One chance to get it right: improving clinical handovers for better symptom control at the end of life
Poor communication contributes to morbidity and mortality, not only in general medical care but also at the end oflife. This leads to issues relating to symptom control and quality of care. As part of an international project focused on bereaved relatives’ perceptions about quality of end-of-life ca...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2021-07-01
|
| Series: | BMJ Open Quality |
| Online Access: | https://bmjopenquality.bmj.com/content/10/3/e001436.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1846157911467753472 |
|---|---|
| author | Grace Ting Katrin Sigurdardottir Wojciech Leppert Katarzyna Wolszczak Vilma Tripodoro Gabriel Goldraij Martin Weber Christina Gerlach Lair Zambon John Ellershaw Catriona Mayland Catriona Rachel Mayland Dagny Faksvåg Haugen Vilma Adriana Tripodoro Melisa Aloisio Sandra Analía Castro Marit Irene Hansen Eduardo Garcia Yanneo Juliana Nalin Passarini Ivete Bredda Saad |
| author_facet | Grace Ting Katrin Sigurdardottir Wojciech Leppert Katarzyna Wolszczak Vilma Tripodoro Gabriel Goldraij Martin Weber Christina Gerlach Lair Zambon John Ellershaw Catriona Mayland Catriona Rachel Mayland Dagny Faksvåg Haugen Vilma Adriana Tripodoro Melisa Aloisio Sandra Analía Castro Marit Irene Hansen Eduardo Garcia Yanneo Juliana Nalin Passarini Ivete Bredda Saad |
| author_sort | Grace Ting |
| collection | DOAJ |
| description | Poor communication contributes to morbidity and mortality, not only in general medical care but also at the end oflife. This leads to issues relating to symptom control and quality of care. As part of an international project focused on bereaved relatives’ perceptions about quality of end-of-life care, we undertook a quality improvement (QI) project in a general hospital in Córdoba city, Argentina.By using two iterative QI cycles, we launched an educational process and introduced a clinical mnemonic tool, I-PASS, during ward handovers. The introduction of the handover tool was intended to improve out-of-hours care.Our clinical outcome measure was ensuring comfort in at least 60% of dying patients, as perceived by family carers, during night shifts in an oncology ward during the project period (March–May 2019). As process-based measures, we selected the proportion of staff completing the I-PASS course (target 60%) and using I-PASS in at least 60% of handovers. Participatory action research was the chosen method.During the study period, 13/16 dying patients were included. We received 23 reports from family carers about the level of patient comfort during the previous night.Sixty-five per cent of healthcare professionals completed the I-PASS training. The percentage of completed handovers increased from 60% in the first Plan-Do-Study-Act (PDSA) cycle to 68% in the second one.The proportion of positive reports about patient comfort increased from 63% (end of the first PDSA cycle) to 87% (last iterative analysis after 3 months). Moreover, positive responses to ‘Did doctors and nurses do enough for the patient to be comfortable during the night?’ increased from 75% to 100% between the first and the second QI cycle.In conclusion, we achieved the successful introduction and staff training for use of the I-PASS tool. This led to improved perceptions by family carers, about comfort for dying patients. |
| format | Article |
| id | doaj-art-cbefde6f2c43400eaacd8a99855e8c3f |
| institution | Kabale University |
| issn | 2399-6641 |
| language | English |
| publishDate | 2021-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Quality |
| spelling | doaj-art-cbefde6f2c43400eaacd8a99855e8c3f2024-11-25T02:20:13ZengBMJ Publishing GroupBMJ Open Quality2399-66412021-07-0110310.1136/bmjoq-2021-001436One chance to get it right: improving clinical handovers for better symptom control at the end of lifeGrace TingKatrin Sigurdardottir0Wojciech LeppertKatarzyna WolszczakVilma Tripodoro1Gabriel Goldraij2Martin Weber3Christina Gerlach4Lair ZambonJohn Ellershaw5Catriona Mayland6Catriona Rachel Mayland7Dagny Faksvåg Haugen8Vilma Adriana Tripodoro9Melisa Aloisio10Sandra Analía Castro11Marit Irene HansenEduardo Garcia YanneoJuliana Nalin PassariniIvete Bredda Saad2 Specialist Palliative Care Team, Department of Anaesthesia and Surgical Services, Haukeland University Hospital, Bergen, NorwayResearch Network RED-InPal, Institute Pallium Latinoamérica, Buenos Aires, ArgentinaInstituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina1 Quality of Care and Patient Safety Office, World Health Organization, Regional Office for Europe, Athens, GreeceInterdisciplinary Palliative Care Unit, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, GermanyMarie Curie Palliative Care Institute, University of Liverpool, Liverpool L69 3BXUniversity of Sheffield, Sheffield, UKDepartment of Oncology and Metabolism, The University of Sheffield, Sheffield, UKRegional Centre of Excellence for Palliative Care, Haukeland University Hospital, Western Norway, Bergen, Norway5 Pallium Latinoamérica, Buenos Aires, ArgentinaInstituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, ArgentinaPalliative Care Program, Hospital Privado Universitario de Córdoba, Córdoba, ArgentinaPoor communication contributes to morbidity and mortality, not only in general medical care but also at the end oflife. This leads to issues relating to symptom control and quality of care. As part of an international project focused on bereaved relatives’ perceptions about quality of end-of-life care, we undertook a quality improvement (QI) project in a general hospital in Córdoba city, Argentina.By using two iterative QI cycles, we launched an educational process and introduced a clinical mnemonic tool, I-PASS, during ward handovers. The introduction of the handover tool was intended to improve out-of-hours care.Our clinical outcome measure was ensuring comfort in at least 60% of dying patients, as perceived by family carers, during night shifts in an oncology ward during the project period (March–May 2019). As process-based measures, we selected the proportion of staff completing the I-PASS course (target 60%) and using I-PASS in at least 60% of handovers. Participatory action research was the chosen method.During the study period, 13/16 dying patients were included. We received 23 reports from family carers about the level of patient comfort during the previous night.Sixty-five per cent of healthcare professionals completed the I-PASS training. The percentage of completed handovers increased from 60% in the first Plan-Do-Study-Act (PDSA) cycle to 68% in the second one.The proportion of positive reports about patient comfort increased from 63% (end of the first PDSA cycle) to 87% (last iterative analysis after 3 months). Moreover, positive responses to ‘Did doctors and nurses do enough for the patient to be comfortable during the night?’ increased from 75% to 100% between the first and the second QI cycle.In conclusion, we achieved the successful introduction and staff training for use of the I-PASS tool. This led to improved perceptions by family carers, about comfort for dying patients.https://bmjopenquality.bmj.com/content/10/3/e001436.full |
| spellingShingle | Grace Ting Katrin Sigurdardottir Wojciech Leppert Katarzyna Wolszczak Vilma Tripodoro Gabriel Goldraij Martin Weber Christina Gerlach Lair Zambon John Ellershaw Catriona Mayland Catriona Rachel Mayland Dagny Faksvåg Haugen Vilma Adriana Tripodoro Melisa Aloisio Sandra Analía Castro Marit Irene Hansen Eduardo Garcia Yanneo Juliana Nalin Passarini Ivete Bredda Saad One chance to get it right: improving clinical handovers for better symptom control at the end of life BMJ Open Quality |
| title | One chance to get it right: improving clinical handovers for better symptom control at the end of life |
| title_full | One chance to get it right: improving clinical handovers for better symptom control at the end of life |
| title_fullStr | One chance to get it right: improving clinical handovers for better symptom control at the end of life |
| title_full_unstemmed | One chance to get it right: improving clinical handovers for better symptom control at the end of life |
| title_short | One chance to get it right: improving clinical handovers for better symptom control at the end of life |
| title_sort | one chance to get it right improving clinical handovers for better symptom control at the end of life |
| url | https://bmjopenquality.bmj.com/content/10/3/e001436.full |
| work_keys_str_mv | AT graceting onechancetogetitrightimprovingclinicalhandoversforbettersymptomcontrolattheendoflife AT katrinsigurdardottir onechancetogetitrightimprovingclinicalhandoversforbettersymptomcontrolattheendoflife AT wojciechleppert onechancetogetitrightimprovingclinicalhandoversforbettersymptomcontrolattheendoflife AT katarzynawolszczak onechancetogetitrightimprovingclinicalhandoversforbettersymptomcontrolattheendoflife AT vilmatripodoro onechancetogetitrightimprovingclinicalhandoversforbettersymptomcontrolattheendoflife AT gabrielgoldraij onechancetogetitrightimprovingclinicalhandoversforbettersymptomcontrolattheendoflife AT martinweber onechancetogetitrightimprovingclinicalhandoversforbettersymptomcontrolattheendoflife AT christinagerlach onechancetogetitrightimprovingclinicalhandoversforbettersymptomcontrolattheendoflife AT lairzambon onechancetogetitrightimprovingclinicalhandoversforbettersymptomcontrolattheendoflife AT johnellershaw onechancetogetitrightimprovingclinicalhandoversforbettersymptomcontrolattheendoflife AT catrionamayland onechancetogetitrightimprovingclinicalhandoversforbettersymptomcontrolattheendoflife AT catrionarachelmayland onechancetogetitrightimprovingclinicalhandoversforbettersymptomcontrolattheendoflife AT dagnyfaksvaghaugen onechancetogetitrightimprovingclinicalhandoversforbettersymptomcontrolattheendoflife AT vilmaadrianatripodoro onechancetogetitrightimprovingclinicalhandoversforbettersymptomcontrolattheendoflife AT melisaaloisio onechancetogetitrightimprovingclinicalhandoversforbettersymptomcontrolattheendoflife AT sandraanaliacastro onechancetogetitrightimprovingclinicalhandoversforbettersymptomcontrolattheendoflife AT maritirenehansen onechancetogetitrightimprovingclinicalhandoversforbettersymptomcontrolattheendoflife AT eduardogarciayanneo onechancetogetitrightimprovingclinicalhandoversforbettersymptomcontrolattheendoflife AT juliananalinpassarini onechancetogetitrightimprovingclinicalhandoversforbettersymptomcontrolattheendoflife AT ivetebreddasaad onechancetogetitrightimprovingclinicalhandoversforbettersymptomcontrolattheendoflife |