Postoperative handover among nurses in an orthopedic surgical setting in Myanmar: a best practice implementation project.

Khin Sanda Tun, K. Wai, Yin Yin, May Khin Thein
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引用次数: 4

Abstract

INTRODUCTION Clinical handover is a communicative process where the responsibility of patient care is transferred through the exchange of patient information between the care providers. Postoperative handover is an important phase of perioperative care that presents challenges to handover personnel due to transitions in care throughout the perioperative period and the inability of surgical patients to participate in their own care. This paper reports on the best practice implementation project conducted in the field of postoperative handover among nurses in a 500-bed orthopedic surgical setting in Myanmar in 2017. OBJECTIVES The aim of this project was to improve the postoperative handover practice within the local context of the orthopedic surgical setting by implementing best practices. METHODS The project used the JBI Practical Application of Clinical Evidence System and the Getting Research into Practice audit tool to conduct a baseline audit and two follow-up audits. A total of 120 postoperative handovers were observed and data were collected. Education sessions and a series of discussion and engagement efforts were employed to increase the compliance with evidence-based postoperative handover practice. RESULTS Baseline audit showed low compliance in audit criteria 3, 5 and 6, whereas compliance was observed to varying degrees in the criteria 1, 2 and 4. Improvement was seen with five criteria in follow-up audits except for criterion 1. Compliance with criterion 1 was inconclusive because staff attendance at postoperative handovers varied depending on patients' different handover needs. Nurses attendance, however, improved through engagement efforts and education sessions, which highlighted teamwork practice. CONCLUSION We were able to make significant improvements in the underperforming areas related to postoperative patient handover. This project confirms that an SBAR (Situation, Background, Assessment, Recommendation) checklist has been implemented to navigate and document every postoperative handover at main operating theater; the handover process at intensive care unit complies with the COLD (Connect, Observe, Listen, Delegate) process; and attendance of handovers by nurses has increased. It is recommended that regular audits are conducted to sustain the change and improve where required.
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缅甸骨科手术环境中护士的术后交接:最佳实践实施项目。
临床交接是一个沟通的过程,病人护理的责任是通过病人信息的交换在护理提供者之间转移。术后交接是围手术期护理的一个重要阶段,由于围手术期护理的过渡以及手术患者无法参与自己的护理,对交接人员提出了挑战。本文报道了2017年缅甸某500张床位骨科医院护士术后交接领域的最佳实践实施项目。目的本项目旨在通过实施最佳实践,改善骨科手术环境下的术后交接实践。方法采用JBI临床证据系统的实际应用和将研究转化为实践的审核工具,进行1次基线审核和2次随访审核。共观察120例术后交接并收集数据。采用教育课程和一系列讨论和参与努力来提高对循证术后移交实践的依从性。结果基线审计中审计准则3、5、6符合性较低,准则1、2、4符合性不同程度。除标准1外,在后续审核中有五个标准有所改善。标准1的依从性是不确定的,因为工作人员在术后移交时的出勤率取决于患者不同的移交需求。然而,通过参与努力和强调团队合作实践的教育课程,护士的出勤率有所提高。结论我们对术后病人交接的薄弱环节有了明显的改善。本项目确认实施了SBAR(情况、背景、评估、建议)检查表,以指导和记录每次主手术室的术后交接;重症监护病房的交接流程遵循COLD (Connect, Observe, Listen, Delegate)流程;护士接班的人数也有所增加。建议进行定期审计,以维持变化并在需要时进行改进。
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