research explored a multitude of factors such as patient health status and nurses' socio-demographic variables and their impact on nurses' perception of handover quality. Several nurse and patient-related factors were found to impact the handover process. This current research provided findings that could direct future improvements in nursing handover practice to ensure high-quality patient care.

Having a Bad Day Is Not an Option: Learner Perspectives on Learner Handover.

Learner handover is the sharing of learner-related information between supervisors involved in their education. The practice allows learners to build upon previous assessments and can support the growth-oriented focus of competency-based medical education. However, learner handover also carries the risk of biasing future assessments and breaching learner confidentiality. Little is known about learner handover's educational impact, and what is known is largely informed by faculty and institutional perspectives. The purpose of this study was to explore learner handover from the learner perspective. Constructivist grounded theory was used to explore learners' perspectives and beliefs around learner handover. Twenty-nine semistructured interviews were completed with medical students and residents from the University of Ottawa and University of California, San Francisco. Interviews took place between April and December 2020. Using the constant comparative approach, themes were identified through an iterative process. Learners were generally unaware of specific learner handover practices, although most recognized circumstances where both formal and informal handovers may occur. Learners appreciated the potential for learner handover to tailor education, guide entrustment and supervision decisions, and support patient safety, but worried about its potential to bias future assessments and breach confidentiality. Furthermore, learners were concerned that information-sharing may be more akin to gossip rather than focused on their educational needs and feared unfair scrutiny and irreversible long-term career consequences from one shared mediocre performance. Altogether, these concerns fueled an overwhelming pressure to perform. While learners recognized the rationale for learner handover, they feared the possible inadvertent short- and long-term impact on their training and future careers. Designing policies that support transparency and build awareness around learner handover may mitigate unintended consequences that can threaten learning and the learner-supervisor relationship, ensuring learner handover benefits the learner as intended.

Transferencia segura de pacientes y mejora de la comunicación en distintos entornos asistenciales

Inadequate information management, especially during patient handoff, contributes to a large part of health care-related adverse events. The Committee for Quality of Care and Patient Safety of the Asociación Española de Pediatría has developed this document to provide an overview of handover practices in different paediatric care settings (emergency, inpatient, intensive care, neonatal and primary care). It describes resources to achieve safe and effective communication in all these settings, such as standardized handoff tools. It also proposes recommendations for the prevention of medication errors during the handover process, to improve safety in interhospital and intrahospital patient transfer, and to optimize communication and continuity of care in chronically ill and medically complex children.

Clinical Handover Practice in the Emergency and Trauma Department of SASMEC@IIUM: An Observational Qualitative Study.

Clinical Handover Practice in the Emergency and Trauma Department of SASMEC@IIUM: An Observational Qualitative Study.

Strategies for strengthening UX competencies and cultivating corporate UX in a large organisation developing robots

ABSTRACT Integrating UX into industry practices is a well-researched topic particularly for software companies. However, little is known about how UX integration and adoption ‘works’ within the robotics industry. This study identifies behaviours impeding UX adoption at the individual, team, and organisational level within a company developing robots. We carried out a one-year long Action Research study in a large, international company during design and development of a service robot. Based on a UX maturity assessment, we carried out six interventions, where the researcher and practitioners worked deliberately with UX competence-development and the company's UX culture. Together we identified six barriers: achieving appropriate confidence levels, trust in UX, commitment and support structures, trade-offs in UX, handover practices, and UX management. To address these barriers, we developed and tested 21 strategies to help foster good UX practices and promote a ‘UX-friendly’ culture that empowers non-UX professionals to drive user-involved initiatives themselves.

Quality of Postoperative Handover as Perceived by Nurses in Saudi Arabia: A Cross-Sectional Study

Background: Handover is considered a basic nursing practice in which a patient's care information is moved to another nurse. Handover of patients after surgery is critical due to number of care transitions, presence of a surgical procedure, and the influence of anesthesia. High-quality postoperative handover is essential to safe patient care. Few studies have been conducted to evaluate the quality of current postoperative handover practices and the factors contributing to quality of such process, especially in Saudi Arabia.

Effectiveness of handover practices between emergency department and intensive care unit nurses.

Nurses from the emergency department (ED) and the intensive care unit (ICU) must interact during the handover procedure. Factors such as unit boundaries, the interaction between different specialities, patient acuities, and treatment adjustments generate specific negotiating and teamwork problems during the transition of patients from ED to ICU. This study aimed to describe the opinions of nurses regarding the effectiveness of handover practices between nurses in the ED and ICU in a major academic hospital in Gauteng province, South Africa. An analytical cross-sectional survey design was used. Data were collected using a 16-item handover evaluation tool. It comprises two sections (1) biographical details and (2) 16 statements about handover quality divided into five constructs, namely information transfer, shared understanding, working atmosphere, overall handover quality, and circumstances of handover. Data analysis was done utilising descriptive and non-parametric statistics. The majority (51.8%; n=115) of the handovers occurred during the day. Out of 171 nurses, there were specialist practice emergency (19.2%; n=33) and intensive care (28.0%; n=48) nurses. There was statistical significance in information transfer between the ED and ICU nurses. (Me=4.0, p<0.05), compared to ICU nurses (Me=3.0). Nurse specialist and non-specialist nurses' handovers differed statistically significantly on 12 of the 16 items on the rating scale, compared to 10 for non-specialist nurses' handovers. The study showed that ED and ICU nurses have significantly different requirements and expectations for handover procedures. In addition to completed documentation, subtle interpretations of the information provided and received also impact the need. The ED and ICU nurses would need to agree on the contents of a structured handover framework because different specialities and departments have varied expectations to achieve an effective handover.

Shift handover quality in Saudi critical care units: determinants from nurses’ perspectives

BackgroundNurses’ 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.MethodsA 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.ResultsThe 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 recommendationsNursing 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.

Nurses' perspectives on shift-to-shift handovers in relation to person-centred nursing home care.

The aim of this study was to gain insight into nurses' perspectives on the shift-to-shift handover in relation to providing Person-centred care (PCC) in nursing homes. PCC is perceived as the gold standard for nursing home care. To preserve the continuity of PCC, an adequate handover during the nurses' shift change is essential. There is, however, little empirical evidence for what constitutes best shift-to-shift nursing handover practices in nursing homes. An exploratory qualitative descriptive study. Nine nurses were selected purposively and through snowball sampling from five Dutch nursing homes. Semi-structured face-to-face and telephone interviews were conducted. Analysis relied on Braun and Clarke's thematic analysis. Four main themes were identified related to enabling PCC informed handovers: (1) knowing the resident to be enable to provide PCC was key, (2) the actual handover, (3) additional ways of information transfer and (4) nurses' knowledge of the resident prior to start shift. The shift-to-shift handover is one way that nurses become informed about residents. Knowing the resident is essential to enable PCC. The fundamental underlying question is to what extent nurses have to know the resident in order to enable PCC. Once that level of detail has been established, in-depth research is needed to determine the best method for conveying this information to all nurses. Only then can we start to rethink the role of the shift-to-shift handover in conveying PCC-driven information. No Patient or Public Contribution.

Developing an ESP workshop to promote handover practices in nursing communication: A case study of nurses in a bilingual hospital in Hong Kong

Handovers are major clinical tasks in nursing practice involving the transfer of responsibility and accountability for patient care from one nurse to another. As English-medium nursing training is increasing, nurses who use English as a second language may find handovers challenging. Ineffective communication during handovers due to incomplete and unstructured information can be a major contributor to patient harm and critical incidents in hospitals. This study evaluates whether ESP workshops can enhance nurses’ communication skills in handovers by incorporating handover protocols (i.e., the use of ISBAR, CARE) for better logical sequencing of clinical information and good quality of interactions between nurses. A 3-hour ESP handover communication workshop was implemented in a hospital in Hong Kong with a study population of 55 nurses. Data were collected through observations, surveys, and interviews and were analysed pre- and post-workshop. The findings indicate that post-workshop both informative and interactive dimensions improved in 1) message delivery after using ISBAR, 2) coherence due to sequential marker use and 3) increased interaction between incoming and outgoing staff as demonstrated by active clarification seeking and comprehension checking. ESP support for nurses should focus on English needs in performing clinical tasks so that optimal care can be provided.

NURSING HANDOVER PRACTICES AMONG STAFF NURSES OF INTENSIVE CARE UNIT AT SELECTED HOSPITAL GUWAHATI ASSAM: AN EVALUATIVE STUDY

The nursing handover is a key moment for guaranteeing the continuity of care and the patient's safety. Poor communication information is the main possible factor and related risk factor for sentinel events.1 To assess the Aims: nursing handover practices among the staff nurses of ICU at selected hospital Guwahati, Assam. Exploratory survey approach was Methodology: adopted to assess the nursing handover practices among 60 staff nurses of ICU by using purposive sampling technique. The study nding Results: reveals satisfactory handover practices among staff nurses in ICU as majority of the ndings showed 100%. The physical factors of the staff nurses also play an important role in the patient care. Regarding psychological factors, the present study also revealed that 91.97% of the staff nurses did not get rest at work place. Social factor also had an impact on the staff nurses. The nding related to the professional factor was satisfactory as majority of the aspects in it were fullled. Keeping in view with the Conclusion: ndings it is recommended that regular educational programs and training to the staff nurses for developing the nursing handover.

Nursing Handover: Experiences and Perspectives in the Critical Care Unit at Murang’a County Referral Hospital

Continuity in delivery of nursing care to patient in the critical care unit is of utmost importance. Although nurses have a variety of guidelines and formats to conduct the handover, gaps have been detected regarding the contents of the handover and its effects on the continuity of care in the critical care unit. The focus of the study was to explore the experiences and perspectives of nurses with nursing handover in the critical care unit. The study adopted a phenomenological qualitative design. A sample of 9 critical care nurses participated in this study. The study found critical care nurses believed they were individually equipped with adequate knowledge to carry out effective departmental and interdepartmental nursing handover. The existence of handover policies in the critical care unit was considered a major enabler of the handover. The participants also believed that strained human resource, lack of standardized handover tools and deviation from the set handover rules negatively impacted the handover process. Furthermore, they reported perceived insufficiency in the management’s role in handover evaluation and feedback. Moreover, all participants advocated for improvement of the current handover practices for improved quality of patient care as well as sense of self-accomplishment among the nurses. There are pertinent implications in the findings of this research for critical care nurses, nurses in other departments and policy makers. The resultant implication for each group of stakeholders promotes the adoption and formulation of effective handover practices and consequently enhanced quality of patient care through transfer of adequate patient information and sense of self-accomplishment among nurses. Keywords: Nursing handover, experiences, perspectives, critical care unit

QI initiative to introduce a formal anaesthetic shift handover in a district general hospital

Background: International research has highlighted a number of problems in handovers. 1 Despite being identified as a key part of a patient’s journey, no standardised best practice exists.2 In our anaesthetic department, anecdotal reports of suboptimal handover practice, poor trainee survey results, and accreditation requirements all naturally led to targeted improvement. We aimed to: (1) introduce a standardised anaesthetic shift handover process compliant with Royal College of Anaesthetists (RCoA) Anaesthesia Clinical Services Accreditation (ACSA) standard 1.1.1.3 (‘there is a structured handover between shifts’)3 with a target of >75% of handovers being dated and persons identifiable; (2) undertake semi-structured interviews to test the hypothesis that the intervention: (a) led to improved stakeholder perception of handover, (b) improved perception of patient safety, and (c) better information exchange.

Effective nursing shift handover in critical care: A concept analysis.

To explore the concept of effective shift handover in critical care settings.Ineffective handover is one of the leading causes of adverse events in healthcare settings. Nursing shift handover in the intensive care unit (ICU) is more complex and detailed than in other in-patient wards due to the complexity of medical issues experienced by ICU patients. It is, therefore, critical that nurses be able to conduct handover effectively. Despite the importance of handover, the definition and attributes of effective handover are not clearly understood.Walker and Avant's eight-step approach to concept analysis.Effective handover in nursing is an interactive process between two nurses, resulting in the direct transfer of adequate patient-specific recent information in a manner that creates a shared understanding of information. Its defining attributes are (1) content-related and (2) process-related attributes. The antecedents of effective handover are organizational support, interpersonal relationship, and work environment. Its consequences include patient and nurse satisfaction, improved care, and continuity of care. Empirical referents include several tools developed to measure some of the effective handover attributes.The definition provides a connotative meaning and is the first step toward concept validation and instrument development to measure effective handover practice in the ICU.

Improving the Medical and Surgical Out-of-Hours Handover at a Hospital in Regional New South Wales, Australia.

Introduction: Effective handover between shifts is widely accepted as essential for continuity of care and patient safety. Problems with out-of-hours handover were identified at our hospital, having come to light following attendance at handover meetings by the authors.Methods: Consultation of junior doctors was performed to identify issues with the out-of-hours handover and a baseline audit was conducted to objectively assess handover practice. Local guidelines were used to create a handover tool, which was subsequently implemented and assessed via multiple PDSA (plan, do, study, and act) cycles. In addition, registrar education was undertaken. Concurrently, meetings with senior clinicians and managers were held to address wider issues including venue, intensive care registrar attendance, emergency call procedures, and implementation of an electronic handover tool.Results: Junior doctor consultation and baseline audit identified failings in handover. Following our intervention, improvements were demonstrated in the handover of patient information, including diagnosis (50% increase), investigations (76% increase), and plan (33% increase). Doctor attendance and punctuality also improved, along with a more punctual start time and reduced handover duration of five minutes on average.Conclusion: Bringing structure and leadership to an informal and inconsistent handover system using simple and well-defined methods can improve the quality and consistency of handover. The sustainability of the intervention was demonstrated with continued improvements seen in a subsequent cycle.

Lost in relocation: longitudinal surveys evaluating the effectiveness of ICU to ward handover after the introduction of an electronic patient record

ABSTRACT Background Poor communication and lack of standardized handover practices contribute to adverse events. Intensive care organizations recommend standardized, structured written and verbal handover. Objectives Investigate the effectiveness of, and barriers to, Intensive Care Unit (ICU) patient handover at ward transfer. Screen for patient safety incidents related to poor handover and improve practice where deficiencies are identified. Methods A survey of ward doctors about specific ICU to ward transfers and online surveys ascertaining opinions of handover processes were sent to ward-based and ICU doctors at a large, adult, university affiliated, Australian quaternary hospital. We delivered departmental education and created then publicized a new electronic ICU transfer summary. The summary included a mandatory tick-box to confirm verbal handover completion. Surveys re-assessing practice were then performed. Results Forty ward-based doctors were surveyed about specific transfers, with 7 (18%) instances of issues related to handover identified. Eighty-seven ward doctors completed the pre-interventions survey; 48 (55%) were aware of the existing written transfer summary. Post-interventions, 47 (75%) of 63 ward doctor responders were aware of it (p < 0.05). Pre-interventions, 14 (16%) ward doctors rated ICU handovers as excellent or good, rising to 21 (34%) post-interventions (p < 0.05). Thirty-nine ICU doctors completed the pre-interventions survey; 5 (13%) rated ICU to ward handover as excellent or good, rising to 9 (35%) when re-surveyed (p = 0.097). Conclusions The perceived quality of ICU to ward handover improved after our interventions. However, ICU doctors continue to transfer patients without verbally handing over, with contacting the ward team representing a significant handover barrier.

Exploring nurses' perceptions of clinical handover in regional health care facilities: A exploratoryqualitative study.

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. 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. 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. 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. 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. 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.