RESUMO
OBJECTIVES: The objective of this evidence-based quality improvement project was to improve clinical nursing handovers between registered nurses. INTRODUCTION: Clinical nursing handovers transfer critical information about the patient's care to oncoming shift nurses. Nurses use structured handover tools to handover patient information. In three adult surgical wards of a Singapore tertiary hospital, a lack of consistency was found in the local handover process when shifts changed. These resulted in ineffective handovers and compromised the patient's safety. Thus, evidence-based interventions were needed so that patient handovers and continuity in safe patient care could improve. METHODS: This project was implemented in three phases from January 2017 to November 2017 at three adult surgical wards of a tertiary hospital, utilizing the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRiP) module. The pre- and post-implementation audits were conducted using JBI PACES audit criteria. An evidence-based four-pronged approach was employed, including adequate human resource coverage during handovers, a structured and standardized handover, visual cues and a teaching video. RESULTS: The results of the post-implementation audit of nurses performing handovers (nâ=â33) showed that handovers using standardized documentation improved from 0% to 21.0% (pâ=â0.005), which was statistically significant. However, handovers of detailed observations of patients improved from 72.7% to 87.9% (pâ=â0.215) and handovers of relevant history of patients improved slightly from 93.9% to 97.0% (pâ=â1.000) but was not statistically significant. Medication error incidents related to handovers was reduced by 72% over a six-month period. CONCLUSION: The multi-modal approach improved the comprehensiveness and completeness of clinical nursing handovers. These strategies had a significant effect on reducing medication errors related to handovers.
