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

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.