ISQUA18-1848Empowering Nurses and Parents to Talk: Bringing Handover Back to the Bedside

Abstract

Objectives: Within three months a) increase compliance with documentation of nursing handover in the electronic medical record (eMR) to 100% and b) develop a ward specific bedside handover checklist, formatted in the ISBAR template, to facilitate parental engagement in bedside handover. Method(s): In early 2017 C1South ward, a 16 bed ward within Sydney Children's Hospital, part of the Sydney Children's Hospitals Network (SCHN), specialising in the care of infants and young children with cardiac or renal conditions, undertook a Quality Improvement (QI) project to improve family engagement in, and nursing documentation of, Clinical Bedside Handover. The project was led by the Clinical Nurse Educator supported by the Quality team. QI ethics approval for this project was obtained through the SCHN Human Research Ethics Committee, ethics number: QIE-2017-04-04. Baseline audits of current practice were conducted to record the number of bedside checklists in use, the number completed, and the number of handovers that occurred at the bedside during an allocated shift handover. The results were shared with nursing staff and a case of change was established. Nursing staff focus groups were held to identify key information for bedside handover to provide safe and consistent clinical care. Parents on the unit were also asked to review current checklist and identify critical points for clinical handover. This was used to inform a ward-specific checklist, tested with junior and senior nurses through simulation so modifications could be made before trial. The trial commenced in February 2017 and continued over three months. The trial checklist was placed in bedside charts, a larger copy displayed at each bedside as a visual for families, and a template for nursing documentation of handover in eMR was developed. Audits continued throughout the trial. Result(s): Within 24 hours of the start of the trial, 100% of bedside handovers were documented in eMR. Weekly documentation audits were conducted in the first 4 weeks, then monthly until June with only 1 record of 54 non-compliant. Adherence to bedside handover is improving and parent surveys (n = 20), conducted in December 2017, over half felt included in bedside handover. Parents report that they felt important information is being shared at the handover and that nurses know about their child's needs. When asked what could be better parents wanted to be actively involved in the handover process by making the language less formal and including capacity to write questions. Using simulation enabled nursing staff to actively contribute to the change and implementation. We believe this created a sense of ownership for the nurses which was critical for successful engagement and change. Repeat audits, and parent and staff surveys will occur in March and July. Since the trial began, three other wards have implemented this process with similar improvements in documentation and parent engagement in bedside handover. Two other wards have commenced nursing and patient consultations. Conclusion(s): We found QI methodology an accessible and tangible medium for nursing staff and parents to engage with making improvements. By using simulation nurses were involved in the change process and have ownership over its implementation. Documenting handover in patient notes makes staff accountable. With parents and patients having a visual prompt of handover they are confident to engage in handover, empowering them to participate.