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Title: Nursing handover from ICU to cardiac ward: standardised tools to reduce safety risks.
Epworth Authors: Botti, Mari
Wood, Beverley
Redley, Bernice
Other Authors: Graan, S. M.
Keywords: Preventable Rrrors
Intensive Care Unit
Patient Safety and Quality
Standardised Framework
Clinical Handover
Cardiac Ward
Handover Processes
Risk Recognition Matrix
Clinical Handovers
Context-specific Checklists
Patient Safety Risks
Evidence-based Frameworks
Safety Checklist
Critical Care Clinical Institute, Epworth HealthCare, Victoria, Australia
Epworth Deakin Centre for Clinical Nursing Research, Victoria, Australia
Cardiac Sciences Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: Aug-2016
Publisher: Elsevier Australia
Citation: 2016 Aug;29(3):165-71
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.
DOI: 10.1016/j.aucc.2015.09.002
PubMed URL:
ISSN: 1036-7314
Journal Title: Australian Critical Care : official journal of the Australian College of Critical Care Nurses (ACCCN)
Type: Journal Article
Affiliated Organisations: Deakin University, School of Nursing and Midwifery, Burwood Highway, Burwood 3125, Australia.
Type of Clinical Study or Trial: Prospective Observational Study
Appears in Collections:Critical Care
Cardiac Sciences
Health Administration

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