Nursing handovers and patient safety: Findings from an umbrella review

To summarise available reviews on nursing handover (NH) and patient safety (PS), providing a set of evidence-based recommendations for clinical practice and research.Umbrella review.We systematically searched PubMed, CINAHL, and Cochrane Library CENTRAL databases up to October 2018.Retrieved reviews were critically evaluated using the Checklist for Systematic Review and Research Syntheses. Then, an iterative approach and two different frameworks were adopted to categorize the findings in: (a) practice; and (b) research recommendations.A total of 17 reviews were included: among them, 16 reported a range of recommendations for clinical practice to promote PS by reducing adverse events. For what concerns research, 16 reviews recommended specific strategies to improve and strengthen research and its quality in the field of NHs and PS.Changing nursing handover practices to increase PS is complex: it means changing the culture, roles and behaviour of any given clinical nursing setting. To be effective, the change requires a tailored approach, time and implementation strategies including education and support. Future studies should address the flexibility required by handovers in daily practice and the multiple needs with the aim of increasing the robustness of the available evidence on NHs. These should also embrace the Complex Interventions Research Framework.Several reviews have been performed as summaries of research and practice evidence on NHs, but no summary of the established clinical and research recommendations on NHs and PS has been provided to date. Standardized handovers supported by technological solutions, facilitating face-to-face contact between nurses, possibly alongside bedside reports, can improve PS. Well-designed longitudinal studies, on a wide scale, in different settings, based on a strong rationale and focused on measuring the association between handover and patients' safety issues are recommended.目的: 总结针对护理交接(NH)与患者安全(PS)的现有评估结果,为临床实践和研究提供一套循证建议。 设计: 伞样综述。 数据来源: 我们对PubMed、CINAHL和Cochrane图书馆CENTRAL数据库截至2018年10月所发表的文献进行了系统搜索。 评估方法: 采用《系统评估和研究综合检查表》对所检索到的评估结果展开批判性评价。然后,采用迭代方法和两种不同的框架将发现结果分为两类:(a)实践结果;(b)研究建议结果。 结果: 共纳入了17项评估结果,其中有16项提出了一系列临床实践建议,通过减少不良事件来加强患者安全。针对研究关注问题,16项评估结果给出了提高并加强护理交接与患者安全领域研究及其质量的具体战略。 结论: 改变护理交接方式期以提高患者安全这一过程较为复杂:因为它意味着需改变任何特定临床护理环境的文化、角色和行为。为行之有效,这一改变需有量身定制的方法、时间和实施战略,其中包括学校教育和社会支持。未来研究应侧重于解决日常实践中交接工作所需的灵活性和多重需求,以期提高护理交接现有证据的稳健性。这还应包括复杂干预措施研究框架。 影响: 人们已针对护理交接研究和实践证据的总结开展了多项评估工作,但迄今为止尚未提供有关护理交接和患者安全既定临床和研究建议的总结结果。依赖于技术解决方案的标准化交接方式,不仅方便护士之间进行面对面接触,协同病床报告还可提高患者安全。我们建议开展不同环境下的较大规模、精心设计的纵向研究,依托于强大的理论基础,着重衡量交接工作与患者安全问题之间的联系。.