1. Title of the Change Project
Student ID.
MSc in Healthcare Management,
Institute of Leadership, Royal College of Surgeons in Ireland
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Implementing a change in Handover utilising an ISBAR Communication Sheet and Accountability Tool
James Geoghegan, RCSI Institute of Leadership
Abstract
As patients move from nurse to nurse it is critical that timely, accurate information about the patient’s care plan, treatment and any recent or anticipated changes goes with them. Therefore accurate communication during nursing handover is a key element in the safety and quality of patient care. This nursing handover takes place in all healthcare facilities where patient care is transferred between healthcare professionals, in both structured and semi-structured events in active and busy environmental settings. There have been a large number of reviews which have reported adverse events to patients, noting that communication was the root cause of 65 to 70% of these incidents.
A number of communication barriers were identified which included a lack of structure, policies and procedures related to the content and timing of the report, no shared model or framework for verbal healthcare communication, differing opinions among nurses to what information should be communicated during the handover, frequent interruptions and distractions.
Utilising a standardised approach to handover would aid in promoting clarity of purpose and the content of the handover, which by extension would improve the continuity of care, reduce errors and potential harm to the patient. There are various communication tools as a basis for a structured handover.
The ward developed such a communication sheet based on the ISBAR (Identify, Situation, Background, Assessment, Recommendation with an accountability tool.
The HSE’s Directorate of Quality and Safety ‘Quality and Performance Improvement Tool’ was used to evaluate the change. Theme Two (Standard Two) – Effective Care and Support (Care is planned and delivered to meet the individual service user’s initial and ongoing assessed healthcare needs). The finding showed that to date the project has completed two of the four performance levels. The findings noted assessment of need is undertaken and identified on nursing handover, information provided by service user and inputs from other healthcare professionals. Care and treatment decisions are discussed with the patient and are in accordance with agreed Handover Protocols. There are arrangements in place to identify and respond rapidly to clinical deterioration through the implementation of the National Early Warning.
To ensure sustainability of the project ongoing evaluation of the handover through the Quality and Performance Improvement tool process will have to be undertaken until it reaches performance level four.

2. Introduction & Background Organisational Impact
Implementing a change in Handover utilising an ISBAR Communication Sheet and Accountability Tool
James Geoghegan, RCSI Institute of Leadership
Introduction & Background
Methodology
Figure 3. Quality and Performance Improvement Tool
Handovers have been defined as “The transfer of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another person or professional group on a temporary or permanent basis” 1.
There has been a move in the literature towards standardising handover, which has been shown to improve consistency and reliability of outcomes.
The Change project was set on a medical ward in a Level Four hospital, with a current system of office based handovers.
The HSE Model was used, as It would ensure that staff were able to engage in working together to improve the service and promote a consistent approach to the change in handover planned (2008).
Initiation:
The requirement for the change was acknowledged. Key stakeholders were identified.
Planning:
Focus on the organisation wide commitment, momentum and capacity for change.
Implementation:
Lewin’s (1951)3 Three stage model of change used to assist staff adapting and embracing the new change to the handover.
Mainstreaming:
Support and ongoing evaluation is required to ensure that the changes are embedded to the everyday activity of the ward.
Figure 2: HSE Change Model 2
Level Of Quality
Guiding Prompts
Select
Emerging Improvement
Level One
Assessments reflect patients’ initial and ongoing assessed needs and
agreed outcome goals.
Continuous Improvement
Level Two
Audit results inform training programmes and improvement plans.
Sustained Improvement
Level Three
Consistent achievement of outcome goals is demonstrated.
Excellence
Level Four
Learning from national and international investigations and reports
informs improvements
Aims & Objectives
The Aim of the Change Project
To provide a structured approach to handover on the ward by implementing an end of bed handover, with a prepared ISBAR communication sheet and accountability tool.
The Objectives of the Change Project
Develop a Standardised Guideline for Handover between nursing staff.
Develop a standardised communication sheet using the HSE’s ISBAR tool with a new accountability sign off sheet.
Figure 1. ISBAR communication sheet.
Organisational Impact
The ward has incorporated the end of bed handover utilising the ISBAR sheet and accountability tool. This project can be used on all hospital wards with adequate training.
Conclusion
The project has provided a standardised approach to undertake handover on the ward. Staff have embraced the change. Ongoing audits and evaluation using the Quality and Performance Improvement are required to ensure sustainability. Future projects should consider increased IT resources to expand the handover hospital wide.
Evaluation
Identify
Situation
Background
Assessment/
Recommendation
Pt Name
Consultant
Presenting symptoms
Relevant history
Plan of care/Problem
 Agreed Action
Quality and Performance Improvement Tool, (2012), Theme 2 used for evaluation (Fig, 2).
Focus Groups utilised to assess the staff nurses perception of the change in handover practice
Audits of Handover and accurate use of accountability tool.
References
1. British Medical Association. Safe handover: Safe patients Guidance on clinical handover for clinicians and managers. London, United Kingdom; BMA House; 2004.
2. Health Service Executive. Improving our services- A User’s Guide to Managing Change in the Health Service Executive. Dublin:HSE; 2008.
3. Lewin, K. Field theory in Social Science. New York, USA: Harper and Row; 1951.