Elsevier

Australian Critical Care

Volume 29, Issue 3, August 2016, Pages 165-171
Australian Critical Care

Research paper
Nursing handover from ICU to cardiac ward: Standardised tools to reduce safety risks

https://doi.org/10.1016/j.aucc.2015.09.002Get rights and content

Abstract

Background

Standardising handover processes and content, and using context-specific checklists are proposed as solutions to mitigate risks for preventable errors and patient harm associated with clinical handovers.

Objectives

Adapt existing tools to standardise nursing handover from the intensive care unit (ICU) to the cardiac ward and assess patient safety risks before and after pilot implementation.

Methods

A three-stage, pre-post interrupted time-series design was used. Data were collected using naturalistic observations and audio-recording of 40 handovers and focus groups with 11 nurses. In Stage 1, examination of existing practice using observation of 20 handovers and a focus group interview provided baseline data. In Stage 2, existing tools for high-risk handovers were adapted to create tools specific to ICU-to-ward handovers. The adapted tools were introduced to staff using principles from evidence-based frameworks for practice change. In Stage 3, observation of 20 handovers and a focus group with five nurses were used to verify the design of tools to standardise handover by ICU nurses transferring care of cardiac surgical patients to ward nurses.

Results

Stage 1 data revealed variable and unsafe ICU-to-ward handover practices: incomplete ward preparation; failure to check patient identity; handover located away from patients; and information gaps. Analyses informed adaptation of process, content and checklist tools to standardise handover in Stage 2. Compared with baseline data, Stage 3 observations revealed nurses used the tools consistently, ward readiness to receive patients (10% vs 95%), checking patient identity (0% vs 100%), delivery of handover at the bedside (25% vs 100%) and communication of complete information (40% vs 100%) improved.

Conclusion

Clinician adoption of tools to standardise ICU-to-ward handover of cardiac surgical patients reduced handover variability and patient safety risks. The study outcomes provide context-specific tools to guide handover processes and delivery of verbal content, a safety checklist, and a risk recognition matrix.

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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