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

Sher Michael Graan; Mari Botti; Beverley Wood; Bernice Redley

doi:10.1016/j.aucc.2015.09.002

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

Aust Crit Care. 2016 Aug;29(3):165-71. doi: 10.1016/j.aucc.2015.09.002. Epub 2015 Oct 26.

Authors

Sher Michael Graan¹, Mari Botti², Beverley Wood³, Bernice Redley⁴

Affiliations

¹ Deakin University, School of Nursing and Midwifery, Burwood Highway, Burwood 3125, Australia; Epworth Healthcare, 89 Bridge Road, Richmond 3121, Australia. Electronic address: bashirgran@hotmail.com.
² Deakin University, School of Nursing and Midwifery, Burwood Highway, Burwood 3125, Australia; Epworth Deakin Centre for Clinical Nursing Research, 185-87 Hoddle Street, Richmond, Victoria 3121, Australia. Electronic address: mari.botti@deakin.edu.au.
³ Deakin University, School of Nursing and Midwifery, Burwood Highway, Burwood 3125, Australia; Epworth Deakin Centre for Clinical Nursing Research, 185-87 Hoddle Street, Richmond, Victoria 3121, Australia. Electronic address: beverley.wood@deakin.edu.au.
⁴ Deakin University, School of Nursing and Midwifery, Burwood Highway, Burwood 3125, Australia; Epworth Deakin Centre for Clinical Nursing Research, 185-87 Hoddle Street, Richmond, Victoria 3121, Australia. Electronic address: Bernice.redley@deakin.edu.au.

PMID: 26515413
DOI: 10.1016/j.aucc.2015.09.002

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.

Keywords: Checklist; Clinical handover; Intensive care unit; Patient safety and quality; Standardised framework.

MeSH terms

Cardiovascular Nursing*
Checklist
Critical Care Nursing*
Female
Focus Groups
Humans
Interrupted Time Series Analysis
Male
Medical Errors / prevention & control
Middle Aged
Patient Handoff / standards*
Patient Safety*