Mixed methods evaluation of a quality improvement and audit tool for nurse-to-nurse bedside clinical handover in ward settings

BACKGROUND: Nurse bedside handover quality is influenced by complex interactions related to the content, processes used and the work environment. Audit tools are seldom tested in 'real' settings. OBJECTIVE: Examine the reliability, validity and usability of a quality improvement tool for audit of nurse bedside handover. DESIGN: Naturalistic, descriptive, mixed-methods. SETTING: Six inpatient wards at a single large not-for-profit private health service in Victoria, Australia. PARTICIPANTS: Five nurse experts and 104 nurses involved in 199 change-of-shift bedside handovers. METHODS: A focus group with experts and pilot test were used to examine content and face validity, and usability of the handover audit tool. The tool was examined for inter-rater reliability and usability using observation audits of handovers across six wards. Data were collected in 2013-2014. RESULTS: Two independent observers for 72 audits demonstrated acceptable inter-observer agreement for 27 (77%) items. Reliability was weak for items examining the handover environment. Seventeen items were not observed reflecting gaps in practices. Across 199 observation audits, gaps in nurse bedside handover practice most often related to process and environment, rather than content items. Usability was impacted by high observer burden, familiarity and non-specific illustrative behaviours. CONCLUSION: The reliability and validity of most items to audit handover content was acceptable. Gaps in practices for process and environment items were identified. Context specific exemplars and reducing the items used at each handover audit can enhance usability. Further research is needed to develop context specific exemplars and undertake additional reliability testing using a wide range of handover settings. WHAT IS ALREADY KNOWN ABOUT THIS TOPIC: CONTRIBUTION OF THE PAPER.