Improving Shift Handovers in ICU: A Critical Review and Action Plan

Running head: NURSING
Nursing
Name of student:
Name of university:
Author note:

1NURSING
Introduction
Healthcare settings are responsible for delivering best possible services to the
healthcare consumers to achieve better outcomes within a stipulated time. Professionals
working in collaboration with each other in different settings are to demonstrate suitable
professional skills and competencies to engage in safe practice. It is to be remembered that the
care setting is accountable for putting in place the varied policies for clinical practice as per the
best interests of the patient population. In this regard it is crucial that changes are implemented
in practice to augment the policies or procedures adhered to. Action plans are to be articulated
based on research evidence that can guide positive changes in different areas of practice within
the different wards. These are to be then implemented in consultation with all stakeholders and
a thorough evaluation is also warranted for understanding the effectiveness of the same. The
present paper reports on handovers of shift duty as the chosen area of practice in the current
ward of ICU at a reputed healthcare setting at Riyadh, Saudi Arabia and critically reviews its
procedure. Based on evidence based approach, an action plan is drawn up on how the practice
can be better improved. The report identifies the problem in the clinical area and gives a
rationale for improvement on the basis of relevant literature. A standard setting statement is
drafted in this regard. Details for the implementation of the plan are discussed including how the
standard would be communicated to others and the method of evaluation of the standard set. A
conclusion is provided at the end of the paper to summarize key points.
Problem identified in clinical area
Delivery of appropriate and safe health care is at the core of the services provided at the
present ICU at the Riyadh hospital. The ICU is the specialized department that focuses on
providing intensive treatment to the patient population. The professionals working at the unit are
accountable for catering to the needs of individuals suffering from life threatening diseases and
illness. Patients require close monitoring and constant support provided in a professional
manner by skilled workers (Haniffa et al., 2017). The ward is distinguished from other wards in
that the staff-to-patient ratio is higher and access to advanced equipment and resources is
enabled.
Shift handover is a common tradition among nursing professionals at the ward that has
drawn the attention at present in relation to need of betterment. Clinical handovers refer to the
transfer of accountability and professional responsibility of patient care aspects from one
professional or professional group to another on a temporary and permanent basis. The

2NURSING
purpose of the handover is to make sure that professionals about to take in charge of care have
the required level of understanding of clinical priorities (Blais et al., 2015). At the present ward, a
number of concerns have been identified in relation to the procedure of shift handover. Though
it Is acknowledged that shift handover is essential and inevitable for shift working pattern, not
much have been done to ensure that the procedure for the same is robust. Clinical handovers
between shifts has remained a high risk activity at the setting for patient safety. Critical
information is not transferred in a correct and effect manner that maintains continuity of care.
Observations at the ICU indicated that shift handovers did not take place at a designated
area and at a particular time without interruptions. While some professionals considered
completing the handovers at the bedside, others did not consider so. At one instance it was
noticed that a nurse had used the office room for the handover. Handovers at places other than
the bedside are not effective as the professionals are not able to observe the patient and collect
updated patient information at the time of the handover (Malekzadeh et al., 2013). The staff
taking part in the handover has a crucial role in the process. The desired process model
encompasses staffs from all grades to be present (Graan et al., 2016). At the current ward the
handovers included only the incoming and outgoing nursing professional. The duration of the
handovers were also found to be differing to a considerable extent. While some handovers
lasted for 45 minutes, some were completed within 15-20 minutes. It is the best practice that
shift handovers are carried out without interruption so that optimal information is passed on
within a short time frame in an accurate manner. At the present ICU it was observed that
handovers were often disturbed and interrupted. Moreover, the proportion of urgent and non-
urgent distractions was nearly equal. Despite a guideline put in place for handover, there has
been non-adherence to the same. It is therefore significant to bring improvement in the standard
of shift handovers at the unit.
Rationale for improvement
The importance of shift handovers has been gaining recognition in the recent times
against the evolving healthcare needs of patient population. In the past, ICUs were only covered
by senior medical officers and experienced nursing professionals. In the more recent time, with
the advent of modern technologies and knowledge of medical science, ICUs have increasingly
become populated with junior physicians and nurses with lesser working experiences. It is
therefore crucial that appropriate guidelines are put in place so that the process of care delivery
is not impaired at any stage (Spooner et al., 2018).

3NURSING
Shift handovers are the transfer of clinical issues pertaining to a patient that needs to be
known and the changes required in the treatment plan outlined after the responsibility of care
has been transferred from one professional to another. The intensive care unit handover is
perceived to be a core skill of the professionals working in it. For many professionals it has been
highlighted to be a stressful event of their regular practice (Zegers et al., 2016). Skills for
effective handovers are to be taught to professionals as a part of their formal education.
Nevertheless, the actual scope for developing the skills for handovers is gained during the daily
practice. As pointed out by Thomson et al., (2018) the main aim of shift handover is provision of
a high quality care. Nevertheless, communication of poor information at the time of handover
endangers safety of the patient. A rich pool of evidence points out that ineffective shift
handovers are responsible for medication errors together with increase of risks of sentinel
events. Further, the risks of delays in the course of treatment are witnessed that leads to
prolonged length of stay at hospital and decreased patient satisfaction. Effective communication
is an integral part of clinical handovers and has been referred as one of the most important
goals for patient safety. This entails that credible and up-to-date information is passed on that is
minimally disrupted.
Marshall et al., (2018) have brought into focus the benefits of appropriate ICU handover.
The most significant benefit is that safety of the patients is protected. Lapses when present in
handover lead to mistakes that are fatal for patients. The subsequent result is mortality and
morbidity. Poor handover also leads to inconsistency and fragmentation of care. If one is to
achieve greater continuity of care robust handover is to be undertaken. Increases service
satisfaction in the next benefit of proper handover. Patient’s perception and outlook of
competency and professionalism is improved and reaffirmed as a result of proper handover
communication. The researchers mentioned that timely diagnosis and investigations of health
problem presented by patients is possible when handover is accurate. This is a sign of
increased efficiency and improvement in service delivery of the care setting.
Kowitlawakul et al., (2015) mentioned that good handover not only is beneficial for the
patients but is also beneficial for the physicians and other health care professionals apart from
nurses. With the recent shift of the focus care to a more debatable culture within care systems,
accountability of the professionals has been prominent and drawn attention of all. Accountable
and clear communication protects against inconvenient attribution of charge for errors occurring
in due course of care. Under condition when updated and clear information is present as a
result of hand over, it is easier for physicians to take control of the care activities in a more