The PICOT question
In acute care patients (P), does the implementation of bedside report or handoff during shift change (I) for 4-6 months (T) improve the quality of care and patient safety (O) as compared to the handoffs performed away from the bedside (C)?
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- P- (Patient, population, or problem): acute care patients.
- I- (Intervention): the implementation of bedside report or handoff during shift change.
- C- (Comparison with other treatment/current practice): the performance of handoffs away from the bedside.
- O- (Desired outcome): improved quality of care and patient safety during the patients’ hospital stay (measured with quality and safety indicators).
- T- (Time Frame): 4-6 months.
The practice issue, its scope and the need for change
The process of handing patients over (patient handoffs or handovers) performed by nurses during shift changes is a major patient safety and care quality concern in various settings, including acute care (Bradley & Mott, 2013). In particular, handoffs can result in the loss of important information and miscommunication, leading to medical errors. For example, Mardis et al. (2016) report that 80% of medical errors occur due to handoff-related miscommunication (p. 54).
One approach to reducing miscommunication issues is bedside handoffs, which presuppose conducting the handoff directly at a patient’s bedside. The approach involves face-to-face communication between the staff members and requires encouraging the patient to participate in the process (Bradley & Mott, 2013). There is some evidence that bedside handoffs improve the quality of care and patient safety concerning several indicators, including patient falls and catheter-associated urinary tract infections. However, the research in the area is relatively scarce (Mardis et al., 2016). Still, the bedside approach is evidenced to lead to better quality and safety outcomes than the traditional approach (Bradley & Mott, 2013).
Thus, the employment of inefficient patient handoff methods can be viewed as a safety management issue. This problem exists within the area of clinical practice (Bradley & Mott, 2013). From the perspective of the scope, it can be suggested that the employment of inefficient handoff methods in an organizational issue, but it tends to affect large populations (patients of these organizations) and, eventually, individuals. The need for change is apparent in this case.
Evidence that must be gathered
The main sources of evidence that are likely to support the project include literature (especially original research, systematic reviews, and meta-analyses), guidelines, standards, and expert opinions. The literature review will provide theoretical frameworks that can guide the project (especially the implementation processes) and evidence that can support the intervention. Guidelines and standards are an important source of evidence that can effectively inform practice (Spruce, Wicklin, Hicks, Conner, & Dunn, 2014); they will be especially helpful in supporting the intervention and suggesting the pathways for its implementation. Finally, patient preferences are an important source of support for the intervention: one of the advantages of bedside handoffs is the inclusion of the patient, making this approach more patient-centered (Bradley & Mott, 2013; Mardis et al., 2016). Therefore, considering patient preferences within the proposed project is in line with its intervention, aims, and vision. Other sources may also be eventually employed if deemed feasible.
The studied phenomenon has multiple synonyms that should be checked, which reinforces the need for narrowing the search to make it faster and more effective. To this end, the search will focus on recent sources and peer-reviewed articles, which can be achieved with the help of filter options offered by the majority of modern databases. Apart from that, search operators will be used when searching the databases that use them. For instance, quotation marks can help find a specific phrase, and the use of the “allintitle” operator ensures that the chosen phrase is located in the title of the article.
Bradley, S., & Mott, S. (2013). Adopting a patient-centred approach: An investigation into the introduction of bedside handover to three rural hospitals. Journal of Clinical Nursing, 23(13-14), 1927-1936. Web.
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Mardis, T., Mardis, M., Davis, J., Justice, E., Holdinsky, S., Donnelly, J., … Riesenberg, L.A. (2016). Bedside shift-to-shift handoffs. Journal of Nursing Care Quality, 31(1), 54-60. Web.
Spruce, L., Wicklin, S. A., Hicks, R. W., Conner, R., & Dunn, D. (2014). Introducing AORN’s new model for evidence rating. AORN Journal, 99(2), 243-255. Web.