Question:
Clinical Practice Improvement Project Report
Enter your assignment in the white spaces provided and the rows of the template will expand as large as you need.
Title of the project:
Project Aim
Relevance and relevance of Clinical Governance to your Project
You can see evidence that the issue / problem is worthwhile solving
These are the key stakeholders:
CPI Tool
Summary of interventions suggested:
Barriers to implementation, and maintaining change:
Evaluation of project:
Answer to Question: NURS2006 Chronic Illness And Nursing Care
Clinical Practice Improvement Project Report
Project Title:
Clinical Handover Communication using Patient Intervention Comparison
Project Aim
To see if ISOBAR is a better option than general verbal technique to handle clinical handovers.
Relevance and relevance of Clinical Governance to your Project
Clinical governance is the process and criteria used by NHS organisations to improve the quality services provided. This also protects the high standards of medical treatment through the creation an environment that fosters excellence in clinical healthcare.
This is not just a term that applies to NHS organizations. It also refers to practice management principles and integrated principles used in successful dentistry.
Clinical handovers were established to reduce the likelihood of clinical errors in medical settings. However, in most cases the handovers process is not being followed properly (Black et.al., 2015).
Clinical handovers are not always used correctly. This is why there are so many problems and issues in the clinic.
The lack of communication during shift handovers has led to a number of problems in the care planning and execution of patients.
Boswell, et al. (2015), found that nursing handovers contain important information about patient condition and how to handle that patient.
Care standards and quality are affected when the nursing handover guidelines fail to be followed.
More specifically, it is vital that the nursing handsovers be completed in all situations when patients are required to relocate to different wards for critical conditions. When the handovers fail to provide enough information, the medical conditions of the patients can deteriorate to the point where they could become life-threatening.
Johnson et.al. (2014) state that failure to comply with handover protocols indicates a decreased clinical performance standard. 2014).
The clinical standards are not the same as the practice of clinical handover. Some bedside handovers must be done, but in others, the informal verbal handovers method is used.
There are risks of serious clinical errors if the verbal handover is done in an informal manner.
Researchers found that nurses cannot relay sufficient information to their patients via verbal handovers.
Boswell et. al. (2015) also note that information about the patient is not sufficient to verify the authenticity and reliability a documented nursing handover.
The policy on Environmental Safety for Staff, Patients and the Public is another important governance policy that must be assessed in clinical practice.
It states that patients have the same right to clean and safe treatment.
The system is vital in building trust in patients while they receive healthcare by defining the steps at specific stages of nursing.
Health and Safety at Work Act 1974 provide the basic foundations for keeping hospital patients safe and protecting workers.
This policy outlines the employer’s obligations to employees as well as the public.
In addition, the act encourages companies to review workplace risks and devise solutions (Mikkonen (2016) p.187).
Fair and manageable care are another key theme in clinical care.
This goal is to provide timely healthcare services, as well as give patients access to treatment.
Human Rights Act of 1998; Race Relations and its Amendment Act ((2000)) and InfirmityDiscernment Act ( 1995) ensure fair and manageable health care.
The Race Relations Act is designed to promote equity and good mutual relationships among people from different backgrounds.
It also allows patients of diverse ethnicities to have access to the services available to them.
The Human Rights Act encompasses a wide range of social and political equality. The Disability Separation Act makes it illegal to oppress any man for his handicap in the business, offices, and administration.
Unauthorized persons should be allowed to enter the building to review current consistency.
Given the potential for professional and managerial development, the problems that plague this sector because of improper use of clinical handsovers are numerous.
First of all, it is important to mention that nursing is a profession based on solid evidence.
Nursing professionals are required to make sound clinical decisions in cases where patients are in dire need of emergency nursing interventions.
These activities increase the scope of practice, as well as enhancing the nurses’ ability to deal with critical patients.
But these critical decisions can be costly and could even result in the nursing professional being punished (Clarke und Persaud 2011).
Elwyn et al.
The nursing handover information is essential for shift change nurses to understand basic care needs and an overall idea of patient condition. If this information is not provided in a timely manner, it can disrupt the process of patient assessment and care planning.
The nursing professional could be misled by incomplete information in the handover, leading to severe consequences.
This limits the possibilities for professional growth and leads to a decrease in career opportunities for the nurse professional (Elwyn et.al. 2013).
When the clinical handovers do not go according to schedule or are not completed in a timely manner, the situation can pose a number of clinical risks.
It is important that data concerning patients such as vital signs and health, patient problem, allergy, past medical history or medication charts are clearly explained.
The nursing professional can’t include all the details in verbal handovers.
This can lead to errors in medication administration, hospital-acquired infections, falls, allergic manifestations, cardiac issues, and other clinical problems.
There was a need to create a standardised procedure for maintaining nursing handovers, with a protocol to adhere (Flemming und Hubner 2013).
With the help of government initiatives, there were many steps taken to ensure maximum consumer value and safe health care services. But, due to the lack of an immovable protocol or guideline to keep in handover system, that includes the importance for traceability of clinical decisions made nursing professionals communicating the subjective concerns of the patient, the likelihood of the full story being shared with the shift nurse is clearly reduced (Boswellet al. (2015)).
You can see evidence that the issue/problem has worth solving
After literature research and evaluation, it is clear that nursing handsovers are an essential part of the healthcare system. These handovers must be integrated and detailed, and should be used whenever the patient’s needs are assessed by a licensed nurse.
The government has taken a few steps to ensure that the nursing handover process is implemented.
For example, in 2004, the British government launched the “safehandover: safepatient” scheme. It was the first government initiative to standardize nursing handovers. The scheme was closely followed in Australia and the USA by “handoffs” in 2007 (Klim and al. 2013).
It is important to mention that different patterns and frameworks have been developed to improve the reliability, authenticity, and authenticity of nursing handovers.
Poor clinical handling can lead to incompetent frameworks, which could result in patient death. This is true even under the most unfavorable conditions.
Clinical handover is vital to ensure continuity of patient care as well as patient safety.
It serves many purposes and there are many variables that can influence clinical handover. Because of this, maintaining a standard protocol or framework while maintaining clinical handovers will be extremely important to provide safe and optimal care for the patient (Kerr. 2016).
ISoBAR can be used to design optimal clinical handovers. This framework is the most popular and widely used. It’s the most scientifically-sounding and logical way to make nursing handovers detailed.
It is a mnemonic structure that is meant to improve the patient safety as well as care quality.
The ISoBAR method or framework has five components. The first element is identification. This allows you to identify the patient who will be handing over the care (Stanhope und Lancaster 2015).
The second section focuses on the current situation. This describes the medical issues that the patient faces at the moment.
The third section is background, which describes the patient’s past medical history. Finally, the fourth section includes detailed information about the patient’s assessment data.
The final section of this tool recommendation is where the nursing professional will note any suggested intervention that may prove beneficial in helping the patient overcome any health related complications. (Graan et.al. 2016).
The ISOBAR is considered to one of most secure techniques for the transfer of patent information. In many research studies, this tool has been proven efficient in designing nursing handovers that promote optimal patient safety (Sherwood und Barnsteiner 2017). Rushton et al.
2015 cohort analysis study used the ISOBAR tool to assess the effectiveness of handovers at the bedside. The results showed that ISOBAR handovers were combined with verbal communications, which yielded the best results in terms of reducing clinical error and improving patient safety.
This project will use the ISoBAR procedure to investigate its effect on the percentage of clinical mistakes.
The principal stakeholders are:
When implementing clinical handover communications and implementation, it is important to consider the roles of healthcare providers, payers (employers), patients, and other key stakeholders.
Before creating the framework, it’s important to recognize the roles of each one.
In addition, the social environment is an important aspect that one should consider when creating the strategic plan. (Moran Conrad, Burson, 2016,).
CPI Tool
Patient safety recommendations in clinical practice and improvement are essential criteria.
This project adheres strictly to the Human Service and Health Department guidelines of March 2003.
PLAN: The first activity in this [project is to plan the whole process in a systematic manner. This ensures that each detail of planning is taken into account.
The finalization of the heath care settings in which the intervention method will be implemented is the first activity.
The health care setting selected for this project is an acute ward. The bedside handover by nurses will be strictly adhered to the ISoBAR templates.
The study will involve all registered nurses on wards. It will last two weeks.
The data will be gathered based on several parameters, including the percentage of reduced clinical errors per day, the feedback received from patients and their families regarding the safety and quality and, lastly, the nurses’ personal feedback about the ease with which they can take over patient care during shift changes.
You should take care to develop a clear action plan that addresses all the parameters of this project (Lockwood 2016).
DO: The next section will consist of creating an action plan. This plan will address every parameter of each project.
Before moving forward with the project, it is essential to inform and obtain consent from all project participants.
All ethical requirements must be met throughout the project to ensure the best interest of patients is not compromised.
STUDY. This is the next section of the project. It will be guided by CPI.
Due to the possibility of bias in the study design, you should avoid selection bias as much possible.
ACT. This last section documents the project’s plan and the outcome. It should be understood that this project was intended to study the benefits of ISoBAR in maintaining bedside handovers when shift changes or patient takesover occur.
This project is a powerful tool for assessing the positive changes that it can make to care safety, quality, and reducing clinical errors.
The objective data collected and analysed in this step will be documented with a detailed explanation and discussion to reach a possible verdict.
Summary of interventions suggested:
Nursing handover can be used in the case of health acre to help ease the process and minimize the possibility of clinical errors that could result from the incorrect transmission of subjective or objective data about patients.
Although verbal handover is safe and secure, it does not provide the ability to transfer informational data in a trustworthy manner.
It is therefore necessary to establish a protocol that can be used to document the patient and provide information to the nurse caring for him/her (Ouslander, et al. 2014).
ISoBAR technology is a detailed framework that contains all the elements required to make nursing handovers scientifically, detailed, and reliable.
This intervention technique is extremely useful in decreasing the amount of clinical errors that result from miscommunication of patient information. (Piscotty Kalisch and Gracey?Thomas, 2015).
Barriers to implementation, and maintaining change:
These are the major obstacles to critical practices implementations, as well as supporting change.
Time constraint: This project required significant time and effort to complete.
Budget: In order to maintain a strict ISoBAR structure for each patient across all shifts, it is important that a solid budget be used.
Reluctance to Accept: This was a significant conflict to overcome.
Evaluation of project:
The following steps summarize the project’s assessment process.
ISoBAR allows for identification of key parameters to reduce clinical errors in hospitals.
The second step is to evaluate the risks and benefits associated in the project.
The third factor is the determination and establishment of excitations to the overall project’s effectiveness.
Fourthly it is important to determine and evaluate the utility value and cost-effectiveness of the project.
Fifth, it is essential to determine and establish an intervention plan for all emerging or resulting problems.
The final thing to do is to look at the net and healthcare costs related to adverse events in the clinical implications practices.References:Black, A.T., Balneaves, L.G., Garossino, C., Puyat, J.H.
Qian H., 2015.
A program to train point-of care clinicians in research is designed to promote evidence-based practice.
The Journal of nursing management, 45(1) p.14. Retrieved from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263611/Book.+Elsevier+Health+Sciences.&ots=g9nS3v3h1Q&sig=XO0l8EdN1Y37_pDy8nQ5NlLMvVo#v=onepage&q&f=falseBoswell, J.F., Kraus, D.R., Miller, S.D.
Lambert, M.J.
The benefits, challenges, and solutions of routine outcome monitoring in clinical practices.
Psychotherapy research. 25(1). pp.6-19. Retrieved from:https://www.tandfonline.com/doi/abs/10.1080/10503307.2013.817696Clarke, C.M.
Clarke, C.M.
Leading clinical improvement in handover: a strategy to implement best practice in the acute care setting.
Journal of patient Safety, 7(1), pages 11-18. Retrieved from:https://journals.lww.com/journalpatientsafety/Abstract/2011/03000/Leading_Clinical_Handover_Improvement__A_Change.3.aspxElwyn, G., Scholl, I., Tietbohl, C., Mann, M., Edwards, A.G., Clay, C., Legare, F., van der Weijden, T., Lewis, C.L., Wexler, R.M.
Frosch D.L.
“Many miles left …”:” is a systematic review on the implementation of patient-decision support interventions in routine clinical practice.
BMC medical decision making and informatics, 13(2). Retrieved from:https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/1472-6947-13-S2-S14
Flemming D., and Hubner U. (2013).
How can shift handovers be improved and how can collaborative grounding be improved? And what role does electronic patient records play in improving this process?
A systematic literature review.
International journal medical informatics, 1982(7), pp.580-592. Retrieved from: https://www.sciencedirect.com/science/article/pii/S1386505613000622
Graan S.M.M. Botti M. Wood Botti Botti M. Redley B.
The standardised tools that reduce safety risks in nursing handover from ICU and cardiac ward.
Australian Critical care, 29(3), pages 165-171. DOI: 10.1016/j.aucc.2015.09.002
Johnson, M. Sanchez P. Suominen H. Basilakis J. Dawson L. Kelly B. Hanlen L.
Comparison of nursing handover and documentation: one set for patient information. International nursing review, 61(1), pp.73-81. DOI: 10.1111/inr.12072
Kerr D. Klim S. Kelly A.M. McCann T.
Impact of a modified model for nursing handover to improve nursing care documentation in the emergency room: A pre? and post?implementation analysis.
International journal on nursing practice, 22(1) pp. 89-97. DOI: 10.1111/jocn.12274
Kerr D. McKay K. Klim S. Kelly A.M. Kelly and T. McCann (2014)
Handover at the bedside: attitudes of emergency room patients.
Journal of clinical nurses, 23(11-12), pages 1685-1693. Retrieved from: https://onlinelibrary.wiley.com/doi/10.1111/jocn.12308/full
Klim S.; Kelly A.M.; Kerr D.; Wood S.; McCann T.
A framework for nursing transfer in the emergency department: A systemic and individualised approach.
Journal of clinical nurses, 22(1), pp.2233-2243. DOI: 10.1111/ijn.12365Lockwood, C., 2016.
What is the best method of nursing handover for ensuring continuity of information for hospitalized patients?
International journal nursing studies, no. 58. pp.97-99. DOI: https://dx.doi.org/10.1016/j.ijnurstu.2016.03.004Melnyk, B.M., Gallagher?Ford, L., Long, L.E.
Fineout?Overholt E. (2014)
The development of evidence-based practice competencies to support registered nurses and advanced practice nurses in real world clinical settings. It will allow for the improvement of healthcare quality, reliability, outcomes and costs.
Worldviews on evidence-based nursing, 11(1). pp. 5-15. Retrieved from: https://onlinelibrary.wiley.com/doi/10.1111/wvn.12021/fullMikkonen, K., Elo, S., Kuivila, H.M., Tuomikoski, A.M. and Kaariainen, M., 2016.
An analysis of qualitative studies that examined the experiences of healthcare students from cultural and linguistically varied backgrounds in clinical learning: A systematic review.
International journal nursing studies, 54. Retrieved from: https://www.sciencedirect.com/science/article/pii/S0020748915001984
Moran K.J. Conrad D. Burson R. 2016.
The doctoral dissertation on nursing practice. Jones & Bartlett Publishers. Retrieved from:https://books.google.co.in/books?hl=en&lr=&id=kqDOCwAAQBAJ&oi=fnd&pg=PP1&dq=Moran,+K.J.,+Conrad,+D.+and+Burson,+R.,+2016.+The+doctor+of+nursing+practice+scholarly+project.+Jones+%26+Bartlett+Publishers.+&ots=S2aw2L7QIL&sig=h5KWz7AW1Ku2_2OFP3SXG0fSiAI#v=onepage&q&f=false
Ouslander J.G. Bonner A. Bonner L. Herndon J. Shutes J.
The Interventions to Reduce Acute Care Transfers – Quality Improvement Program: A guide for medical directors, primary care clinicians and other health care professionals in long-term healthcare.
Journal of the American Medical Directors Association. 15, pp.162-170. Retrieved from:https://www.sciencedirect.com/science/article/pii/S1525861013006907
Piscotty R.J. Kalisch B. Gracey?Thomas A.
Impact of healthcare IT technology on nursing practice.
Journal of Nursing Scholarship. 47(4). pp.287-293. Retrieved from: https://onlinelibrary.wiley.com/doi/10.1111/jnu.12138/full
Rushton C.H. Batcheller J. Batcheller K. Schroeder K. Donohue P.
High-intensity nursing: Burnout and resilience
American Journal of Critical Care. 24(5): pp.412-420. Retrieved from: https://ajcc.aacnjournals.org/content/24/5/412.shortSherwood, G. and Barnsteiner, J. eds., 2017.
Quality and safety of nursing: A competency approach for improving outcomes.
John Wiley & Sons. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=zToODgAAQBAJ&oi=fnd&pg=PR3&dq=Sherwood,+G.+and+Barnsteiner,+J.+eds.,+2017.+Quality+and+safety+in+nursing:+A+competency+approach+to+improving+outcomes.+John+Wiley+%26+Sons.+&ots=x77bfATHL3&sig=qWR4iDfBFNwZ0dNUaZ_a9zhKPZY#v=onepage&q&f=false
Stanhope M., and Lancaster J.
Public Health Nursing Ebook: Population-Centered Medical Care in the Community. Elsevier Health Sciences. Retrieved from:https://books.google.co.in/books?hl=en&lr=&id=mvWQCgAAQBAJ&oi=fnd&pg=PP1&dq=Stanhope,+M.+and+Lancaster,+J.,+2015.+Public+Health+Nursing-E-Book:+Population-Centered+Health+Care+in+the+Community.+Elsevier+Health+Sciences.+&ots=SYexHDre8O&sig=MRMW7s4OmbFRR-WJjWCdkQXIa9A#v=onepage&q=Stanhope%2C%20M.%20and%20Lancaster%2C%20J.%2C%202015.%20Public%20Health%20Nursing-E-Book%3A%20Population-Centered%20Health%20Care%20in%20the%20Community.%20Elsevier%20Health%20Sciences.&f=false