Suggestions That Will Help to Better Clinical Handover - Assignment Example

A)

To come up with suggestions that will help to better clinical handover in the medical department of a big hospital by about 30% in a period of 6 months

B)

Clinical governance is a system whereby the organisation is needed to improve the quality given by its workers and safeguarding high standards of care by creating surroundings that are perfect for clinical care will develop. The strongholds of clinical governance are:

• Clinical performance and evaluation: the use, monitoring dissemination, and evaluation of evidence given the clinical standards.
• Proffesional development and management: supports and documents clinical developmentand the maintenance of professional standards
• Clinical Risk: concentrates on reducing risk and bettering overall clinical safety
• Consumer Value: inspires clinical services to encompass their communities in maintaining and improving current performance and in planning what is to come.

Clinical handover is a vital part of clinical care that is practiced in many different ways in all health care settings daily. Failures in clinical handover has been seen as a major preventable cause of patient harm. Poor handover can also result to wastage of resources in the process of clinical handing over patients are key. Evaluating their perspectives andexperience gives a valuable information regarding personal aspects of care. It also points out area that might need more work force and give better solution to the issues. Patientscentered or consumer centered care are so important to develop a safe and high quality healthcare system in Australia, encompasses the active participation of patients, consumes and careers in planning delivery and evaluation and the design of all health care system. Also its important to continuously monitor of clinical handover systems so as to be able to see changes that occur over time to assert that the systems continue to function effectively and identify area that might need more work.

The governance framework for clinical systems plays a key role that is development. This is in reference to the execution, assessment and revision of management policies, structure as well as the minimal data sets necessitates in cases on handover in a clinical set up. The chief objective for any hand over policy should be a standardized and flexible approach that is applicable in the local set up. The existent hand over processes have proved to be unreliable and constantly changing. Thus the needs for standardization in a bid to ensure build consistency in the exchange of significant information. From the above discussion it is evident that all the mentioned pillars of clinical governance relate to the issue of clinical handover.

C)

A report done by the Australian commission about safety and quality in health care(ACSQHC) (2012) states that one of the crucial factors that assist continuity of care given to patients is the issue of clinical handovers. Also the Australian medical association (2006) argues that clinical handover hasbecome such a serious issue especially in changing job patterns in the healthcare sector. Health care provider do assement on a daily basis. It is estimated that about 7million clinical handover sessions done in all hospitals in Australia yearly (Australian Commission on Safety and Quality in Health Care, 2010b). The literature however puts across that clinical handover is not a well-defined process and often poorly conducted by health care professional (Wong et al., 2008a). Poor clinical handover is linked to poor patient outcomes (Bittner et al., 2012, Bomba and Prakash, 2005}, amplified medical errors (Pezzolesi et al., 2010, Arora et al., 2007), poor satisfaction of staff (Borowitz et al., 2008, Wong et al., 2008a) amplified medico-legal claims (Jagsi et al., 2005) and increased patient complaints (Singh et al., 2007}.

Efforts to improve clinical handover have become more urgent and essential in order to improve quality and safety of patient care. (wongPhD thesis)

Clinical handover has been identified as one of the key accreditation standards for the Australian healthcare system (Australian Commission on Safety and Quality in Health Care, 2011) and one of the key areas for improvement by the World Health Organization (Riesenberg et al., 2010).

Clinical handover –some facts

• A survey of survey of Australian doctors revealed that 95% supposed that there were no formal or set of procedures for handover(Bomba&Prakash,2005)
• An Australian study of emergency department handover found that in 15.4% of cases not all required information was transferred, resulting in adverse events (Ye et al, 2007).
• An examination of incident-reporting systems concerning clinical handover in Australia, it was found that only 58% of accredited training hospitals had formal handover practice (Fassett et al., 2007).
• A comprehensiveinvestigation of nursing handover exposed that some handovers brought about misunderstanding and did not help in patient care (Sexton et al, 2004).

D)

• The financial support/funding body: managing financial issues of staff who attends in training
• Advisory team members such as a steering committee and reference groups: Their main roles include the provision of support for the project team, provision of administrative guidance and provision of experience and advice for the project team.
• The support team, such as managers and heads of department: team members who have the ability to cooperate and have the capacity to contribute substantially to the project and give the approvals
• Information technology managers
• Information technology designers: to design prototype software for implementing computer based handover
• Information systems experts: to support and assist all attendees with any issues regarding using new soft ware
• Clinicians: attending training, interviews and surveys
• Nurses: attending training, interviews and surveys
• Patients: Having a patient representative on the team throughout clinical handover improvement and asking patients and representative to take part in surveys
• External shareholders, like other institutions, which have effectively implemented solutions or research organizations.
• The quality and safety officer: to often check and assess any safety issues will arise
• Educationalists

E)

The methods utilized to plan, implement and examine the effects of change in the delivery of health services are comprised in the Clinical practice improvement (CPI). In reference to this project the CPI tool utilized comprised of the following components plan, do, study and act (PDSA). The cycles test the idea by temporarily trying change and subsequently evaluating its effects.

The PDSA cycle had four major phases that are explained below

Plan- develop the change that will put to test and implemented Do – conduct the test or change

Study – evaluate at previous data before change and data after change hence reflect on the results of the exercise.

Act – plan for the subsequent cycle of change or implement in totality.

The cycles of PDSA serve as a framework guide in the development, testing and implementation of changes with a view to enhance or improve performance. This framework is backed up by a scientific method and requires moderation when it comes to taking immediate attention without considering the entirety of the project with wisdom. The PDSA cycles facilitates the testing of changes prior to the wholesome implementation by the team thus giving the relevant stakeholders with a chance to evaluate the applicability of the proposed changes.

Managers and clinicians are on a regular basis provided with reports that denote the need for improvements in the delivery of health care. Some of the indicators in this regard include complaints, incidents, audits and performance data. The challenge posed to managers is acting the data in an adequate manner. This necessitated comprehension of variation analysis, organizational change, human factors process and systems.

This project will focus and detail on the specific aims of the author in reference to the varied components of PDSA

Plan:

• Using different research methods, identify the areas of weakness in the existent practice
• To establish a standardisedproforma
• For purposes of enhancing accountability, implement an electronic handover.
• In an effort to meet the best practice standards in the clinical set up there is need to enhance the quality of handover.
• Including nurses in the attendance of trainings and feedback sessions.

DO:

• Form a small group of nurses to participate in the training and induction sessions.
• Identify the problematic issues through evaluating the existent hand over procedure.
• Conduct a survey on the experiences and opinions of the staff in reference to the existent hand over procedures.
• Ensure that the IT department designs the prototype.
• In an effort to enhance the awareness of the safety rules have educational posters designed and displayed
• Ensure that the observed challenges and unexpected incidents are documented.

Study:

• A survey should be designed with the intent of investigating the new handover systems in relation to the major elements of documented best practices. This should also be weighed against anecdotally issues reported.
• Having an analysis done prior to implementation and after implementation
• Measuring poor quality of information transfer, dissatisfaction among patients and staff, miscommunication as well as the reduction of inappropriate hand over.

Act:

• Drawing from the existent studies, standardized guidelines, training and computerization of handovers served as an efficient way to enhance clinical handover. Significant improvements in practice have been recorded by studies that have focused on post intervention cohorts. The findings further emphasize the need for ranking in reference to urgency on the handover jobs on the electronic pro forma. For purposes of implementing the interventions at the right time, the clinical governance team should be accorded permission as soon as it is possible. The entire staff should be given training sessions. Consequently, development of medical handover “New Guide” should be actualized. The guidelines should comprise of summaries of both pro forma and electronic best practice.

F)

• Using a checklist implementation should proceed by following a double checking procedure.
• Training and education program
• Support the involvement of nurses in medical rounds
• Ensuring that the varied hands over options for the nurses are discussed with a view to ensure that a one to one checking of the patient is adhered to.
• Develop adequate orientation and induction of the medical staff
• Conduct debriefs/incident analysis
• Ensure that handover proformas are standardized
• Develop a template on computerized hand over.
• Ensuring that standardized hand over procedure are made official
• As a reminder of appropriate administrative code of ethics and action have lanyards and ward posters.

G)

There is a likelihood of individuals involved in already exiting hand over project to feel threatened by the introduction of a new project. Demonstration of leadership necessitates clear comprehension of the existent hand over practices, ensure that the staff articulate the need for change in practice as well as identify and barriers to the proposed changes. The challenges can be categorized into

Environmental factors that may include culture of the ward and the level of busyness in the ward

Human factors that include staff having competing work task and their adherence to the systems in place.

Technological factors that include level of proficiency among health professionals in health records as well as the availability of electronic medical records.

For purposes of reminding the participants several communication strategies should be employed including pamphlets, websites, letters, emails and workshops.

Given that majority of the stakeholders in health are busy communication should be precise. The feedback drawn from the employees should be acknowledged and where necessary an action plan is developed to deal with the raised issues.

In this regard it is essential to comprehend and deploy initiatives that are significant such

• opportunities for professional development
• In a bid to gain attention of nursing staff several photos should be taken at the hand over.
• Presentations that are conducted on a face to face manner should be brief
• In reference to the incentives a weekly quiz on the hand over process should be done.
• Attendance to varied training sessions should result in awarding of certificates to participants

H)

Contrasting data prior to implementation and after implementation serves as an essential measure of handover improvement project. The collection of data prior to implementation and after implementations will be gathered through structured observations and interviews, shift diagram and safety learning system. The two sets of data will then be contrasted. In a bid to adhere to the principle of flexible standardization, the data should be periodically evaluated and revised in accordance to the proposed hand over solution. For the purpose of this project, the data will be gathered in specified intervals of three months.

The evaluation plan can comprise of the following measures

● Structural measures that include demographic data, data on structural units and their stipulated hand over procedures

● Process measures that include completeness and consistency in the critical steps entrenched in the proposed process. Other elements in this measure include, effectiveness, completion time for the new hand over process, staff level of participation in the designing of the new process and efficiency in patient care.

● Content measures that include consistency of information on transfer, accountability and responsibility as well as efficiency in the transfer of content.

● Cultural measures that should include the satisfaction of both the staff and the patients.

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