Standardising Neonatal Nursing Handover: Impact of a Quality Improvement Project in a Tertiary Care NICU

Introduction: A properly written nursing handover is important to avoid medication errors and to improve patient safety outcomes, as well as daily decision-making. There is variation in handover policies across intensive care units, wards, operating theatres, and during transport. Improper handover can adversely impact patient care, leading to therapeutic misadventures, complications, prolonged hospital stays, and even mortality.

Aim: To create and implement a structured handover protocol in the neonatal intensive care unit through a quality initiative approach.

Materials and Methods: An observational Quality Improvement (QI) study was conducted in the Department of Neonatology, Sanjay Gandhi Postgrdauate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, from January 2021 to March 2021. The QI team included the nurse-in-charge, staff nurses, resident doctors, and the physician-in-charge of the unit. A total of 33 healthcare professionals (7 members of the QI team and 26 nursing staff) participated in the study. The root cause analysis of improper handover was performed first by a team of doctors and nurses using fishbone analysis. A written checklist was created, and various change ideas were tested through sequential Plan-Do-Study-Act (PDSA) cycles.

Results: Nursing handover compliance during the first, second, and third months was 86.75%, 94.17%, and 92.55%, respectively, after PDSA cycles. Overall, nursing handover compliance of 90% was achieved.

Conclusion: A QI approach improved nursing handover in our unit. Having a standardised policy and checklist helps improve nursing handover, and implementation of the policy can be addressed through a QI approach.