Abstract:
Background: Nursing intershift handoff involves communicating
essential patient information between the outgoing
and the oncoming nurses during shift changes. A subsequent
review of reported patient safety incidents at Labib Medical
Center (LMC), Saida, Lebanon, showed that medication
errors, delay in treatment, wrong treatment, duplication of
laboratory tests, and near-miss events were caused by patient
information omissions during intershift handoffs. In response,
LMC initiated a quality improvement project using
a multifaceted intervention to improve the quality of nursing
intershift handoffs.
Methods: The barriers to effective intershift handoff identified
in the literature that best fit the current context of intershift
handoffs at LMC showed that the following three
issues needed to be addressed: (1) the absence of a standardized
intershift communication tool, (2) inadequate training
of RNs on intershift handoff communication, and (3) the
interruptions during the shift reports. Accordingly, a threefaceted
intervention was constructed, entailing (1) introduction
of a standardized intershift handoff tool, (2) training
RNs about effective handoff communication, and (3) decreasing
interruptions.
Results: The mean number of omissions per handoff
across the three units decreased from 4.96 to 2.29 (t = 6.29,
p = .000), as did the mean number of interruptions per intershift
report—from 2.17 to 1.26 (t = 2.7, p = .008). RNs’
knowledge of the criteria to be communicated suggested a
greater appreciation of their own role in patient safety.
Conclusion: The intershift handoff communication
process can be improved using evidence-based strategies that
target internal barriers where the shift report occurs. Regular
monitoring and follow-up are essential to maintain the
improvement.
