| Description |
Introduction: Nurse-to-nurse shift handoffs are highly vulnerable to communication failures that can threaten patient safety and continuity of care. Nurses working in various settings recognize this gap and report low satisfaction with shift handoff communication, but evidence to guide quality improvement initiatives for nursing handoffs is limited. Standardization of the content included in nursing shift handoff is an evidence-based strategy to improve nurses' satisfaction with the quality of handoff communication in general medical settings, but this has not been studied extensively within inpatient psychiatric settings. This study aimed to improve nurses' satisfaction with shift handoff communication on an inpatient psychiatric unit by piloting an electronic shift handoff tool which standardized a minimum set of content to include for each patient during nursing shift handoff. Method: Development of the standardized electronic shift handoff tool was informed by content experts, the best available evidence, and nursing staff working on the unit designated as the site for this study. The shift handoff tool was incorporated into the electronic health record of each patient for a 3-week pilot-testing period. A survey was administered to nursing staff working on the designated unit (N=17) before and after the pilot-testing period. The survey was comprised of 12 questions that measured nurses' satisfaction with 12 elements of shift handoff communication. The questions used a 5-point Likert-scale (1= strongly agree, 2= agree, 3= neutral, 4= disagree, 5= strongly disagree) to measure nurses' satisfaction. Lower scores reflected higher levels of satisfaction. A Wilcoxon Signed Rank Test was conducted to compare pre-& post-intervention survey data for each of the 12 questions. Results: Statistical analysis revealed significantly lower scores for 5 of the 12 elements of shift handoff communication following the pilot-testing period for the standardized electronic shift handoff tool, indicating an increase in nurse satisfaction in these 5 areas (p<0.05). Specifically, nurses reported an increase in satisfaction with the organization of handoff communication (pre-post mean 2.6, 1.9, p=0.015), the consistency in quality of handoff communication (pre-post mean 3.5, 2.7, p=0.02), the amount of background information provided for each patient (pre-post mean 2.5, 1.9, p=0.031), the accessibility of critical patient information in the electronic chart (pre-post mean 2.2, 1.6, p=0.026), and an increase in overall satisfaction with shift handoff practice on this unit (pre-post mean 2.8, 2.1, p=0.008). Conclusions: Nursing staff identified a need for the improvement of shift handoff communication in an inpatient psychiatric setting. Nursing staff reported a statistically significant increase in satisfaction with shift handoff communication after the integration of a shift handoff tool into the electronic health record to standardize critical content to include in shift handoff for each patient. Nurses identified insufficient education and training as a barrier for consistently effective shift handoff communication in this setting. |
