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The NUR 490 Module 5 example, in full
Did the Handoff Change? An Evaluation Plan for a Structured I-PASS Nursing Handoff Using the RE-AIM Framework
[Student Name]
Southern New Hampshire University
NUR 490: Transformational Capstone
Capstone Evaluation Plan
[Instructor Name]
[Date]
The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.
Did the Handoff Change? An Evaluation Plan for a Structured I-PASS Nursing Handoff Using the RE-AIM Framework
The Change Being Evaluated
The capstone change project introduced a structured nursing handoff at shift change on an adult medical unit of 32 beds, a composite drawn for this paper, adapted from the I-PASS approach, in which the giving nurse states how sick the patient is, summarizes the patient, lists actions still due and plans for what might go wrong, and the receiving nurse then repeats back the key points. Handoff took place at the bedside with a printed tool generated from the electronic record. Before the change, handoffs varied widely, and incident reports frequently cited missed information at shift change.
The evidence behind the change is strong for physician handoffs and promising for nursing. Across nine pediatric residency sites and more than 10,000 admissions, the medical-error rate fell from 24.5 to 18.8 per 100 admissions after the I-PASS program was introduced, preventable adverse events fell from 4.7 to 3.3 per 100 admissions, and oral handoffs took no longer than before (Starmer et al., 2014). A study of the I-PASS nursing handoff bundle found that key elements such as illness severity, the to-do list and the chance for the receiving nurse to ask questions were included far more often after implementation, interruptions fell, and handoff duration did not change (Starmer et al., 2017). The evaluation must therefore look for the same kinds of change on this unit: more complete handoffs, fewer interruptions, no added time and, over a longer period, fewer handoff-related safety events.
Evaluation Framework
The evaluation uses the RE-AIM framework, which assesses an intervention's reach, effectiveness, adoption, implementation and maintenance (Glasgow et al., 1999). The framework is well suited to a unit-level practice change because a handoff tool can be effective in principle but fail in practice if only some nurses use it, if it is used inconsistently, or if it fades after the project team steps back. Each dimension is translated into one or two measures in the table below.
Table 1
Evaluation Measures Organized by the RE-AIM Framework
| Dimension | Measure | Data source | Baseline | Target |
|---|---|---|---|---|
| Reach | Share of shift changes at which the structured handoff is used | Weekly observation sample | 0 percent | 90 percent by month 3 |
| Effectiveness | Handoff-related safety events per 1,000 patient-days | Incident reporting system | 2.1 | Reduction of at least 30 percent at 12 months |
| Effectiveness | Nurses rating handoff quality as good or excellent | Staff survey | 41 percent | 75 percent |
| Adoption | Share of unit nurses who have completed training and used the tool | Education records and observation | 0 percent | 100 percent by month 2 |
| Implementation | Required handoff elements present, out of 10 | Observation checklist | Median 5 | Median 9 |
| Implementation | Handoffs interrupted; minutes per patient | Observation | 62 percent; 3.8 minutes | 40 percent or fewer; no increase |
| Maintenance | Required elements present at 12 months without champions present | Observation | Not applicable | Median 9 |
Note. Baseline values are composite figures from the unit's pre-implementation review.
Data Collection
Direct observation is the core of the evaluation. Two trained observers, a clinical nurse specialist and a charge nurse from a different unit, will observe ten handoffs per week across day and night shift changes for the first three months, then five per week through month twelve. Observers will use a checklist of ten required elements, record interruptions and time each handoff. To reduce the effect of being watched, observers will rotate and observations will be spread unpredictably across days. Interrater reliability will be checked by having both observers score the same five handoffs each month.
Incident reports will be reviewed monthly by the quality nurse, who will classify each event as handoff-related or not using definitions agreed in advance. The staff survey, a short set of items on handoff quality, confidence and time, will be administered at baseline and at months three, six and twelve.
Analysis and Reporting
Observation results will be plotted monthly on run charts, which show trends over time and allow the team to judge whether changes are real. Handoff-related safety events are relatively rare, so they will be tracked on a control chart over twelve months and compared with the baseline year rather than interpreted month by month. Survey results will be compared across time points using simple percentages. Results will be reported monthly to unit staff at huddles, quarterly to the nursing quality council and at twelve months in a written summary for nursing leadership.
Decision Rules
The evaluation includes explicit decisions. At six months, if reach and element completeness targets are met but interruptions remain high, the team will add a protected handoff time with a do-not-disturb signal. If completeness falls on one shift, targeted coaching will be provided for that shift. At twelve months, the practice will become permanent policy if completeness and reach are sustained without champions and safety events have decreased or held steady with no increase in handoff time; if not, the team will investigate barriers before deciding whether to continue.
Including Patients' Perspectives
Because the handoff now happens at the bedside, patients experience it directly, and their views belong in the evaluation. A short set of questions will be added to the unit's discharge phone call for a sample of patients each month: whether nurses introduced the oncoming nurse, whether the patient felt included in the conversation, and whether anything said at the bedside made them uncomfortable. Bedside handoff raises privacy concerns in shared rooms and when visitors are present, so the observers will also note how often sensitive information was moved away from the bedside. These data do not decide whether the change continues, but they help refine how it is done.
Limitations
Because the design compares the unit with its own past, with no control unit, so other changes in the hospital could affect outcomes. Observation may alter behavior despite rotation. Incident reports undercount events, and reporting may rise simply because staff pay more attention to handoff. Twelve months may be too short to detect a change in rare safety events. These limits will be stated in every report so that results are interpreted with appropriate caution.
Conclusion
This evaluation plan uses the RE-AIM framework to judge a structured nursing handoff not only by whether it improves safety but by whether it reaches every shift, is adopted by every nurse, is delivered as designed and lasts. Clear measures, a practical observation method, defined decision points and honest limitations will allow the unit to decide, with evidence, whether the new handoff should become the way the unit works.
References
Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health, 89(9), 1322-1327. https://doi.org/10.2105/AJPH.89.9.1322
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., 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
How this NUR 490 Module 5 example is structured
An evaluation plan must be specific enough that another nurse could carry it out, so the paper defines what will be measured, how, when and by whom. After a short recap of the change and the evidence, the RE-AIM framework is introduced and used to organize the measures. A table lists each measure with its data source, baseline and target. The data collection section explains the observation method for handoffs, which is the most demanding part of the plan. Analysis and reporting follow, along with the decision rules the unit will use at six and twelve months. A brief section addresses limitations of the evaluation design.
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NUR 490 Module 5 questions, answered
What does a NUR 490 evaluation plan include?
Capstone evaluation plans usually describe how the success of the change will be judged: outcome, process and balancing measures, data sources, timing, methods of analysis and how results will be reported and used. Some guidelines ask for an evaluation framework. Your classroom instructions list the required elements.
What is the RE-AIM framework?
RE-AIM evaluates an intervention across five dimensions: Reach, the share of the intended population affected; Effectiveness, the impact on outcomes; Adoption, the share of settings or staff who use it; Implementation, whether it is delivered as intended; and Maintenance, whether it lasts. It helps show whether a change works in real practice, not only in principle.
How do I evaluate a communication change like handoff?
Combine direct observation of handoffs using a checklist of required elements, measures of workflow such as duration and interruptions, staff perceptions, and patient safety outcomes such as reported communication-related events. Observation takes effort, so sample a set number of handoffs per week rather than trying to observe all of them.