PVG Culture Change in Handover: Module 1

What is nursing handover?

The nursing handover report is probably the most important part of each nurse’s shift. It is the time when essential information is passed on to the next shift and gives the team leader the opportunity to “resource manage” the time and subsequent financial cost of the nurses on her/his ward.

Handover has traditionally taken place off the ward, usually in the office, this can lead to long, irrelevant and, sometimes, unprofessional reporting. Alternative methods of passing on information such as, bedside reporting, tape-recording and written reports, may refine the process and make it more applicable to practice.

The nursing handover process
If you are giving the handover start by having a written report for each patient you need to discuss, keep to the facts and if you’re worried you may have missed something ask other members of the team if they have anything to add.

Your report should contain every detail of the treatment and care given to the patient during your shift.

It is best not to abbreviate medical and nursing terms as this can often lead to misunderstanding and confusion. If you do need to abbreviate make sure that you fully understand what they mean, someone will always ask!

When giving the report keep it as concise as possible, stick to the facts and try not to get sidetracked.

If you are reporting at the bedside remember that the patient is within earshot and be aware of what they know about their condition and treatment. When receiving the report write down all the important points, don’t be afraid to ask if you are unsure of anything.

Role and function of ‘handover’

 * The sharing of patient information
 * Continuity of care
 * Protection of the patient
 * Clinical Education
 * Group collaboration
 * Social support for staff
 * Demonstration of knowledge and expertise

Why clinical handover?

 * Huge impact on quality of care
 * Major contributor to adverse and sentinel events
 * There is lots of room for improvement

Need to recognize:

 * There are pockets of excellence, pockets of absence
 * Clinical handover is complex
 * Different types of handover are required to meet different agendas for different groups
 * Few “rules” exist – Few evidence-based solutions exist

Aim for change of culture in handover:
Content
 * To provide a summary of the current understanding of patient safety issues related to clinical handover

Why evaluation?
Evaluation is the conscious reflection on what we do, with the aim of discovering:


 * Opportunities to improve practice (e.g., flaws in systems or processes)
 * Whether or not we have achieved the outcomes that we set out to achieve for patients; and/or whether key areas within our services are performing as expected
 * Whether or not an improvement has been made as a result of a quality improvement activity (e.g., a project or new process)

What can be done to improve clinical handover?

 * Leadership
 * Resources
 * Organisational structures
 * Use of IT

What is bedside handover?
The nurse who has given direct care hands over at the patient’s bedside to the nurse who will be giving care to the patient over the following shift. Clearly placing the patient at the centre of care.

Advantages of Bedside Handover:

 * Consistency
 * Continuity
 * Personal
 * Informative
 * Excellent source of information
 * Collaborative caring
 * Empowers the patient

Processes – Prior to Handover

 * Patient allocation completed by outgoing charge nurse.
 * Handover sheet contains information on all patients; updated each shift and copies made for oncoming staff. Patient informed that bedside handover will start shortly.
 * Families may stay for the handover with the patients’ consent.
 * Visitors asked to wait in the ‘lounge’ or other waiting area.

Processes – During Handover

 * Outgoing staff introduce patient to oncoming staff.
 * Content: reason for admission, history, tests, treatments, ADL, nursing care plan, changes in patient condition, pending tests or specimens.
 * SBAR used when patients are less known to staff.
 * Safety Scan: patient (visual check), environment (equipment, lines), bedside chart (observation and medication record, risk assessments).
 * Patients invited to comment or ask questions.
 * Patients presence prompts other key issues to be discussed.
 * Confidential/sensitive information on the handover sheet or shared away from patients and visitors.

Processes – After Handover

 * Team leaders give the charge nurse a short handover if the charge nurse did not attend the bedside handover.
 * Handover sheet is key component of this handover.
 * Staff who start ‘between handovers’ join teams, using the handover sheet as a guide for tasks to be undertaken under the directions of the team leader.

What is transition of care?
The movement of patients from one healthcare practitioner or setting to another as their condition and care needs change


 * Occurs at multiple levels Within Settings
 * Primary care Specialty care ICU Ward Between Settings
 * Hospital Sub‐acute facility Hospital Home
 * Across health states
 * Curative care Palliative care/Hospice
 * Personal residence Assisted living