1 Change of Shift Handoff Interruptions, 2019; 1–9. © 2019 Sigma Theta Tau International Original Article Change-of-Shift Nursing Handoff Interruptions: Implications for Evidence-Based Practice Lori M. Rhudy, PhD, RN ● Maren R. Johnson, MS, RN, CCRN ● Catherine A. Krecke, BA, CCRP ● Danielle S. Keigley, DNP, RN ● Sarah J. Schnell, DNP, RN ● Pamela M. Maxson, DNP, RN ● Sharon M. McGill, DNP, RN ● Karen T. Warfield, MS, RN ABSTRACT Background: The importance of change-of-shift handoffs in maintaining patient safety has been well demonstrated. Change-of-shift handoff is an important source of data used in surveillance, a nursing intervention aimed at identifying and preventing complications. Surveillance requires the nurse to acquire, process, and synthesize information (cues) encountered during patient care. Interruptions in handoff have been observed but there is a gap in the evidence concerning how interruptions during nurse-to-nurse handoff impact the change-of-shift handoff process. Aims: To describe registered nurses’ perceptions of interruptions experienced during change- of-shift handoff at the bedside in critical care units and analyze the number, type, and source of interruptions during change-of-shift handoff at the bedside. Methods: An exploratory descriptive design was used. One hundred nurse-to-nurse handoffs were observed, and four focus groups were conducted. Observation data were analyzed with descriptive statistics and quantitative content analysis. Focus group data were analyzed with qualitative content analysis. Results and Findings: Of the 1,196 interruptions observed, 800 occurred in the communica- tion between the two nurses involved in the handoff. Over 80% (645) of these interruptions were from the nurse receiving handoff and included questions or clarification of information received. About half of the nurses reported that interruptions occurred during handoff. Focus group findings revealed that whether or not something is an interruption is determined by the individual nurse’s appraisal of value added to their knowledge of the patient and/or plan of care at the time of handoff. Linking Evidence to Action: Interruptions during handoff are evaluated as useful or disruptive based on the value to the nurse at the time. Strict structuring or mandating of handoff ele- ments may limit nurses’ ability to communicate information deemed most relevant to the care of a specific unique patient. BACKGROUND AND SIGNIFICANCE Nurses work in complex environments that require a constant state of attention to multiple cues in order to maintain pa- tient safety through surveillance (Schmidt, 2010; Sitterding, Broome, Everett, & Ebright, 2012). Surveillance is used by nurses to acquire, process, and synthesize vast amounts of information in the course of a patient encounter (Bulechek, Butcher, Dochterman, & Wagner, 2013). Furthermore, sur- veillance is defined as the “purposeful and ongoing acquisi- tion, interpretation, and synthesis of patient data for clinical decision-making” (Bulechek et al., 2013). Change-of-shift handoffs have been identified as im- portant sources of cues (data) and information needed and used by nurses to maintain patient safety (Henneman, Gawlinksi, & Guiliano, 2012; Henneman et al., 2010; Pfrimmer et al., 2017; Rhudy & Androwich, 2013; Schmidt, 2010). Many organizations across the globe including the World Health Organization (WHO Collaborating Centre for Patient Safety Solutions, 2007), The Joint Commission (2017), and the Australian Commission on Safety and Quality in Health Care (2017) have focused increasing at- tention on the handoff as a key component of patient safety. Consequently, numerous initiatives aimed at improving handoff have been undertaken including shifting handoff to the bedside and identifying best practices such as defin- ing criteria for inclusion in handoff. However, despite all Key words handoff, shift reports, interruptions, nursing, observation, focus group, critical care