Using "best-fit" interventions to improve the nursing intershift handoff process at a medical center in Lebanon

Nursing intershift handoff involves communicating essential patient information between the outgoing and the oncoming nurses during shift changes. A subsequent review of reported patient safety incidents at Labib Medical Center (LMC), Saida, Lebanon, showed that medication errors, delay in treatment, wrong treatment, duplication of laboratory tests, and near-miss events were caused by patient information omissions during intershift handoffs. In response, LMC initiated a quality improvement project using a multifaceted intervention to improve the quality of nursing intershift handoffs.

The barriers to effective intershift handoff identified in the literature that best fit the current context of intershift handoffs at LMC showed that the following three issues needed to be addressed: (1) the absence of a standardized intershift communication tool, (2) inadequate training of RNs on intershift handoff communication, and (3) the interruptions during the shift reports. Accordingly, a three-faceted intervention was constructed, entailing (1) introduction of a standardized intershift handoff tool, (2) training RNs about effective handoff communication, and (3) decreasing interruptions.

The mean number of omissions per handoff across the three units decreased from 4.96 to 2.29 (t = 6.29, p = .000), as did the mean number of interruptions per intershift report--from 2.17 to 1.26 (t = 2.7, p = .008). RNs' knowledge of the criteria to be communicated suggested a greater appreciation of their own role in patient safety.

The intershift handoff communication process can be improved using evidence-based strategies that target internal barriers where the shift report occurs. Regular monitoring and follow-up are essential to maintain the improvement.