The EPIC (Excellent Practice in Communication) Project. Neurosurgical Nursing Clinical Handover Improvement Practices among acute inpatients: a Best Practice Implementation Project

The nursing handover normally occurs at the beginning of a nurse’s shift and is considered essential for continuity of care. Nursing handover has the potential to communicate accurate information about a patient’s condition, treatment and anticipated needs but also has the potential to be ineffective or even harmful if information is incomplete or omitted. The Australian Commission on Safety and Quality in Health Care (ACSQHC) has recognised clinical handover as a National Standard, thus reinforcing its importance.

This project aimed to conduct an audit of nursing clinical handover practices, to implement evidence-based best practice recommendations and to maximise the effectiveness of clinical handover in a neurosurgical unit of a large tertiary hospital.

The project used the Joanna Briggs Institute’s (JBI) Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) audit tool for promoting change in healthcare practice. A baseline audit of 30 observations of nursing clinical handover was conducted and measured against seven best practice recommendations, followed by the implementation of targeted strategies and follow up audits.

The baseline audit revealed deficits between current practice and best practice in four of the seven criteria. Barriers for implementation of nursing clinical handover best practice criteria were identified by the project team and a neuroscience specific nursing handover framework and bundled education strategy was implemented. There were improved outcomes across the best practice criteria in the follow up audit.

The findings showed how audit may be used to promote best practice in healthcare and that focussed education and provision of relevant resources can have an immediate and positive impact on clinical practice. Some of the measured criteria improved to a moderate degree, leaving plenty of room for improvement, however by the end of the project attitudes towards nursing clinical handover had been ‘transformed’ from a passive, routine ‘must do’ task, to an active process with a focus on safety and patient/carer engagement. Future audits are planned to ensure sustainability.