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.
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