A Quality Improvement Approach to Standardize Clinical Handover for Nurse s in Critical Care Units of Selected Tertiary Care Hospital, Dehradun Uttarakhand

Abstract

Introduction: The World Health Organization's priority for patient safety has been the driving force behind improvement in clinical handover and health communication broadly globally (WHO 2010). To provide high-quality treatment, health care workers need to communicate with other professionals. One of the most crucial communication transactions is the clinical handover. The Joint Commission has said that enhancing handover should be a national patient safety objective and has pointed to communication issues as a common source of medical mistakes. Effective communication, care continuity, error prevention, and patient safety are all enhanced by well-executed handover. Purpose: To assess the existing nursing clinical handover practice and develop & implement an evidence-based standardized framework in the critical care unit of a tertiary care hospital in Uttarakhand. Methodology: Pre-Implementation: A mixed-methods approach was employed to assess nursing clinical handover practices in a critical care setting. An audit of the existing handover checklist in the critical care unit aimed to ensure consistency and standardization. Nurses in the critical care unit participated in a focused group discussion, and their handover practices were observed using a self-structured observational checklist in 30 instances per shift. Descriptive and content analysis of the gathered data revealed shortcomings in the existing handover tool, prompting the development of a standardized ISBAR framework tool. Implementation Process: The ISBAR tool underwent validation by professionals, followed by a pilot study to assess feasibility. Subsequently, nurses in the critical care unit received training, and the ISBAR tool was officially adopted. Quarterly audits were instituted to monitor progress and sustainability, and nurses provided feedback through Google Forms. Results: Post-Implementation: Following the implementation of the ISBAR tool, notable improvements were observed. Handover time decreased from 20 to 15 minutes, with enhanced note-taking (100% compliance), improved two-way communication (reaching 100% in February and May 2023), and a significant reduction in noise and interruptions during handovers. The ISBAR tool was well-received by nurses, with positive feedback indicating its relevance (90%), time-saving nature (90%), organizational effectiveness (89%), provision of comprehensive information (90%), and easy comprehensibility (93%). Nurses reported that the ISBAR tool significantly increased efficiency, saving time and improving completeness in patient information reporting. Communication-related incidents showed a marked decrease from 0.47% (Jan-Aug 2022) to 0.017% (Aug 2022-May 2023). Conclusion: In conclusion, the implementation of the ISBAR framework proved highly effective in addressing the shortcomings of the pre-existing handover practices. The standardized tool not only streamlined the handover process but also contributed to a significant reduction in communication-related incidents, ultimately enhancing patient outcomes.