Maristella I. Divinagracia, RN; Herann Joy A. Castaneda, RN; Jayson Hagos, RN; Genevieve Casino, RN; Mercedita V. Jocson, RN; Nerissa M. Gerial, PhD, RN, CESE
National Kidney and Transplant Institute
Background of the Study
Endorsement and rounds of nurses in the Institute take 2.5 to 3 hours. Consequently, nurses render additional hours of service beyond their prescribed time fulfilling required documents instead of performing bedside care. The management saw the need to change this system in order to promote a balanced work life for the nurses while rendering more time for direct patient care.
The study aims to have an effective, efficient, and timely handovers for the outgoing and incoming nurses in a 12- hour or 8- hour shift in the wards of the clinical patient care areas from 2-3 hours to 1 hour.
The quality circle utilized quality improvement methodology starting with identification of the problem and through root cause analysis, recognized the root causes of the problem and proposed solutions to remove them. Solutions implemented were to create a Patient Assignment and Patient Classification System, creation of a Total Patient Care (TPC) and Handover Assessment Tool, creation of new set of guidelines for handover, and nurses' orientation on the new process. Evaluation was regularly done to monitor adherence to solutions and their effectiveness.
The duration of the handover process and individual rounds decreased significantly to a minimum average of 0.38 hour and a maximum average of 0.78 hour. This exceeded the group's objective of achieving a maximum of 1 hour for handover and rounds without compromising effectiveness and efficiency in delivering healthcare services thereby improving patient’s experience in the Institute. In addition, due to the decreased turn-around time for handover and rounds in Clinical Patient Care Areas, there were no overtime pay during the study. As such, the Institute was able to save Php 1, 318, 680 for the sample months of January and February during the period when the TPC was implemented.
The Department Order#9 s. 2017 “Full implementation of Total Patient Care (TPC) and the New End–of–shift Handover Process in the Clinical Areas and Peritoneal Dialysis Unit” was created to standardize the solutions included in the implementation and guidelines will be incorporated in the Nursing Work Instruction Manual.