"The best thing that's happened in years"- Changing shift handover practice in an acute surgical ward

Background In July 2015 the Productive Ward program was introduced to an acute surgical ward in the author’s institution. Productive Ward aims to increase the amount of time nurses spend directly caring for patients by... [ view full abstract ]

Background
In July 2015 the Productive Ward program was introduced to an acute surgical ward in the author’s institution. Productive Ward aims to increase the amount of time nurses spend directly caring for patients by improving the ward environment and making nursing processes more efficient.
Baseline time in motion studies showed that nurses spent a large amount of time in shift handover therefore this area was targeted for quality improvement work which began in December 2015.

Aim and objectives
1. Increase the amount of time nurses spend directly caring for patients
2. Reduce the time spent in shift handover
3. Increase standardisation of shift handover
4. Allow night staff to go home on time

Description of innovation
We developed a prefilled shift handover template to streamline and standardise the handover process.
Audits of shift handover and time-in-motion studies were used to measure outcomes
Our quality improvement project depended on extensive staff engagement to produce a workable and efficient template that staff genuinely owned rather than merely accepted.

Impact of innovation
Our data indicated that the average morning shift handover took 41 minutes and 17 seconds. Our interventions reduced this to 25 minutes 33 seconds.

This equates to 15 minutes 44 seconds of time released to care per staff member.

Put into context-based on 5 Staff nurses, one HCA and two CNM’s- that’s 2 hours and 5 minutes of nursing time released to care per day from morning handover.

Cumulatively 704 hours and 51 minutes of nursing time are released to care per year.

Conclusions and implications
Including staff in the design and audit process was the key driver of our success. Empowering frontline staff to control and influence the project fostered a sense of pride and ownership that has sustained our improvements.