An observation audit tool for nurse-tonurse bedside clinical handover.

Abstract

Background: The study aims were to 1. Examine the reliability, validity and usability of a multi-purpose tool for training, and auditing nurse-to nurse bedside handover and 2. Evaluate the quality of nurse-to nurse bedside handover practices. Methods: A naturalistic, descriptive, mixed method study conducted in three stages: Stage 1- face and content validity of an existing tool were examined using literature review and focus group with five local nursing and midwifery experts. Stage 2-the tool was revised and pilot tested; the final tool included 52 items related to content, process and environment aspects of handover practice, evaluated using a 3-point scale. Stage 3 - an observation audit of 199 'real' handover events across 5 wards; in 72 handover events, independent second observers were used to examine tool reliability; and unstructured field notes captured data on tool usability. Descriptive statistics were used to analyse audit data; the Kappa statistics was used to measure inter-observer agreement to examine reliability. Qualitative description was used for qualitative analyses. Results: Content validity was supported by both literature and expert review. Interobserver agreement was acceptable for 70.5% (n=11) of content items, 58.8% (n=10) of process items and 44.4% (n=8) of environment items. The organisation set a benchmark for illustrative behaviours to be observed in 80% of handovers. Analyses revealed only 11.7% (n=2) Behaviours related to content, 17.6% (n=3) behaviours related to process, and no behaviours related to environment were observed I more than 80% handovers. Analyses revealed only 11.7% (n=2) behaviours related to content, 17.6% (n=3) behaviours related to process, and no behaviours related to environment were observed in more than 80% of handovers. Conclusion: This research provides a model and tool for ongoing quality improvement that addresses the three key components of handover practice : content, process and environment. The content and face validity of the bedside handover tool was acceptable, however use of context specific exemplars could improve face validity and usability, particularly when evaluating behaviours related to handover processes and environmental safety.