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

Graan, Sher Michael, Botti, Mari, Wood, Beverley and Redley, Bernice 2016, Nursing handover from ICU to cardiac ward: standardised tools to reduce safety risks, Australian critical care, vol. 29, no. 3, pp. 165-171, doi: 10.1016/j.aucc.2015.09.002.

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Title Nursing handover from ICU to cardiac ward: standardised tools to reduce safety risks
Author(s) Graan, Sher Michael
Botti, MariORCID iD for Botti, Mari
Wood, Beverley
Redley, BerniceORCID iD for Redley, Bernice
Journal name Australian critical care
Volume number 29
Issue number 3
Start page 165
End page 171
Total pages 7
Publisher Elsevier
Place of publication Amsterdam, The Netherlands
Publication date 2016-08
ISSN 1036-7314
Keyword(s) checklist
clinical handover
intensive care unit
patient safety and quality
standardised framework
Summary 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.
Language eng
DOI 10.1016/j.aucc.2015.09.002
Field of Research 111099 Nursing not elsewhere classified
1110 Nursing
Socio Economic Objective 920210 Nursing
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2015, Australian College of Critical Care Nurses
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