Abstract
BACKGROUND: The quality of intensive care unit (ICU) nursing handover impacts patient safety, including infection prevention and control (IPC) and antimicrobial stewardship (AMS) practices. We report a co-designed quality improvement study using a visual, structured nurse handover tool in a low resource setting. METHODS: The study was conducted with clinical nurses in an 8-bed medical ICU at a tertiary hospital in South Africa. Using a participatory action research (PAR) framework and visual participatory methods, the handover tool development had three phases: data collection, journal club, and co-design. To engage busy nurses and create real-time discussions and input, 7-minute focussed sessions in the ICUs using large-scale graphics to facilitate were used. Qualitative data were thematically analysed. RESULTS: Between September - October 2022, baseline data were collected from 16 handovers (46 patient discussions over 4 hours). The tool was co-designed through 18 contact sessions involving 31 nurses (April-June 2023). Variation was observed in patterns of handover structure (sequence of what was presented) and content (type and the level of detail of information provided). An evidence-based visual tool was co-designed to identify and manage key patient care risk factors. The tool included a structured section to report on IPC and AMS. Nurses reported the visual prompts to be beneficial to ensuring consistent inclusion of critical information in handovers. CONCLUSIONS: An innovative approach involving ICU nurses in co-designing a visual handover tool resulted in a structured method for systematically reporting patient care risk factors, body systems, IPC, and AMS. Implementation and dissemination in this unit, and expansion to other units, is underway to promote sustainable change in nursing clinical practices.