This is an original excerpt written by our team to show structure, depth and referencing. It is modelled on the course named above but is not a university document. Use samples as a study guide and follow your school's academic integrity policy.
The safety problem
On the 30-bed medical-surgical unit in this proposal, nurses hand off at the start of each shift with no standard format. Each nurse decides what to mention, and safety reports describe information lost at handoff, such as a pending potassium result that the next nurse didn't know about. The unit details are illustrative.
What the evidence shows
I-PASS is a mnemonic for structuring verbal handoffs: Illness severity, Patient summary, Action list, Situation awareness and contingency planning, and Synthesis by receiver (Starmer et al., 2012).
- Residents. In a handoff improvement program at nine hospitals covering 10,740 admissions, the medical-error rate fell by 23% (24.5 to 18.8 per 100 admissions) and preventable adverse events fell by 30% (4.7 to 3.3 per 100 admissions). The length of oral handoffs didn't change significantly (Starmer et al., 2014).
- Nurses. On a pediatric intensive care unit, the I-PASS Nursing Handoff Bundle (training, the mnemonic and visual reminders) raised the share of handoffs that included an illness severity assessment from 37% to 67%, a to-do list from 35% to 100%, and a chance for the receiving nurse to ask questions from 34% to 73%. Handoffs with interruptions fell from 67% to 40%, and the median handoff time didn't change significantly (18.8 vs. 19.9 minutes; Starmer et al., 2017).
The evidence has limits. The larger study involved residents, and the nursing study was a single-unit before-and-after study in pediatric intensive care. Results on an adult medical-surgical unit have to be measured, not assumed.
The change and how it will be tested
The proposal uses Plan-Do-Study-Act (PDSA) cycles, starting small:
- Cycle 1: two volunteer nurse pairs use an I-PASS handoff sheet for three day-to-night handoffs and say what to change.
- Cycle 2: all day-shift nurses use the revised sheet for two weeks after a 30-minute training session.
- Cycle 3: both shifts use I-PASS, with the template built into the electronic health record.
Measures
| Type | Measure | Data source |
|---|---|---|
| Process | Share of observed handoffs that include all five I-PASS elements (target 80%) | 20 observed handoffs a week |
| Outcome | Handoff-related safety reports per month | Safety reporting system |
| Balancing | Minutes per handoff and nurse overtime at shift change | Observation and payroll data |
Results go on run charts reviewed with staff each week, so each cycle can be adopted, adapted or abandoned.
The MSN-prepared nurse's role
The MSN-prepared nurse leads the project: building the case with unit data, recruiting nurse champions, training staff, collecting and displaying data, and reporting results to unit leaders and the quality committee.
References
Starmer, A. J., Schnock, K. O., Lyons, A., Hehn, R. S., Graham, D. A., Keohane, C., & Landrigan, C. P. (2017). Effects of the I-PASS Nursing Handoff Bundle on communication quality and workflow. BMJ Quality & Safety, 26(12), 949–957. https://doi.org/10.1136/bmjqs-2016-006224
Starmer, A. J., Spector, N. D., Srivastava, R., Allen, A. D., Landrigan, C. P., Sectish, T. C., & I-PASS Study Group. (2012). I-PASS, a mnemonic to standardize verbal handoffs. Pediatrics, 129(2), 201–204. https://doi.org/10.1542/peds.2011-2966
Starmer, A. J., Spector, N. D., Srivastava, R., West, D. C., Rosenbluth, G., Allen, A. D., Noble, E. L., Tse, L. L., Dalal, A. K., Keohane, C. A., Lipsitz, S. R., Rothschild, J. M., Wien, M. F., Yoon, C. S., Zigmont, K. R., Wilson, K. M., O'Toole, J. K., Solan, L. G., Aylor, M., . . . Landrigan, C. P. (2014). Changes in medical errors after implementation of a handoff program. New England Journal of Medicine, 371(19), 1803–1812. https://doi.org/10.1056/NEJMsa1405556
