FACTORS INFLUENCING EFFECTIVE CLINICAL HAND-OVER OF CRITICALLY ILL PATIENTS IN INTENSIVE CARE UNITS IN WESTERN REGION OF KENYA

Abstract

Handover involves transfer of health care providers’ responsibility and accountability for some or all aspects of care for a patient, or groups of patients, to another person, such as a clinician or nurse on a temporary or permanent basis. A health care provider can take over responsibility for a patient only if he or she receives all relevant information to facilitate continuation of effective and safe patient care. Handover is essential for safe health care and is used in all clinical situations. In Western Kenya there is little evidence of studies carried out on factors of critically ill patients. This study therefore sought to address the gap. The study was conducted in Moi Teaching and Referral Hospital, Jaramogi Oginga Odinga Teaching and Referral Hospital, Mediheal and Aga Khan Hospital in Kisumu. A cross sectional analytical research design was adopted in conducting the study. Purposive sampling method was used to select the institutions while convenient sampling was used to pick 80 study participants. Quantitative data was collected by use of questionnaires and observation check list and analyzed by descriptive techniques and inferential showing association between factors and handover. Qualitative data was collected through key informant interviews and was analyzed thematically. The study results showed that handover was done at the beginning, admission, discharge and end of shift using both oral and written. Majority (82.5%) of the participants had been trained on patient handover. Sixty (60%) thought that patient’s bedside is the most appropriate place for handover as compared to 37.5% who preferred nursing station, while 2.5% indicated that the conference room was the most appropriate place for handover. All the interviewed staff took part in handover process. Majority (91.2%) agreed that alarms were a major distraction in their unit during handover. This was followed by emergency cases and noise. Majority (95%) agreed that unstable hemodynamics of patients and severity of illness (93.8%) greatly influenced handover. Further findings showed that staff who agreed that visitors and emergency cases affect handover, were up to 8 (p = 0.1) and 7 (p = 0.3) times more likely to have been more effective in their handover performance. On the contrary health care providers who mentioned that clinical handover is done at the beginning or the end of shift were 80% less likely to have been effective in their performance (OR: 0.2; 95% CI: 0.1 – 0.8; p = 0.02). health care providers who agreed that supplies which include consumables (OR:3.2,95% Cl:1.1- 8.9,p=0.02) availability of clinical handover policy in the unit (OR:3.3;95%Cl:1.1- 9.5;P=0.02) were three times more likely to perform effectively. The study concludes that health care provider should ensure proper handover is done on critically ill patients to ensure quality outcomes. Similarly, proper documentation should be enhanced because heath care provider needs to review handover from this documentation and confirm that the care was done. The study recommends formal teaching session in medical training colleges to enhance staff’s competency in handing over among health care providers. There should be protocols and guidelines to assist during handover.