Effects of the I-PASS Nursing Handoff Bundle on communication quality and workflow. Issue 12 (5th July 2017)

• Record Type: Journal Article
• Authors: Starmer, Amy J; Schnock, Kumiko O; Lyons, Aimee; Hehn, Rebecca S; Graham, Dionne A; Keohane, Carol; Landrigan, Christopher P
• Is Part Of: BMJ quality & safety. Volume 26:Issue 12(2017)
• Page Start: 949
• Page End: 957
• Publication Date: 2017-07-05
• Subjects: Hand-off -- Communication -- Nurses -- Patient safety; Medical care -- Quality control -- Periodicals; Health facilities -- Risk management -- Periodicals; Medical errors -- Prevention -- Periodicals; 362.106805
• DOI: 10.1136/bmjqs-2016-006224
• Languages: English
• ISSNs: 2044-5415

Abstract

Abstract : Background and objective: Handoff communication errors are a leading source of sentinel events. We sought to determine the impact of a handoff improvement programme for nurses. Methods: We conducted a prospective pre-post intervention study on a paediatric intensive care unit in 2011–2012. The I-PASS Nursing Handoff Bundle intervention consisted of educational training, verbal handoff I-PASS mnemonic implementation, and visual materials to provide reinforcement and sustainability. We developed handoff direct observation and time motion workflow assessment tools to measure: (1) quality of the verbal handoff, including interruption frequency and presence of key handoff data elements; and (2) duration of handoff and other workflow activities. Results: I-PASS implementation was associated with improvements in verbal handoff communications, including inclusion of illness severity assessment (37% preintervention vs 67% postintervention, p=0.001), patient summary (81% vs 95%, p=0.05), to do list (35% vs 100%, p<0.001) and an opportunity for the receiving nurse to ask questions (34% vs 73%, p<0.001). Overall, 13/21 (62%) of verbal handoff data elements were more likely to be present following implementation whereas no data elements were less likely present. Implementation was associated with a decrease in interruption frequency pre versus post intervention (67% vs 40% of handoffs with interruptions, p=0.005) without a change in the median handoff duration (18.8 min vs 19.9 min, p=0.48) or changes in time spent in direct or indirect patient care activities. Conclusions: Implementation of the I-PASS Nursing Handoff Bundle was associated with widespread improvements in the verbal handoff process without a negative impact on nursing workflow. Implementation of I-PASS for nurses may therefore have the potential to significantly reduce medical errors and improve patient safety.