Nursing handovers as resilient points of care: Linking handover strategies to treatment errors in the patient care in the following shift

Aim: To examine the relation between the strategies the nurses employ during handover and the number and types of treatment errors in patient care in the following shift. Background: Patient handover has repeatedly been declared an area of considerable vulnerability to patient safety. This study examined factors that affect treatment errors in patient care, including the use of handover strategies from high reliability organizations. Design: Prospective study. Method: Data were collected in 2012-2013 from 200 randomly selected handovers in five internal wards. Handover strategies previously adopted from High Reliability Organizations were assessed via observations; treatment errors - dosage discrepancy, order postponed, no documentation - captured from the patient's files and demographical data were collected via questionnaires. Findings: On average, in nearly one-fifth of the patient's files, medication dosage given was inaccurate; in nearly one-third a care order was fulfilled late; and in nearly half, documentation was partially missing. Rate of use of handover strategies previously adopted from high reliability organizations varied substantially. Results of negative binomial regression analysis revealed that face-to-face verbal update with interactive questioning, update from practitioners other than the outgoing, topics initiated by incoming and outgoing team, including the latter's stance on care plans and writing a summary prior to handover, were significantly and negatively linked to number of treatment errors (P < 0·05). Conclusions: Nursing handover is an opportunity for nurses to prevent errors and unsafe practice by implementing more risk-aware handover strategies. Implications for facilitating the use of such strategies are discussed.