| Sumario: | In the burn intensive care unit (ICU), effective nurse handovers are critical to patient safety. Communication gaps during the transfer of accountability (TOA) contribute to preventable safety incidents. We designed a quality improvement (QI) initiative to standardize TOA and improve safety culture. A baseline safety culture survey of 31 burn ICU nurses and a 3-month review of incident reports (mean: 18/month) identified handover-related communication failures, including omitted treatments, delayed wound care, and missed monitoring responsibilities. We co-developed a structured, burn-specific TOA tool with frontline nurses and introduced it through targeted education. The intervention was implemented over eight weekly Plan-Do-Study-Act (PDSA) cycles. Outcomes included incident rates, nurse-reported safety culture, and process adherence. Postintervention, safety incidents decreased by 50% (from 18 to 9/month), and TOA-related safety culture scores improved by 20%, achieving both SMART objectives. Tool adherence exceeded 90% by the final cycle. Nurses reported improved clarity, reduced cognitive load, and enhanced interprofessional communication. No adverse workflow impacts were observed. A co-designed TOA tool, integrated with education and iterative PDSA refinement, significantly improved handover safety and reduced incidents in the burn ICU. This initiative provides a practical, scalable model for enhancing communication and safety culture in high-risk clinical settings.
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