Bedside nurse-to-nurse handoff promotes patient safety (original) (raw)
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Transitioning Nurse Handoff to the Bedside
Nursing Administration Quarterly, 2018
The emergency department is a complex environment in which reliable communication is vital for safe patient care. Communication during nurse shift report can be risky without an effective report process in practice. Reliability improves with the use of a standardized, patient-centered nurse handoff process. Quality improvement methods were used to promote reliable information exchange during nurse shift handoff through the implementation of a standardized, patient-centric bedside report process. Forty-six hospital-based emergency nurses participated in the project. Outcomes were measured through observation of bedside report process, nurse, and patient surveys. Of 13 handoffs observed, 92% occurred at the bedside and 54% of patients actively participated in the report process. The offgoing nurses adopted most elements of the handoff process, while the oncoming nurses were less successful. Nurses believed that the new process influenced their ability to respond to patient needs and patients were more satisfied with nurses. A structured, patient-centered bedside handoff process can reduce safety risk and promote satisfaction with care through reliable information exchange. This implementation template for bedside handoff engages staff and patients while translating best practice.
Strategies to support continuity of care and improve patient safety during clinical handover have been developed. The aims of this study were to identify the strengths and limitations in current practice of nursing clinical handover and implement a new bedside handover process. A total of 259 nurses completed a cross-sectional survey at change of shift on 1 day, which was followed by an audit of the pilot implementation of bedside handover. The survey results showed great variation in the duration, location and method of handover with significant differences in the experience of nurses employed part-time compared with full-time. Following implementation of standardized bedside handover on two wards, the audit revealed significant improvement in the involvement of patients, use of Situation-Background-Assessment-Recommendation, active patient checks and checking of documentation. These findings suggest the use of standardized protocols and communication tools for bedside handover improve continuity of patient care.
Change‐of‐Shift Nursing Handoff Interruptions: Implications for Evidence‐Based Practice
Worldviews on Evidence-Based Nursing, 2019
Background: The importance of change-of-shift handoffs in maintaining patient safety has been well demonstrated. Change-of-shift handoff is an important source of data used in surveillance, a nursing intervention aimed at identifying and preventing complications. Surveillance requires the nurse to acquire, process, and synthesize information (cues) encountered during patient care. Interruptions in handoff have been observed but there is a gap in the evidence concerning how interruptions during nurse-to-nurse handoff impact the change-of-shift handoff process. Aims: To describe registered nurses' perceptions of interruptions experienced during changeof-shift handoff at the bedside in critical care units and analyze the number, type, and source of interruptions during change-of-shift handoff at the bedside. Methods: An exploratory descriptive design was used. One hundred nurse-to-nurse handoffs were observed, and four focus groups were conducted. Observation data were analyzed with descriptive statistics and quantitative content analysis. Focus group data were analyzed with qualitative content analysis. Results and Findings: Of the 1,196 interruptions observed, 800 occurred in the communication between the two nurses involved in the handoff. Over 80% (645) of these interruptions were from the nurse receiving handoff and included questions or clarification of information received. About half of the nurses reported that interruptions occurred during handoff. Focus group findings revealed that whether or not something is an interruption is determined by the individual nurse's appraisal of value added to their knowledge of the patient and/or plan of care at the time of handoff. Linking Evidence to Action: Interruptions during handoff are evaluated as useful or disruptive based on the value to the nurse at the time. Strict structuring or mandating of handoff elements may limit nurses' ability to communicate information deemed most relevant to the care of a specific unique patient. BACKGROUND AND SIGNIFICANCE Nurses work in complex environments that require a constant state of attention to multiple cues in order to maintain patient safety through surveillance (Schmidt, 2010; Sitterding, Broome, Everett, & Ebright, 2012). Surveillance is used by nurses to acquire, process, and synthesize vast amounts of information in the course of a patient encounter (Bulechek, Butcher, Dochterman, & Wagner, 2013). Furthermore, surveillance is defined as the "purposeful and ongoing acquisition, interpretation, and synthesis of patient data for clinical decision-making" (Bulechek et al., 2013). Change-of-shift handoffs have been identified as important sources of cues (data) and information needed and used by nurses to maintain patient safety (Henneman,
Bedside nursing handover: A case study
International Journal of Nursing Practice, 2010
A case study of six wards in two hospitals was undertaken to describe the structures, processes and perceptions of outcomes of bedside handover in nursing. A total of 532 bedside handovers were observed and 34 interviews with nurses conducted. Important structural elements related to the staff, patients, the handover sheet and the bedside chart. A number of processes prior to, during, and after the handover were implemented. They included processes for managing patients and their visitors, sensitive information, and the flow of communication for variable shift starting times. Other key processes identified were the implementation of a safety scan and medication check. The situation, background, assessment, recommendations (SBAR) approach was used only in specific circumstances.
Bedside handover at the change of nursing shift: A mixed‐methods study
Journal of Clinical Nursing
Aim: To describe the structures, processes and content of bedside handover at the change of nursing shift in an acute care context. Background: The handover of patient information and care at the change of nursing shift is an essential, albeit risk laden, time consuming activity in clinical practice. Design: A convergent parallel mixed methods design was used. Methods: Thirty episodes of bedside handover were concurrently audio recorded and observed using a researcher developed tool modelled on the five domains of the British Medical Association's Safe Handover-Safe Patients framework. The audio recordings were analysed using content analysis. Quantitative and qualitative data generated, were then triangulated to develop a more complete interpretation of the structure, process and content of information transferred at the patient's bedside during the change of nursing shift. This study followed Good Reporting of a Mixed Methods Study guidelines. Results: Bedside handover was observed to be mainly conducted at a fast pace. However, within this timeframe large volumes of complex information was shared and important nurse-patient interactions occurred. Analysis of the audio recordings provided evidence that the dialogue during handover was nurse dominated and the outgoing nurse appeared to influence the degree of patient participation. Conclusion: Bedside handover at the change of nursing shift involves three key stakeholders: outgoing nurse, incoming nurse and the patient. A combination of intricate communication skills both verbal and non-verbal facilitate the rapid sharing of large volumes of complex information which is necessary for the continuity and safety of patient care across nursing shifts.
International Journal of Nursing Education, 2015
Patient's clinical handoff which is a critical organizational and clinical process is considered one of the fundamental responsibilities of nurses. In this regard, lack of tools and resources to be applied for this purpose threatens the life of patients. The present study aimed to investigate the nursing handoff skill among nurses using situation-background-assessment-recommendation questionnaire. This observational research was carried out on 64 nurses in internal and surgical wards in selected hospitals affiliated to Shahid Beheshti University of Medical Sciences in Tehran, Iran in 2018. The research population included the content of reports related to nursing handoff of nurses working in the hospitals. The reliability and validity of the questionnaire were confirmed, and descriptive statistics were applied to evaluate the data. It is worthy to note that the majority of participants were female (68.8%). After the evaluation, patient information was reported in areas of current situation (90.0%), clinical background (10.0%), assessment of systems' status (57.5%), and recommendations (92.5%). Based on the results of the study, less attention was paid to mentioning clinical background and assessing patients' systems during nursing handoff, which necessitates the training courses on accurate reporting for nurses to ensure patient safety.