and a 30 % reduction in preventable adverse events [ 18 ]. Subsequent research has found that fewer mistakes or omissions were made, staff were more satisfied with the organisation of the information conveyed and there were fewer interruptions when using the I-PASS system [ 20, 22, 25 ].
Introducing I-PASS into practice
The author introduced I-PASS to her practice in June 2021, with a 3-month introduction and training period. The author decided to implement the handover system in the in-patient care setting, focusing on VN training first. This followed the success reported in a recent study from human healthcare [ 12 ], in which I-PASS was implemented at in-patient nursing shift changes first, as the researchers found this affected more patients.
The author organised focus groups for the entire nursing team, including RVNs, SVNs and veterinary care assistants. During the focus groups, the team provided their thoughts, concerns and ideas about the current handover system. The author noted their feedback( Table 1) to share with the team in the decision-making process, which was identified as a positive step in managing the change.
Table 1. Feedback from the veterinary nursing team about the previous handover system, taken from focus groups.
Feedback‘ Handovers are too long’‘ Some handovers are great, but others are not’
‘ There is way too much information that ' s not always relevant’
‘ There are always distractions during handovers’
‘ I don ' t always know if the other person is listening to me’
‘ Instructions can be missing and it creates confusion’
Training sessions were scheduled for the nursing team to attend over a 6-week period. The sessions, which were prepared by the author, were structured to encourage participation and engagement, and included an overview of the supporting literature and a thorough explanation of I-PASS. The sessions also featured examples, written by the author and another ward VN, of different conditions and handovers from various areas of the practice, such as wards and the intensive care unit. The training sessions ended by inviting the participants to present their own cases to the group.
The team was engaged in the training and follow-up surveys confirmed this. Three out of 18 VNs stated they would have liked to have been involved in the decision-making process when choosing a new system. While this is important to acknowledge, the author felt the implementation of a hospital-wide system change was justified and safe, having reviewed the evidence and consulted with the senior nursing leadership team and the clinical director( a VS). Furthermore, the small-group teaching sessions ensured the team members were all fully aware and prepared for the change. This is vital as the system requires absolute buy-in from the end users [ 12 ].
Immediate compliance was variable, with some handovers including non-essential information and some that did not use closed-loop communication. The author recruited the help of three VNs who were compliant with the system to act as I-PASS representatives. Their role was to observe and provide immediate formative feedback. Soon, the team members also began to ask for feedback.
A major barrier to the implementation of I-PASS was the perception that the closed-loop element would result in longer handovers. The literature suggested there would be no significant change in handover duration [ 18 ]. At first, the author found that handovers were taking slightly longer, perhaps due to a lack of familiarity with the system. However, over time, the handovers became more efficient and concise as the team grew more confident about which information to include.
I-PASS needs to be used consistently to maintain the structure. It is thought that verbal handovers can be improved by using a coordinated written handover tool [ 24 ]. Initially, the author was concerned that using handover sheets may not be inclusive of all learning differences. For example, people with dyslexia might struggle to process verbal information while also trying to process the written handover requirements. However, after four revisions to the handover sheet, a document was created that, at the time of writing this article, has been consistently used in practice for almost 3 years.
Since implementing the handover system, there has been a reduction in reports of miscommunication during handovers. Errors still occur, however, and reports often identify that information has not been transferred. Further investigations with VNs identified that this was because the information was not known at the time of handover, indicating a communication error before the handover. This has prompted the author ' s practice to consider expanding the use of I-PASS to all handovers within the hospital, including handovers between clinicians and VNs at patient admission.
The overall feedback from the veterinary nursing team has been overwhelmingly positive, with team members embracing the change and consistently performing handovers using the I-PASS protocol. During 2024 and 2025, the author has also rolled out I-PASS training to other practices in Yorkshire and across the UK.
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