RT Journal Article
SR Electronic
T1 Effects of the I-PASS Nursing Handoff Bundle on communication quality and workflow
JF BMJ Quality & Safety
JO BMJ Qual Saf
FD BMJ Publishing Group Ltd
SP 949
OP 957
DO 10.1136/bmjqs-2016-006224
VO 26
IS 12
A1 Amy J Starmer
A1 Kumiko O Schnock
A1 Aimee Lyons
A1 Rebecca S Hehn
A1 Dionne A Graham
A1 Carol Keohane
A1 Christopher P Landrigan
YR 2017
UL http://qualitysafety.bmj.com/content/26/12/949.abstract
AB 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.