Applying QI methodology to improve patient safety

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Our Cardiology Department is using Quality Improvement (QI) methods to improve their handovers – and ultimately improve patient safety.

Handovers between teams during shift changes in hospitals are a critical transition time for patients – as the potential for error or miscommunication is high.   It is worth noting that 1 in 10 patients are harmed while receiving hospital care – with 50% considered preventable. Evidence suggests that memory is not enough for staff to retain information and that a standardised, recorded handover reduces medical errors – so it is essential that staff get this process right.

Our Cardiology Team sought to tackle their handover process using the QI methodology and the Model for Improvement:

The Cardiology Team began the process by sending out a Knowledge, Attitude, Practice (KAP) study to all professional stakeholders to establish current practice, evaluate staff satisfaction and motivation for change, determine areas for improvement and intervention, and also set a base line for improvement.

Results showed that 69% of respondents were dissatisfied with current practice, highlighting that the content in handovers and clear lack of standardisation meant that important content was missed.

Respondents were asked what they would like in handovers. The overwhelming response showed that they would like a clear structure for handovers, regular nursing input and for the model to be standardised using an electronic list.

The team then used the results from the survey to set some measurable aims and begin a PDSA cycle:

Establish standardised handover and maintain consistency for patientCompliance studies at regular intervals, followed by further KAP questionnaire70% compliance
Improve staff satisfaction with handoversFurther KAP questionnaire70% satisfaction

The following changes were implemented:

  • Handover expected in CCU every time
  • Handover at set times – 0800, 1530, 1930
  • New 1550 afternoon boardround
  • Key team members in attendance – Charge Nurse, SHO, Day Registrar Consultant, Night Registrar
  • Consistent structure and content (a flowchart was developed based on survey responses)
  • Electronic handover documentation set up

The new processes were embedded at meetings, with emails and with lots of verbal prompting and reminders. An easily accessible handover document was also produced.

At the end of the first cycle, change was measured at 4 weeks and the results showed 65% compliance – which is a huge achievement for the first cycle.

Further improvements have also been highlighted – for example making the flowchart more visible, helping to support charge nurses to attend and publishing attendance data.

The aim is to introduce this new handover process as a long term behaviour change. To achieve this the team will continue to do repeated PDSA cycles – to refine and embed the improvement and to put patient safety at the heart of their use of QI methodology.