INTRODUCTION:

The transfer of information and knowledge between shifts to shift have been researched in a number of settings such as manufacturing, flight control, hospitality and emergency services (Behara, Wears et al. 2005).¹ These organizations, give the critical services such as patient care, have round the clock shift work practices, so quality handover in this scenario is essential to avoid serious mistakes.

In health care organizations (e.g. 24-hour nursing), shift handover plays a crucial role in the continuity of patient care (Ferran, Metcalfe et al. 2008)².Accurateinformation and communication at the end of the shift is one of the primary functions of handover to ensure safe transit of shift responsibility from the outgoing to the incoming teams in a healthcare setting. At present, formal training and standardization of the structure of handover is not widely available in health care.

Patients in hospital receive 24 hour nursing care from a number of nurses. Nursing roasters differ according to the department and the type of care provided. In a busy ward there are usually three shifts each day: early morning, afternoon and late evening/night. It is essential that each nurse involved in patient care has up to date information about his/her patient’s status and treatment and this is only possible by good communication that occurs at the end of each shift through the process of hand over. Clinical communication plays a critical role in patient care and safety, with miscommunication contributing to a large proportion of adverse events (Haig, Sutton, and Whittington, 2006).³

One form of communication, shift-to shift nursing handover, has gained research interest for three reasons. The first is a response to the worldwide safety agenda, recognizing that the content and process of handover can either promote the quality of communication, and therefore ensure safe care (former Australian Council on Safety and Quality in Health Care, 2005).⁴ Second, as a critical process of transferring accountability for patient care from one team of providers to another. (Australian Medical Association (AMA), 2006)⁵ Third, nursing handover conducted at the bedside provides an opportunity for engaging patients and their attendants in patient care, which reflects a professional commitment to patient-centered care (Chaboyer et al.)⁶.

PROBLEM STATEMENT:

“Assessment of quality of patient handover among nurses in selected hospitals of Ujjain city”

OBJECTIVES:

To assess quality of hand over among nurses

To identify felt needs for patient hand over

To associate quality of hand over with selected demographic variables

REVIEW OF LITERATURE:

In the context of healthcare, a ‘handover’ was defined as early as 1969 as "…the oral communication of pertinent information about patients" (Clair and Trussell 1969).⁷A few studies have explored shift handovers in healthcare settings. Some of these studies report of errors and fatalities in healthcare that may be directly attributed to inefficiencies of the handover process. Also, literature indicates that poor communication might lead to inaccuracies in handovers. In 2000, the Institute of Medicine (IOM) published a worldwide report about the errors in healthcare state that around 98,000 patients die in hospitals due to communication failures (Kohn, Corrigan et al. 2000).⁸ In 2007, the World Health Organization (WHO) introduced the “High 5s Project” aiming to raise the safety of patients around the world. The “High 5s Project” announced five standard operating protocols that deal with significant patient safety concerns. One of these standards involves the improvement of communication during patient handover. Despite the development of various tools and strategies to advance communication during handover, the uptake of these tools hasn't generally been as high as expected. (Anwari 2002⁹; Obstfelder and Moen 2006)¹⁰study on exploration of nurses’ knowledge sharing problems during shift handover in 6 Australian hospitals indicate many problems in effective knowledge sharing and suggest that handover standards, codification guidelines, the format of templates, and need of training in conducting handover to be improved. Further bedside handover provides an opportunity for active involvement of patients and attendants in patient care and it can help to educate patient and attendants which is important in maintaining accuracy, which promotes safe, high quality care.

MATERIAL AND METHODS:

A cross sectional study was conducted during April to June 2012among 60 nurses of teaching and non-teaching hospitals of Ujjain city. Nurses those were available on duty at the time of data collection and ready to participate in the study were selected purposively. Self-administered semi-structure questionnaire on patient hand over was used. It took approximately 10-15 min to complete this questionnaire. Reliability of the research tool was calculated by split half method and it was 0.76. Ethical consideration was obtained by college ethical committee and written informed consent was obtained from each participant.

RESULT AND DISCUSSION:

Demographic variable:57% nurses were from teaching and 43% were from non-teaching hospital. Out of these77% and 23% were female and male respectively. As per qualification 40%were GNM, 17% were B.Sc. Nursing and 43% were ANM. 43%, 53% and 6.6% were having experience of one year, 2-5 year and more than five year respectively. 87% were having no previous knowledge about hand over. All nurses (100%) answered that source of information about handover was from seniors and colleagues.

QUALITY OF HAND OVER:

Table 1 Quality of hand over

Quality	Frequency	Percentage
Poor	14	23.33
Average	34	56.7
Good	12	20

Table 1 show only 20% nurses obtained good quality hand over scores, 56.7% had average and23.33% had poor scores on quality of patient hand over.

Ad hoc analysis shows that47%, 10% and 43% take 10 minutes, 20 minutes and 30 min respectively for patient hand over. All nurses (100%) answered that they had no problems with the current way of handover. Only 6.66% nurses mentioned that stock and emergency medicine checking should be part of hand over. 10% mentioned that they need printed hand over chart.96% nurses answered that purpose of hand over is to provide only patient information like medication administration, investigation, or any changes in doctors order sheet.97% nurses usually hand over only patient information, 12 % includes admission and discharge and only 3-6% nurses also includes number of patients, pre-operative and post-operative patients, patient referred from other departments, condition of equipment and instruments, essential drugs and total number of deaths in wards. So we can say knowledge about purpose of handover directly affects nature of handover practices and most of the nurses were not involving all content of hand over.

Association with selected demographic variables:

Table 2 association of hand over scores with selected demographic variables

Variable	Χ² ( cal)	Χ² ( tab)	D.F	Significant/ No significant
Professional qualifications	12.74	9.49	4	Significant
Teaching/ non-teaching hospital	10.8	5.99	2	Significant
Years of experience	2.86	9.49	3	No significant

5% level of significance D.F: degree of freedom

Table 2 shows significant relationship between professional qualifications and teaching/ non-teaching hospitals v/s patient hand over scores as Χ²(cal) 12.74 and 10.8 is more than Χ²(tab) 9.49 and 5.99 at D.F. 4 and 2 respectively. There is no significant relationship was established between years of experience v/s patient hand over scores as Χ²(cal) 2.86 is less than Χ²(tab) 9.49 at D.F 3.

CONCLUSION:

Study concludes that nurses are following only traditional practices of patient hand over which were learned from seniors and colleagues. There is no evidence based practices followed. Most of the nurses having poor and average knowledge about patient hand over and further it was significantly more in nurses working in teaching hospitals and having higher qualification clearly indicate need of education and training which improve quality hand over and safe patient care.

BIBLIOGRAPHY:

1. Behara, R., Wears R. L., Perry, S. J., Eisenberg, E., et al 2005. A conceptual framework for studying the safety of transitions in emergency care, Citeseer.

2. Ferran, N. A., Metcalfe, A. J. and O'Doherty, D. 2008. "Standardised proformas improve patient handover: audit of trauma handover practice," Patient Safety in Surgery, (2), pp 24-24.

3. Haig, K. M., Sutton, S., and Whittington, J. (2006). SBAR: A shared mental model for improving communication between clinicians. Joint Commission’s Perspectives on Patient Safety, 32,167—175.

4. Australian Council for Safety and Quality in Health Care. (2005).Clinical handover and patient safety, pub. no. 3640. Sydney: Australian Resource Centre for Healthcare Innovations.

5. Australian Medical Association (AMA). (2006). Safe handover:Safe patients; guidelines on clinical handover for clinicians and managers. http://www.ama.com.au/web.nsf/ doc/WEEN-

6. Chaboyer, W., Johnson, J., Hardy, L., McMurray, A., Wallis, M., and Chu, S. (2009). Bedside handover: Quality improvement strategy to ‘transform care at the bedside’. Journal of Nursing Care Quality, 24(2), 136—142.

7. Clair, L. and Trussell P. 1969. "Nursing service. The change of shift report: study sows weaknesses, how it can be improved," Hospitals, (43:19), pp 43- 91.

8. Kohn, L. T., Corrigan, J. and Donaldson, M. S. 2000. To err is human: building a safer health system, National Academy Press, Washington, DC.

9. Anwari, J. 2002. "Quality of handover to the post anaesthesia care unit nurse," Anaesthesia, (57:5), pp 484-500.

10. Obstfelder, A. and Moen A. 2006. "The electronic patient record in community health services-paradoxes and adjustments in clinical work," Studies in Health Technology and Informatics, (122), pp 626.

Received on 22.11.2013 Modified on 25.12.2013

Asian J. Nur. Edu. & Research 4(1): Jan.-March 2014; Page 117-118