QI Padlet by

maryazaikin — 2023-04-28 17:58:16 UTC

Sharp, L., Dahlen, C., & Bergenmar, M. (2019, December 1). Observations of nursing staff compliance to a checklist for person-centred handovers – a quality improvement project. Scandinavian Journal of Caring Sciences . https://web-p-ebscohost-com.lrc-proxy.abtech.edu/ehost/pdfviewer/pdfviewer?vid=4&sid=e4ab8f63-ff7f-4b4c-b014-9a0cd9b6806f%40redis

Supporting data

maryazaikin — 2023-04-28 18:05:50 UTC

Two systematic reviews evaluated different handover models (10, 11). The authors of both reviews conclude that no specific model of nursing handover could be recommended over the others. However, it was recommended that nursing handovers should include face-toface information exchange, patient involvement, structured documentation and sufficient information technology (IT) to support the procedure

Gap in practice

maryazaikin — 2023-04-28 18:09:20 UTC

Nursing handovers have also been heavily criticized for being unstructured, ineffective, time-consuming and not person-centered. The most commonly used nursing handover models are written or verbal handovers, both are often performed at the nurses’ station without direct involvement from patients and/or their loved ones.

Supporting Data

maryazaikin — 2023-04-28 21:37:34 UTC

A total of 43 PCH sessions were observed at two acute care wards, using a structured observation protocol. None of the observed handover sessions included all the 13 PCH checklist subcomponents. The checklist was used in 18 (44%) of the observed handover sessions. A statistically significant higher number of subcomponents were observed when the nurses used the PCH checklist (6.4 vs. 4.5 subcomponents, p < 0.05). The mean time spent on each PCH was 6 minutes. In 56% of the sessions, the patients were observed to actively participate in the handover. Overall, the nursing staffs’ compliance to the PCH checklist needs to be improved.

Gap or problem/ Research question

maryazaikin — 2023-04-28 21:38:11 UTC

Nursing shift-to-shift handovers, or handoffs, have been recognized as complex and often overlooked parts of the clinical information exchange, which could impact safety, patient satisfaction, continuity and other clinical outcomes.

maryazaikin — 2023-04-28 22:00:27 UTC

The quality improvement project was performed at two wards at a large university hospital. The staff on both wards had the same working schedules, with typical shifts of 8–8.5 hours and with some staff working exclusively night shifts (10-hour shifts). The two wards were specialized in upper abdominal surgery, hepatology and inflammatory bowel diseases and provided surgical and medical care around the clock for adult patients

maryazaikin — 2023-04-28 22:02:04 UTC

A total of 43 PCH observations were performed during March to May 2016. The differences between the wards regarding the number of beds, length of stay, workload, staff ratio, RNs education level and years of experience

maryazaikin — 2023-04-29 00:56:34 UTC

The QI research was qualitative because they used the PCH check list as their foundation, observing what affects the PCH checklist had on improving hand off care.

maryazaikin — 2023-04-29 00:59:00 UTC

We also found that more of the subcomponents were included if the checklist was used, but even then, only about half of the subcomponents were observed, leaving room for major improvements. Philpin (31) points out the importance of using a supportive tool during bedside handovers. She found, in her qualitative study, that intensive care nurses regarded an observation chart as useful for the complex information exchange during bedside handovers and describe it as an important tool in organising and structuring the handover process. Tobiano et al. (32) conclude in their qualitative study that a more standardised process would help nurses overcome the barriers they perceived with bedside handovers.

maryazaikin — 2023-04-29 01:02:20 UTC

This evaluation (made shortly after the introduction of the PCH) shows that the nursing staffs’ compliance to the handover checklist needs improvements and highlights the need for greater focus on communication-oriented tasks during handovers. More attention is needed on person-centred information exchange between the patients and nursing staff. The use of the PCH checklist contributes to a more standardised and comprehensive handover procedure in which nurses encourage both patients and their loved ones to take an active role.

maryazaikin — 2023-04-29 01:25:08 UTC

I think this QI provided a more in depth evaluation of using a certain checklist to improve patient care handoff, see as this being a constant problem in the field. I feel like this provide some improvement on how we want to proceed in the future to achieve better hand off report.

maryazaikin — 2023-04-29 01:27:24 UTC

A bedside handover checklist could contribute to this structure. Sexton et al. (6) suggest that the degree of structure on a wards handover routines also could impact both quality of care in addition to job satisfaction. It has also been reported that patients regarded the nurses’ use of documents during bedside handover as reassuring (13). Not using the PCH checklist may increase the risk of only bringing the traditional version of the handover, from the nurses’ station to the bedside, rather than changing to a person-centred handover.

Plan

maryazaikin — 2023-04-29 01:28:00 UTC

To improve the handovers and involve patients and their loved ones in the process. Evaluate the nursing staff's (Registered Nurses, RNs, and nurse assistants, NAs)

Do

maryazaikin — 2023-04-29 01:28:04 UTC

A shift-to-shift handover between nursing staff together with the patient, person-centred handover (PCH) was developed, implemented and evaluated at the Department of Oncology, Karolinska University Hospital (26). The PCH model consists of five components (A. preparation, B. introduction, C. information exchange, D. patient involvement and E. safety check) based on the standard operating procedure for implementing bedside handovers (27) and the SBAR (Situation, Background, Assessment, Recommendation) communication protocol (28). Originally developed for inter-professional communication, SBAR has shown benefits in nurse-to-nurse shift handovers, contributing to increased structure, consistency, comprehensiveness and active patient participation

Study

maryazaikin — 2023-04-29 01:28:17 UTC

Observational studies have been described as an option to capture verbal communication in clinical settings, for example at bedside handovers. In this project, a relatively small number of nursing handover sessions were observed. However, previous research indicates that approximately 20 episodes are needed to capture the variation in key components of handover sessions. The project was limited to checking the nurses’ compliance to the PCH checklist, excluding information on performance such as body language, tone of voice and also experiences.

Act

maryazaikin — 2023-04-29 01:28:21 UTC

The use of the PCH checklist contributes to a more standardised and comprehensive handover procedure in which nurses encourage both patients and their loved ones to take an active role.