Implementation of a Structured Handover in the NICU

Ashwini Khedkar, Saumil Desai, Ruchi Nanavati

Abstract

Aim: This quality-improvement (QI) initiative aimed at implementing a structured handover in the NICU to determine its effect on the efficiency in executing medical orders and rate of medication errors in neonates on respiratory support.

Materials and Methods: A QI team (comprising 2 senior faculty members and 1 neonatology registrar) introduced the use of “Innovation in Pediatric Education - Pediatric Research in Inpatient Settings Accelerating Safe Sign-Outs Study (I-PASS) handover bundle” as part of the structured handover in a 42-bed tertiary care NICU. The completed orders of 40 patient handovers in the preintervention phase was compared with the completed orders after each of the 3 Plan-Do-Study-Act (PDSA) cycles using the Mann–Whitney test.

Results: A gradual improvement was noted in the number of completed orders in each PDSA cycle. A P value of .0008 (significant) was obtained upon comparison of the completed medical orders between the preintervention phase and the third PDSA cycle. The percentage of inaccurately written prescriptions in daily order sheets reduced from 80% to 17.50%.

Conclusion: The implementation of a structured handover process led to increased efficiency in executing medical orders, and a significant reduction in the rate of medication errors was achieved. This indicates that this QI initiative has the potential to bring about a positive effect on patient safety.