Co-design and implementation of nursing handover improvement tool in Kenyan newborn units: a pilot study

Transfer of care and responsibility for patients from one healthcare provider to another during hospitalisation is critical to them receiving the right interventions and overall quality and safety of care, and is dependent on the accurate transfer of patient information. Sick newborns are particularly dependent on health workers being able to meet their needs, but previous work suggests that nursing handovers in newborn units (NBUs) may be poor in Kenya. Initiatives aimed at improving nursing handovers have mainly been tested and implemented in High-Income Countries (HICs), with very little happening in Low- and Middle-Income Countries (LMICs), especially in the context of sick and hospitalised newborn nursing care. In this study, we sought to co-design, implement, and assess a nursing handover tool's effect on the communication of patient information, teamwork, and coordination of care among nurses in selected newborn units.

We adopted a co-design approach where nurses were involved in the design of a nursing handover improvement tool, i.e., the ESBAR tool. To pilot and assess the effects of this tool, a prospective before-and-after study was conducted in three county referral hospitals in Kenya. We utilised both in-depth qualitative interviews (pre = 15, post = 22), observation of nursing handover sessions (pre = 48 sessions, post = 48 sessions) and a survey using a structured self-administered questionnaire (pre = 43, post = 37). The study participants were all nurses working in selected NBUs. The qualitative data were thematically coded in NVivo, and for the quantitative data, descriptive statistics and paired t-tests analysis were conducted in STATA 15.

Our qualitative findings showed a positive influence of ESBAR on nursing handovers, i.e., completeness of information, improvements in the handover process and nursing team interactions. However, quantitatively, we observed no differences in means for all three indicators before and after the use of ESBAR. Implementation challenges included: a lack of interest among staff to adopt new changes and high patient-to-staff ratios. Enabling factors were user involvement in tool design, teamwork, and support of champions.

Standardised handover tools can improve information exchange during handovers in low-resource settings; however, due to contextual challenges, there is potential to integrate these tools more as a communication guide. We recommend adopting a co-design approach with healthcare workers to ensure such initiatives meet their needs and to encourage adoption.