The investigation of adverse clinical events, in a private health care hospital in the Western Cape, during January and February 2022, have indicated that events occur due to poor clinical handover.
These investigations identified that failure to handover risk assessments such as the Morse Fall Risk Score (risk for fall) and the Waterlow score (risk to develop pressure injuries), the nursing diagnosis of the patients, pressure injuries, outcomes of tests and investigations and special instructions for the next shift, compromised patient safety.
The aim of this study was to identify the quality failures Registered Nurses and Enrolled Nurses encountered during clinical handover.
The research had a descriptive mixed methodology design with a qualitative and quantitative content analysis approach. To conduct the study, two surgical nursing units were selected.
The data was gathered by using an audit tool, through a two-month observation of nursing clinical handovers. The Registered Nurses and Enrolled Nurses also completed surveys anonymously, which included open-ended and scaled questions. Then, a qualitative and quantitative content analysis was used for data analysis.
Two major themes (lack of structure and interruptions) and three sub themes (communication, distractions, and time management) emerged through the data analysis.
The first and the second themes linked the lack of organization of the handover process and different interruptions, respectively. The researcher found that the handover processes were inconsistent and highly person dependent. The purpose of handover is to communicate one hundred percent of the critical information of the patient. This was unsuccessful as the elements of the handover were compliant with only 75%. The observation of handovers identified the quality failures as incomplete documentation, lack of standardization of the process, interruptions caused by colleagues, staff not knowledgeable about the patient and a lack of critical thinking skills.
In general, applying a standard approach, managing language barriers and interruptions are recommended for nursing managers to overcome handover quality failures.
Key Words: Quality, Clinical Handover, Safe Patient Care