IntroductionHandover is an inevitable and essential aspect of caring for critically ill patients and information handed over should be accurate, succinct, and sufficient to allow the seamless continuation of care between teams. Objectives To assess staff involvement, time taken for the handover, key components addressed, availability of a standard format and factors causing disturbances to an effective handover were the key components studied to determine the quality and safety. Methodology Study population were doctors and nursing offices working in the general and specialised ICUs of the National Hospital of Sri Lanka, De Soysa maternity hospital and the Castle street hospital for women. Study period was July to September 2013. Sample size was 120. Data was collected using a self-administered questionnaire based on the guidelines on clinical handover by the Australian Medical Association. Data was analysed as simple percentages and review of absolute numbers using bar and pie charts for each ICU. ResultsThe doctor's presence in the nurse's handover and nurse's presence in doctor's handover was less than 70% in all the ICUs. There was no fixed time for handover in 92% of ICU shifts and nearly 90% of times it happened after the conclusion of the shift and the average time taken was 30mins. Compliance with the recommended content of handover was more than 60% in almost all the ICUs. There was no structured format for handover in any of the ICUs. Telephone calls were the most common distracting factor identified. Conclusion / RecommendationsHandover can be made more effective and safe with implementation of a printed handover sheet for use as well as an overlapping shift pattern in duty rosters, dedicated time and a place for handover.
Learning from deaths occurring in intensive care has been given much focus in the recent years in clinical governance processes in order to improve morbidity and mortality in critically ill patients. When mistakes happen, providers need to understand individual as well as system failures and take necessary steps to avoid recurrences of shortcomings. This involves a well-defined response to deaths including a robust system to review deaths as well as parallel governance processes to reinforce lessons learnt. The Structured Judgement Review (SJR) methodology is being introduced in the UK as a tool for standardising and quantifying analysis of the problems in the care of patients that have died in the ITU. It can be restricted to patients who were expected to survive, and so focus resources into searching for systematic failings of the unit where they are most likely to have occurred. The SJR uses local reviewers to review case notes against a series of specific enquiries and then requires them to score the quality of care against a scale for each criterion. This review is then used to link back to education and focusing of resources within the hospital's ITU and parent teams.
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