Bedside Nursing Handovers in the Surgical Context

The Efficacy of Bedside Nursing Handovers in Improving Information Exchange Quality in Surgical Patients: a Randomised Controlled Trial

Nursing handovers are performed 2-3 times a day for each patient, with an approximate average of 2 million nursing deliveries per year in a hospital of medium size. Nursing handovers are considered essential for the continuity and safety of care. If the relevant clinical information is not shared in a precise and timely manner, it may worsen the patients' outcomes with an increase in adverse events, delays or inappropriate treatment until the omission of procedures.

The modality of nursing delivery presents, therefore, a gap of vulnerability where vital information could not be considered and systematically shared.

Patients should be involved in their care to promote a patient-centred approach. The involvement of patients in handovers is effective compared to other delivery methods.

To date, however, the best mode to deliver handovers was still unclear due to a systematic lack of studies to identify the best practice of nursing handovers. The studies in the literature lack of sound methodologies due to not randomized designs.

Thus an intervention to improve quality of handovers and to implement bedside handovers in surgical wards will be performed.

The following hypotheses were made:

• The introduction of nursing bedside handovers will improve the quality of the information exchanged.
• The educational intervention training intervention will positively modify the nursing handovers.
• There is a relationship between the qualitative level of nursing handovers and working status (expert vs novice) of the nurses.
• There is a relationship between the qualitative level of nursing handovers and the patients' characteristics.

Study Overview

• Status: Completed
• Conditions: General Surgery
• Intervention / Treatment: Behavioral: Education for improving handovers quality; Behavioral: Education for improving bedside handovers

• Study Type: Interventional
• Enrollment (Actual): 318
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Italy
  • Como, Italy, 22100
    • Valuduce Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 99 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Surgical patients
• All nurses working with surgical patients who attended the educational intervention

Exclusion Criteria:

• Nurses who did not participate in the educational intervention
• Nursed who did not operate stably in the surgical wards included in the study
• New hired nurses

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Bedside handover; Education for improving handovers quality + Education for improving bedside handovers	Behavioral: Education for improving handovers quality; Specific education on the importance of handovers quality will be provided. The educational session will last 4 hours. The program will be divided into the following sections: 1) a structured survey on the perception of the participants on the handovers importance; 2) Key theoretical concepts on the relevance of handovers with case studies of errors related to this critical moment; 3) showing movie clips of nursing handovers to critically interpret the clips by the participants; 4) presentation of the SBAR method recommended by WHO; 5) general presentation of the nursing delivery assessment project of the Valduce Hospital.; Behavioral: Education for improving bedside handovers; In addition to the education for improving handovers quality, the following intervention will be implemented for nurses assigned to the study department. The course will be supplemented by a section of the duration of an hour, containing 1) information on the principles underlying bedside handovers; 2) how to handle information in front of the patient and on his / her direct involvement; 3) role-playing of the bedside handover will be performed, assigning the roles of nurse and patient among the participants to bring out impressions linked to the functions.
Active Comparator: Control; Education for improving handovers quality	Behavioral: Education for improving handovers quality; Specific education on the importance of handovers quality will be provided. The educational session will last 4 hours. The program will be divided into the following sections: 1) a structured survey on the perception of the participants on the handovers importance; 2) Key theoretical concepts on the relevance of handovers with case studies of errors related to this critical moment; 3) showing movie clips of nursing handovers to critically interpret the clips by the participants; 4) presentation of the SBAR method recommended by WHO; 5) general presentation of the nursing delivery assessment project of the Valduce Hospital.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in handover quality	Handoff CEX (Clinical Examination) [3-9 overall on 6 items about setting, organisation, communication, content, judgment, professionalism; 3 worst - 9 best]	Baseline, at 1 month after intervention, at 6 months after intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Handover length	Time x handover	Baseline, at 1 month after intervention
Missed care / procedures / diagnostic tests	Number of missed care / procedures / diagnostic tests	Baseline, at 1 month after intervention, at 6 months after intervention
Patients satisfaction	Visual Analogic Scale for satisfaction [0-10; 0 worst - 10 best]	Baseline, at 1 month after intervention, at 6 months after intervention

Collaborators and Investigators

• Sponsor: University of Eastern Piedmont
• Collaborators: Valduce Hospital
• Investigators: Principal Investigator: Marco Clari, RN, PhD s, University of Eastern Piedmont

Publications and helpful links

General Publications

• Smeulers M, Lucas C, Vermeulen H. Effectiveness of different nursing handover styles for ensuring continuity of information in hospitalised patients. Cochrane Database Syst Rev. 2014 Jun 24;2014(6):CD009979. doi: 10.1002/14651858.CD009979.pub2.
• Abraham J, Kannampallil T, Patel VL. A systematic review of the literature on the evaluation of handoff tools: implications for research and practice. J Am Med Inform Assoc. 2014 Jan-Feb;21(1):154-62. doi: 10.1136/amiajnl-2012-001351. Epub 2013 May 23.
• Clemow R. Care plans as the main focus of nursing handover: information exchange model. J Clin Nurs. 2006 Nov;15(11):1463-5. doi: 10.1111/j.1365-2702.2006.01524.x. No abstract available.
• Chaboyer W, McMurray A, Johnson J, Hardy L, Wallis M, Sylvia Chu FY. Bedside handover: quality improvement strategy to "transform care at the bedside". J Nurs Care Qual. 2009 Apr-Jun;24(2):136-42. doi: 10.1097/01.NCQ.0000347450.90676.d9.

Study record dates

Study Major Dates

• Study Start (Actual): July 26, 2018
• Primary Completion (Actual): November 1, 2018
• Study Completion (Actual): January 31, 2019

Study Registration Dates

• First Submitted: February 27, 2018
• First Submitted That Met QC Criteria: March 13, 2018
• First Posted (Actual): March 14, 2018

Study Record Updates

• Last Update Posted (Actual): April 16, 2019
• Last Update Submitted That Met QC Criteria: April 12, 2019
• Last Verified: April 1, 2019

More Information

Terms related to this study

• Other Study ID Numbers: UPO1

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No