Optimizing Continuity of Care through Initial Assessment, ISBAR-Based Handover, and Priority-Based Nursing Rounds

Abstract

Continuity of nursing care requires timely initial assessment, structured information transfer, and direct validation of patient problems. This community service program aimed to optimize continuity of care through initial nursing assessment, ISBAR-based handover, and priority-based nursing rounds in a detoxification unit at a hospital in Jakarta. The program was conducted from August 24 to September 14, 2026, through situation assessment, priority setting using the Urgency, Seriousness, and Growth (USG) method, nurse capacity strengthening, implementation, mentoring, monitoring, and evaluation. The pre-implementation audit showed that 6 of 16 initial nursing assessments (37.5%) were completed within ≤24 hours. In the post-implementation audit, 23 of 25 initial nursing assessments (92.0%) were completed within ≤24 hours. The mean knowledge score of 12 nurses increased descriptively from 83.33 to 98.33; however, the difference was not statistically significant based on the Wilcoxon signed-rank test (p=0.063). The mean post-implementation acceptance score reached 92.67% of the maximum questionnaire score. Observations of three nursing round sessions showed an overall skill achievement of 79.17% of the maximum observation score. Three rounds of priority patient-based nursing care were conducted, all resulting in clinical or managerial follow-up actions regarding the identified issues. The integration of initial nursing assessment, ISBAR-based handover, and priority-based nursing rounds demonstrated initial implementation in supporting continuity of care and requires ongoing monitoring and mentoring.