Patient handover in the oncology setting: an evidence utilisation project

Handover is an essential activity in nursing and is an integral part of communication as it will improve and ensure quality patient care in clinical practice. However, handover could be ineffective and harmful to patients and nurses if the information communicated is incorrect, irrelevant or omitted. Thus to achieve optimal care as well as to maintain patient safety, these information needs to be accurately communicated. In recent time, registered nurses in the ward have been staying late beyond their working hours as handover is taking more time than is required. The nurses were taking almost an hour to hand over their reports to the oncoming staff. There was also a lot of distraction and interruption which further prolonged the time spent handing over. This has led to much unhappiness and dissatisfaction in the ward. In addition, it also took the registered nurses away from direct clinical care.

The aim of this project was to improve the quality and duration of inter-shift patient handover from morning to afternoon shift.

This project utilised a pre- and post-audit methodology using the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice module. It was implemented in three phases over a 6-month period from June 2011 to December 2011. The audit utilised four out of the six criteria recommended by Joanna Briggs Institute clinical handover best practice sheet. It took place in a 16-bed oncology ward within an acute care hospital in Singapore, involving a sample size of 15 registered nurses. It involved educating the registered nurses in the process of patients' handover with the aid of cue cards.

All four Criterions achieved 100% compliance. Compliance rate among the registered nurses increased for Criterion 2 to Criterion 4, showing significant improvement, especially in Criterion 4. Fisher's exact test was carried out to determine statistical significance between results of the two audits. Compliance for Criterion 1 remained at 100%. Criterion 2 achieved 100% compliance compared with 80% in the pre-implementation audit, highlighting an improvement of 20% (χ(2) = 3.333, P = 0.068). Criterion 3 showed 100% compliance compared with 80% in the pre-implementation audit, indicating an improvement of 20% (χ(2) = 3.333, P = 0.068). Criterion 4 now showed 100% compliance compared with 47% in the pre-implementation audit, indicating a significant improvement of 53% (χ(2) = 9.130, P = 0.003).

This project not only showed a significant improvement in the inter-shift patient handover, but also shortened the duration of handover by 21.67 min per registered nurse. This project also showed that commitment, acceptance, enthusiasm and support from all the registered nurses and stakeholders are essential contributing factors towards the success of improving clinical practice. Utilising the JBI PACES approach of audit and feedback has helped in reducing the time spent on handover. It has demonstrated that the use of evidence to improve clinical practice is possible in a challenging acute care environment.