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Handover Between Anaesthetists and Post-Anaesthetic Care Unit Nursing Staff Using ISBAR Principles: a Quality Improvement Study

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Handover Between Anaesthetists and Post-Anaesthetic Care Unit Nursing Staff Using ISBAR Principles: a Quality Improvement Study Volume 29 Issue 1 Article 2 3-1-2016 Handover between anaesthetists and post-anaesthetic care unit nursing staff using ISBAR principles: A quality improvement study Patricia Kitney [email protected] Raymond Tam [email protected] Paul Bennett [email protected] Dianne Buttigieg [email protected] David Bramley daFollowvid.br thisamle [email protected] additionalg.au works at: https://www.journal.acorn.org.au/jpn Part of the Health Services Administration Commons, Health Services Research Commons, SeePerioper nextativ pagee, Operfor additionalating Room authors and Sur gical Nursing Commons, and the Surgery Commons This work is licensed under a Creative Commons Attribution 4.0 License. Recommended Citation Kitney, Patricia; Tam, Raymond; Bennett, Paul; Buttigieg, Dianne; Bramley, David; and Wang, Wei (2016) "Handover between anaesthetists and post-anaesthetic care unit nursing staff using ISBAR principles: A quality improvement study," Journal of Perioperative Nursing: Vol. 29 : Iss. 1 , Article 2. Available at: https://doi.org/10.26550/2209-1092.1001 https://www.journal.acorn.org.au/jpn/vol29/iss1/2 This Article is brought to you for free and open access by Journal of Perioperative Nursing. It has been accepted for inclusion in Journal of Perioperative Nursing by an authorized editor of Journal of Perioperative Nursing. Handover between anaesthetists and post-anaesthetic care unit nursing staff using ISBAR principles: A quality improvement study Authors Patricia Kitney, Raymond Tam, Paul Bennett, Dianne Buttigieg, David Bramley, and Wei Wang This article is available in Journal of Perioperative Nursing: https://www.journal.acorn.org.au/jpn/vol29/iss1/2 Peer-reviewed article Handover between anaesthetists and post-anaesthetic care unit nursing staff using ISBAR principles: A quality improvement study Authors Abstract Patricia Kitney A structured approach to communication between health care RN, BAppSc-Nsg, DAppSc-Nsg Ed, MEd professionals contains introduction/identification; situation; (Research), GradCert LdrshipEdTrng, GradCertPeriop background; assessment and request/recommendation (ISBAR). Western Health, Sunshine, Vic ISBAR was introduced into the post-anaesthetic care unit (PACU) Raymond Tam of a large Victorian health service in 2013. The aim of this study MBBS FANZCA was to measure the effect of an education program on ISBAR Western Health, Sunshine, Vic compliance. Paul Bennett Method: A pre/post-test design using a 14-item audit tool was used to RN BN GradCertSc (App Stats) MHSM PhD measure compliance to ISBAR before and after an education intervention in Deakin University, Geelong, Victoria, Western Health – Nursing Research two acute hospitals in Melbourne, Victoria. The intervention consisted of one Centre, Sunshine, Vic 30-minute education session to anaesthetists, and two 30-minute education sessions to PACU nurses, combined with visual cues using ISBAR wall posters. Dianne Buttigieg RN, BHSc (Nursing), Grad Cert Periop Nsg, Results: In Hospital A, significant improvement from pre- to post-audit DipMgt was found in the items of cardiovascular assessment (χ2 (1) = 4.06, p < .05), Western Health, Sunshine, Vic respiratory assessment (χ2 (1) = 12.85, p < .01), analgesia assessment and David Bramley actions (Fisher’s exact test p < .05) and responsibility + referral (χ2 (1) = 4.44, MBBS MPH FANZCA p < .05). For Hospital B significant improvement was found in communication Western Health, Sunshine, Vic difficulties (χ2 (2) = 13.55, p < .01) and significant decreased performance was found in respiratory assessment (χ2 (1) = 8.98, p < .01) and responsibility + Wei Wang Msc (Stats) GdipSci (Stats) MD PhD referral (χ2 (1) = 13.26, p < .01). Deakin University, Geelong, Vic Implication for practice: The results from this study cohort suggest an augmented education program may produce mixed results for ISBAR Corresponding author compliance. More than education and visual tools may be required to improve Patricia Kitney PACU ISBAR compliance. Clinical Nurse Educator - Perioperative Services Keywords Western Health, Gordon Street, Footscray VIC 3011 Handover, anaesthetist, post-anaesthetic care, post-anaesthetic nurse. Tel. 03 8345 0506 [email protected] 30 Journal of Perioperative Nursing in Australia Volume 29 Number 1 Autumn 2016 acorn.org.au Background a surgical procedure. Each team implemented. The aim of the quality member is accountable for the improvement project reported In 2012 the Australian Commission information they transfer from one here was to measure the effect the on Safety and Quality in Healthcare part of the patient journey to the education program had on ISBAR (ACSQHC) identified clinical handover next; however, in Australia, it is compliance. as a key standard in the national most commonly the anaesthetist 1 quality and safety framework . With who performs the post-operative Methods over seven million clinical handovers handover4. The post-operative Design occurring annually in Australian handover consists of the transfer of hospitals, it was concerning that information of the patient’s state A pre/post-test design using audit global handover processes have and care by the anaesthetist to the tools to measure compliance before been highly variable and unreliable, post-anaesthetic care unit (PACU) and after a quality improvement and associated with patient risk staff with appropriate briefing on intervention. 2 and patient safety . A recent review relevant aspects of the surgery and of 31 postoperative handover anaesthetic technique5. Sample primary research studies confirmed ISBAR is a structured approach to A convenience sample of the positive association between communication between health anaesthetists were observed over a handovers and adverse events and care providers. ISBAR refers to: one-week period in two PACU units recommended the standardisation of Introduction/Identification; from two participating hospitals handover processes3. Standardisation Situation; Background; Assessment; within the same health service. of clinical handover is likely to and Request/Recommendation6. The Handovers were performed by improve the safety of patient care as introduction of ISBAR to Western anaesthetists providing a clinical critical information is more likely to Health, a large metropolitan health handover of their patients to PACU be transferred and acted upon1. service in Melbourne, Victoria, was nursing staff were included in the In the perioperative environment undertaken to provide a standardised audit. There were no data in the surgeons, scrub nurses, organisation-wide approach7. The literature to guide detailed sample anaesthetists, anaesthetic nurses introduction of ISBAR identified size calculations for comparison of and scout nurses are all involved issues of non-compliance, resulting before and after compliance with in the care of the patient during in an education strategy being the ISBAR handover tool in PACU. Assuming normally distributed population data in the independent Identification Patient samples, a proposed sample size Staff members of 100 observations in each group Situation Procedure would give 83% power to detect a difference in proportion of handover Anaesthetic type compliance from 50% to 70% at a Background Allergies significance level of 0.05 in a post- Co-morbidities hoc analysis of entire cohort. An Communication difficulties (including non-English historical case load suggested that speaking) this would result in a sample of Assessment Intra-operative issues: approximately 200 events (clinical & Actions • surgery and anaesthesia handovers). Current issues: • cardiovascular observations, limits, therapy Intervention • respiratory observations, limits, therapy The intervention consisted of • analgesia interventions to date, orders two strategies. Firstly, in-service • additional needs, e.g. anti-emetics, BSL. education session to anaesthetists Responsibility Name and contact details and PACU nurses on current handover performance was undertaken. The & Referral ICU/HDU/ward/discharge home education sessions were mainly of a didactic nature, presenting Figure 1: ISBAR cue card evidence supporting the introduction Journal of Perioperative Nursing in Australia Volume 29 Number 1 Autumn 2016 acorn.org.au 31 of structured clinical handover. were made. The tool was then piloted deemed stable by the PACU nurse. The model of ISBAR handover was before the study where further minor The audit tool was piloted in 10 presented and reinforced. Secondly, modifications were undertaken. handovers by two PACU nurse ISBAR poster-sized cue cards (Figure educators and found to be practical, 1) were fixed to the walls of all PACU Data collection timely and demonstrated high patient bays. The pre-audit was undertaken inter-rater agreement. Audits were immediately following the undertaken by PACU nurses who had Tool introduction of ISBAR. The education been trained to complete the audits The audit tool was developed and poster strategy was implemented during the two education sessions. measuring the adherence to ISBAR in the succeeding two weeks Completed audits were placed into principles during the handover immediately following the audit. a secure box, which were collected from anaesthetist to PACU nurses The post-audit was undertaken from the box at the end of the one- (Figure 2). This was designed to four months after the education week period by the project team encompass guidelines from the and poster strategy. The audit tool leader (PK). Australian and New Zealand
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