Research paperNursing handover from ICU to cardiac ward: Standardised tools to reduce safety risks
Section snippets
Background
Highly variable processes for clinical handover during the transfer of professional responsibility and accountability for the care of patients,1 in complex handover situations in high-risk clinical settings increases the risk for serious adverse events and patient harm2 resulting from handover miscommunication.3 Ineffective communication and poor quality handover information4, 5, 6, 7 are identified consistently as lead contributing factors in serious events both in Australia8, 9, 10 and
Methods
The study was conducted in a metropolitan private hospital with a 15-bed, level 3 ICU with a high turnover (1919 admissions in 2013 averaging 36 patient transfers per week to all wards) and a 46-bed cardiac surgical ward. Ethical approval was obtained from the hospital and affiliated university Human Research Ethics Committees (LR08112).
A three-stage multi-method pre-post interrupted time-series design incorporated focus group interviews with stakeholders and observation of episodes of handover
Patient characteristics
The mean age of cardiac surgical patients in handovers observed during Stages 1 and 3 was similar (64.7 vs 63.4 years). Stage 1 involved more female patients than Stage 3 (60% vs 20%), and more patients transferred with pacing (45% vs 15%) and intravenous access (75% vs 50%). All other characteristics (equipment and monitoring) were similar (Table 1).
Nurses’ characteristics
The 35 ICU nurses providing handover in observed episodes in Stages 1 (n = 18) and 3 (n = 17) were similar in their number of years of nursing
Discussion
Standardisation of clinical handover has been shown to reduce safety risks and improve the transfer of responsibilities and accountabilities during clinical handover26, 27; however, it must be suited to the context of intended use.20 This pilot study demonstrated that process and content tools combined with a checklist tailored to the context and reflecting NSQHS Standards assisted nurses in delivery of clinical handover as patients were transferred from ICU to a cardiac ward. The format of the
Conclusion
This pilot study demonstrated both successful adaptation of existing tools to standardise handover for patient transfers from ICU-to-ward informed by the practice context, and the mitigation of the risks observed during baseline handover episodes. The outcomes provide context-specific tools useful to guide handover processes and verbal content, a safety checklist based on the NSQHS Standards and a risk recognition matrix. The methodology used for this project demonstrated sensitivity to changes
Conflict of interest
None
Authors contributions
All authors listed have contributed to the conception and design, drafting and revising for intellectual content, accountable for all aspects of the work: ensure questions are investigated and resolved; and final approval of the version to be submitted.
Acknowledgement
This work was supported by a staff scholarship awarded by Epworth Healthcare.
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2022, Applied Nursing ResearchTransition of patients from intensive care unit: A concept analysis
2022, International Journal of Africa Nursing SciencesHandover practices of nurses transferring trauma patients from intensive care units to the ward: A multimethod observational study
2020, Australian Critical CareCitation Excerpt :Between-ward handovers are challenged by infrequent face-to-face communication between an ICU nurse and ward nurse and a potential lack of clinical expertise by the receiving ward nurse.13 Handover of ICU patients during transfer is further complicated by the challenges of interspecialty communication and collaboration,11 clinicians lacking adequate handover training and expertise,4 increased acuity of patients, and the amount and complexity of information to be communicated.3,14 Patient safety risks are intensified in trauma ICU patients who often have multiple specialist teams providing patient care.
The critical care nurse's perception of handover: A phenomenographic study
2020, Intensive and Critical Care NursingCitation Excerpt :Other studies explore the possibility of implementing technology in handover reports (Johnston et al., 2014; Randell et al., 2011), which was mentioned only in connection to electronic patient charts in this study. In this study, the structure of handover was considered an important factor for good communication, as emphasised in previous studies (DeMeester et al., 2013; Graan et al., 2016; Miller et al., 2009; Randmaa et al., 2014; Riesenberg et al., 2009). However, according to the findings in the present study, more aspects need to be considered to improve handover.
Nurse-to-nurse communication about multidisciplinary care delivered in the emergency department: An observation study of nurse-to-nurse handover to transfer patient care to general medical wards
2020, Australasian Emergency CareCitation Excerpt :Semi-structured and unstructured field note data and nurse characteristics were also recorded electronically into a purpose-designed form in REDCap. The observation tool used the Connect, Observe, Listen and Delegate (COLD) process developed and validated in previous research [15,18] to examine the quality of high-risk patient transfers [12]. The elements are: connect the patient to staff and equipment, observe to ensure immediate care and safety needs are met, listen during verbal exchange of patient information, and delegate responsibility using discussion, a checklist or documents, and clarification of important patient information.
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