Perioperative handover using ISBAR at two sites: A quality improvement project

Abstract

The use of ISBAR handover principles assists in enabling the provision of best care to perioperative patients1. Reviews of post-operative handover research studies confirm the positive association between the quality of handovers and the decrease in adverse patient events2,3. Other reviews identify that globally handovers can be highly unpredictable and unreliable3–6. Therefore, the argument for standardised handovers to reduce the probability of adverse patient events in comparison to unstructured handovers, which have been shown to increase the chances of adverse patient events, is worth investigating. Method: The method used was a multisite quasi-experimental design involving audits of perioperative handovers over a one week period in 2017. Using a pretest–posttest design, the use of ISBAR principles for all handover events during the perioperative journey was audited. The handovers studied included: • ward nurse to holding bay nurse • anaesthetist to Post Anaesthesia Care Unit (PACU) nurse • scout nurse to PACU nurse • PACU nurse to ward nurse. The audits were conducted across two study sites over a one week period. The audit data were collected by study site clinical nurse educators and PACU nurses. Audit tools based on a prior perioperative handover investigation at Western Health (phase 1) were used. Local resources were used to develop video vignettes depicting an ideal ISBAR handover for each of the handover points. These have been made available on WeLearn (organisation online training) as an education tool. In addition, cue cards were developed to prompt and guide practitioners to use ISBAR principles for handover. Results: Interventions to improve perioperative handovers were made and subsequent audit of handovers have commenced. This phase of the study provides comparisons of handovers between anaesthetists and PACU nurses over three different time periods. Some qualitative comparisons have been made. Additionally, this study collected baseline data for all other handover points of care. Implications for practice: The results from this study suggest an augmented education program over time produced statistically significant (p < 0.001) results for compliance with ISBAR principles for handover from anaesthetist to PACU nurse. The results of the audits from the other perioperative handover points provided baseline data that will be used for comparison with further audit data for these handover points.