Author:Sivakumar Murugesan.
Hospitals Project,Patient Safety and Quality Improvement Consultant
Clinical Handover is
to ensure that a timely, relevant and structured clinical handover occurs that
is appropriate to the clinical setting and context of the handover. There
are numerous policies, procedures and resources within health care services to
assist you with clinical handover. It is
important to access, read and adhere to systems, policies and procedures within
your organisation.
Purpose
Clinical handover is
practised every day, in a multitude of ways, in all health care settings. Poor
or absent clinical handover, or a failure to transfer information,
responsibility and accountability, can have extremely serious consequences for
patients.
·
Health service organisations implement
effective clinical handover systems.
·
Health service organisations have
documented and structured clinical handover processes in place.
·
Health service organisations establish
mechanisms to include patients and carers in the clinical handover processes.
It can result in:
• delays in diagnosis, treatment and care
• tests being missed or duplicated
• incorrect treatment or medication
Principles of clinical handover
The
aim of clinical handover is to ensure the accurate and timely transfer of
information, responsibility and accountability.
The key principles include:
PATIENT AND CARER INVOLVEMENT
Where
possible, clinical handover should actively involve the patient and carer as
well as clinicians. Patients and carers
can provide information that is not necessarily available to clinicians. It is important that clinicians listen to
patients and carers to gain an understanding of this information. It is also
essential that patients and carers understand current progress, treatment
options and the plan of care.
The
risk of a patient experiencing an adverse event is reduced by actively
involving them in their own care.
HANDOVER REQUIRES PREPARATION
Handover
requires preparation prior to handover time. Handover should occur at an
allocated time and venue which enables all necessary staff to attend. Documents and progress notes should be
updated and available at handover time.
It is recommended that verbal handover is supported by documentation
such as handover sheets.
Staffing
levels and allocations should ensure that patient care is attended to while
handover is occurring.
HANDOVER NEEDS TO BE WELL
ORGANISED
Handover
should be led by a designated staff member who is responsible for ensuring the
exchange of all relevant communication in a timely manner.
Punctuality
is important as handover is:
• crucial to patient safety
• paid and protected time for employees .
HANDOVER SHOULD PROVIDE
ENVIRONMENTAL AWARENESS
The
incoming team need to be informed of any environmental issues (particularly
occupational health and safety issues), which might impact on the shift.
Handover
should always include notification of:
• patients who may require significant levels
of care or immediate attention
• high acuity patients
• patients who are deteriorating or at risk
of deterioration
• patients who require extra safety measures
e.g. infective or bariatric patients
• potential or scheduled patient transfer or
discharge
• staffing numbers and arrangements e.g.
allocations and activities.
HANDOVER MUST INCLUDE TRANSFER OF
ACCOUNTABILITY AND RESPONSIBILITY FOR PATIENT CARE
Patient
handover must ensure the transfer of responsibility and accountability between
clinicians and health services.
A
standard structure and content for clinical handover assists in accurately
communicating critical information between clinicians.
STRUCTURE OF CLINICAL HANDOVER
All
clinical handover processes need to be structured and documented. This ensures that all participants know the
purpose of the handover, the required information and documentation they need
to share.
Handover
requires the transfer of standard information between:
• clinicians within a discipline
• from one discipline to another
• wards or departments within a health
service
• health services
Handover
should occur:
• at change of shift
• from one ward to another ward or department
• at patient transfer to another facility
• on patient discharge
• when a patient’s condition warrants it.
CLINICAL HANDOVER TOOLS
A
number of handover tools have been developed to assist health care
professionals to conduct clinical handovers in a structured and comprehensive
way.
Structured
handover tools are used to ensure that staff are sharing relevant, concise and
focused information.
They
also:
• encourage patient assessment
• facilitate effective communication
• reduce the need for repetition
• save time for clinicians.
These
tools are checklists which can assist to standardise handover. Acronyms can be used to assist clinicians to
remember the information required for handover.
Minimum
datasets are required for all forms of handover. This is the minimum information and content
required for a particular type of handover.
HANDOVER METHODS
Face
to face handover is recommended wherever possible as it allows interaction and
clarification of information. This should be guided by the agreed patient
handover tool and supported by a summary of updated patient information.
Using
only verbal handover is high risk because it relies heavily on memory. The addition of supportive tools and
documentation can:
• minimise the risk of omitting information
• improve retention of information
• minimise repetition
• reduce the length of handover.
It
is important to ensure that the person receiving handover has understood
correctly.
A
written handover is suitable for patients who are stable, but the sending
clinician should be available to provide clarification of patient information
if required to do so by the receiving team.
YOUR ROLE IN CLINICAL HANDOVER
There
are some important points to consider when giving or receiving handover. It is
vital to maintain the confidentiality of patient information and patient
privacy at all times.
If
the patient is to be escorted to a department by a non-clinical staff member a
clinician must provide a verbal handover to a nominated member of the receiving
department. This staff member will then
assume responsibility and accountability for the patient.
GIVING HANDOVER
If
you are giving handover ensure you have:
Communicated with the patient and
carer
Discuss
details of planned transfers and discharges with the patient and carer.
Communicated with the receiving
clinician
It
is important that the receiving clinician and department are prepared to accept
the patient and are aware of the estimated time and details of patient arrival.
Checked and assessed your patient
Confirm
your patient’s identification details and assess your patient to ensure they
are stable and prepared for handover, transfer or discharge.
Completed documentation
All
required documentation needs to be updated and completed. This includes:
• preparation of handover forms
• updating progress notes
• completing any transfer or discharge forms
including information regarding:
o treating doctor
o admission date and diagnosis
o key events during admission
o discharge summary
o risks and prevention strategies
o referrals
Ensure
all necessary documentation is kept with the patient.
RECEIVING HANDOVER
If
you are receiving handover, ensure you have:
Communicated with the patient and
carer
Introduce
yourself to the patient and carer and orientate them to the environment.
Communicated with the clinician
providing handover
You
should be aware of the estimated time of patient arrival and have the
environment prepared to receive the patient.
Ensure you understand all relevant patient details and clarify anything
you are unsure about.
Checked and assessed your patient
On
arrival, you should perform a baseline head-to-toe assessment on the patient
and document findings in the progress notes.
Any
areas of concern or points that require clarification should be discussed with
the clinician providing handover before accepting responsibility for the
patient.
Completed documentation
Ensure
that all necessary documentation has arrived with the patient. All documentation, including medication and
fluid charts, should be checked for accuracy and completion.
Responsibility
and accountability for the patient must be accepted at the completion of
clinical handover.
ENGAGING WITH PATIENTS AND CARERS
Patients
and carers should be educated about the need for clinical handover and their
role in the process.
This
collaboration enables an opportunity for patients, carers and clinicians to
share information which may impact on the effectiveness of treatment and care
and raise any issues of concern.
You
should consider the following when discussing clinical handover with patients
and carers:
• patients and carers can provide information
that is not necessarily available to clinicians as carers are more familiar
with the patient and may spend more time at the bedside.
• ensuring patients and carers understand
current progress, treatment options and the plan of care
• explaining the need for clinical handover
• explaining the patient and carers role in
clinical handover, and encouraging them to raise questions and concerns with
the health care team
• offering information in languages other
than English and not assuming literacy
• providing an opportunity for patients and
carers to ask questions and have them answered
You
should ensure that the patient and carer understand the course of the care and
have up to date information about the discharge date and plan.
AUDIT AND EVALUATION
You
may be required to participate in audit activities which could include
examination of:
• patient clinical records
• handover documentation
You
may be observed in clinical practice when performing clinical handover.
The
purpose of audit is to measure compliance with policies and protocols and to
monitor the frequency and severity of adverse events in relation to clinical
handover. This information can be used
to improve practice.
REPORTING ADVERSE EVENTS
All
adverse events relating to poor or absent clinical handover should be reported
to the nurse/midwife in charge, the attending medical officer (if necessary)
and be documented in the clinical record.
They should also be reported on your organisation’s risk or incident
management system.
The key messages are:
1. Clinical handover is practised every day, in
a multitude of ways, in all health care settings.
2. Poor or absent clinical handover, or a
failure to transfer information, responsibility and accountability, can have
extremely serious consequences for patients.
3. Current handover practices are highly
variable and unreliable across all disciplines.
This can lead to discrepancies in the content and accuracy of
information provided.
4. The aim of clinical handover is to ensure the
accurate and timely transfer of information, responsibility and accountability.
5. Where possible, clinical handover should
actively involve the patient and carer as well as clinicians. Patients and carers can provide information
that is not necessarily available to clinicians.
6. The key principles include:
• handover requires preparation
• handover needs to be well organised
• handover should provide environmental
awareness
• handover must include transfer of
accountability and responsibility for patient care
7. Structured handover tools are used to ensure
that staff are sharing relevant, concise and focused information.
8. Minimum datasets are required for all forms
of handover. This is the minimum information
and content required for a particular type of handover.
9. Face to face handover is recommended wherever
possible as it allows interaction and clarification of information.
10. It is vital to maintain the confidentiality of
patient information and patient privacy at all times.
11. Patients and carers should be educated about
the need for clinical handover and their role in the process.
12. All adverse events relating to poor or absent
clinical handover should be reported in the risk or incident management
system.
Patients
and carers should be fully informed of any adverse events and the organisation’s
open disclosure processes implemented.
Information
trends can then be used to inform quality improvement activities such as
system, policy, protocol and equipment improvements and education and training
activities.
Learning outcomes
On
completion of this module, clinicians will be able to:
1. Discuss the importance of timely, relevant
and structured clinical handover.
2. Discuss the clinical handover process
including the use of a structured handover tool.
3. Describe your responsibilities in clinical
handover.
4. Describe the process for engaging patients
and carers in clinical handover.
TEST YOURSELF
Fill
in the blanks
1. Standardisation of handover _____________ and
processes improves patient safety by ensuring _____________ in the exchange of
critical information.
2. Where possible, clinical handover should
__________ involve the patient and carer as well as clinicians.
3. ______________ and carers can provide
_______________ that is not necessarily available to clinicians.
4. It is recommended that __________ handover is
supported by ________________ such as handover sheets.
5. Handover should always include notification
of patients who may require significant levels of _______ or immediate
_______________.
6. Patient handover must ensure the transfer of
________________ and ___________________ between clinicians and health services.
7. _________________ handover tools are used to
ensure that staff are sharing ____________, concise and focused information.
8. Minimum datasets are required for _____ forms
of handover. This is the _______________
information and content required for a particular type of handover.
9. Face to face handover is recommended wherever
possible as it allows ______________ and _______________ of information.
10. A standard structure and content for clinical
handover assists in _________________ communicating ____________ information
between clinicians.