Interruptions During Senior Nurse Handover in the Intensive Care Unit: A Quality Improvement Study

This article by Spooner and colleagues was published in June 2018 issue of the Journal of Nursing Care Quality.
Background:  Interruptions during handover may compromise continuity of care and patient safety.
Local Problem:  Interruptions occur frequently during handovers in the intensive care unit.
Methods:  A quality improvement study was undertaken to improve nursing team leader handover processes. The frequency, source, and reason interruptions occurred were recorded before and after a handover intervention.
Interventions:  The intervention involved relocating handover from the desk to bedside and using a printed version of an evidence-based electronic minimum data set. These strategies were supported by education, champions, reminders, and audit and feedback.
Results:  Forty handovers were audio taped before, and 49 were observed 3 months following the intervention. Sixty-four interruptions occurred before and 52 after the intervention, but this difference was not statistically significant. Team leaders were frequently interrupted by nurses discussing personal or work-specific matters before and after the intervention.
Conclusions:  Further work is required to reduce interruptions that do not benefit patient care.
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An observational study of patient handover communications among nurses on an oncology critical care unit.

This article by Milesky and colleagues was published in the December issue of Contemporary Nurse.
Aim/Objectives: The purpose of this quality improvement project was to evaluate the feasibility and utilization of evidence-based recommendations for nurse-to-nurse shift handover on an oncology critical care unit.
Background:  Breakdown in communication is the most common cause of medical errors in hospitals.
Design:  Observational study.
Methods:  Nurses were provided education that integrated evidence-based recommendations for handover of care. Nursing shift report was observed for one month in 2015 and for one month in 2016. Results were evaluated for inclusion of twenty-four evidence-based essential elements for handover communication which included measures of total completeness and interruptions during the handover process.
Results:  Total completeness of handover increased with 86.64% (N=38) in 2015 and 88.68% (N=35) in 2016. Although, the increases were not statistically significant, interruptions during handover were positively correlated with length of handover r=0.587 (n=18, p=0.010), thus confirming need for structured, more effective handover methods.
Conclusions:  Providing education, mentoring and real-time feedback to motivated staff may lead to improvements in handover communication methods, yielding positive patient outcomes. Impact Statement Evidence-based, standardized handover communications among nurses can improve patient safety and prevent harm.
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A Multifaceted Intervention to Improve Outcomes in Intensive Care

This study examines the effectiveness of a patient-centered care and engagement program in the medical ICU | Critical Care Medicine

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Interventions: Structured patient-centered care and engagement training program and web-based technology including ICU safety checklist, tools to develop shared care plan, and messaging platform. Patient and care partner access to online portal to view health information, participate in the care plan, and communicate with providers.

Measurements and Main Results: Primary outcome was aggregate adverse event rate. Secondary outcomes included patient and care partner satisfaction, care plan concordance, and resource utilization. We included 2,105 patient admissions, (1,030 baseline and 1,075 during intervention periods). The aggregate rate of adverse events fell 29%, from 59.0 per 1,000 patient days (95% CI, 51.8-67.2) to 41.9 per 1,000 patient days (95% CI, 36.3-48.3; p < 0.001), during the intervention period. Satisfaction improved markedly from an overall hospital rating of 71.8 (95% CI, 61.1-82.6) to 93.3 (95% CI, 88.2-98.4; p < 0.001) for patients and from 84.3 (95% CI, 81.3-87.3) to 90.0 (95% CI, 88.1-91.9; p < 0.001) for care partners. No change in care plan concordance or resource utilization.

Conclusions: Implementation of a structured team communication and patient engagement program in the ICU was associated with a reduction in adverse events and improved patient and care partner satisfaction.

Full reference: Dykes, P. et al. (2017) Prospective Evaluation of a Multifaceted Intervention to Improve Outcomes in Intensive Care: The Promoting Respect and Ongoing Safety Through Patient Engagement Communication and Technology Study. Critical Care Medicine. Published online: 3rd May 2017

Patient- and Family-Centered Care: First Steps on a Long Journey

Sevransky, J. (2017) Critical Care Medicine. 45(5) pp. 757–758

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ICUs are among the most intimidating locations in the hospital for patients and families. Some machines are connected to the surface. Others invade the substance of the body. Life-sustaining devices and their connections often impair communication and performance of the activities of daily life. Even professionals-turned patients have difficulties communicating effectively when on the other side of the stethoscope (1) in an ICU.

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A Clinicians Guide to Privacy and Communication in the ICU

Francis, L. et al. (2017) Critical Care Medicine. 45 (3) pp. 480–485

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Objective: To review the legal issues concerning family members’ access to information when patients are in the ICU.

Conclusions: The Health Insurance Portability and Accountability Act and related laws should not be viewed as barriers to clinicians sharing information with ICU patients and their loved ones. Generally, under Health Insurance Portability and Accountability Act, personal representatives have the same authority to receive information that patients would otherwise have. Persons involved in the patient’s care also may be given information relevant to the episode of care unless the patient objects. ICUs should develop policies for handling the issues we identify about such information sharing, including policies for responding to telephone inquiries and methods for giving patients the opportunity to object to sharing information with individuals involved in their care. ICU clinicians also should be knowledgeable of their state’s laws about how to identify patients’ personal representatives and the authority of those representatives. Finally, ICU clinicians should be aware of any special restrictions their state places on medical information. In aggregate, these strategies should help ICU managers and clinicians facilitate robust communication with patients and their loved ones.

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How nurses support families of intensive care patients towards the end of life

Families of people dying in intensive care need to receive personalised communication and ongoing support, and be involved in the dying process | NIHR

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Researchers gathered evidence on how nurses care for patients and their families in intensive care when life-sustaining treatment is withdrawn. The included studies explored the care of the family before, during and after the process. Most of the studies in this small, mixed methods review were qualitative.

Reviewers identified three main ways, or themes, in which families are supported. First, information and good communication, such as the focus on careful use of language, was seen commonly. Second, by careful management of treatment withdrawal itself, for example by clarifying the gradual change expected when medically focussed life-sustaining treatments are withdrawn and family centred end-of-life care begins. Lastly they described a common focus on making the nursing contribution more visible, such as using techniques to build lasting memories for families.

 

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Parents’ experience of a follow-up meeting after a child’s death in the Paediatric Intensive Care Unit

Brink, H.L. et al. Intensive and Critical Care Nursing. Published online: 12 August 2016

Objective: ‘To identify parents’ experience of a follow up meeting and to explore whether the conversation was adequate to meet the needs of parents for a follow-up after their child’s death in the Paediatric Intensive Care Unit (PICU).

Design and setting: Qualitative method utilising semi-structured interviews with six pairs of parents 2–12 weeks after the follow-up conversation. The interviews were held in the parents’ homes at their request. Data were analysed using a qualitative, descriptive approach and thematic analysis.

Findings: Four main themes emerged: (i) the way back to the PICU; (ii) framework; (iii) relations and (iv) closure.

Conclusion: The parents expressed nervousness before the meeting, but were all pleased to have participated in these follow-up meetings. The parents found it meaningful that the follow-up meeting was interdisciplinary, since the parents could have answers to their questions both about treatment and care. It was important that the staff involved in the follow-up meeting were those who had been present through the hospitalisation and at the time of the child’s death. Parents experienced the follow-up meeting as being a closure of the course in the PICU, regardless the length of the hospitalisation.

Read the abstract here