Process of Shift to Shift Clinical Handover - Literature review Example

Cover Sheet NURS2002 Communication Event Analysis Assignment Institution Faculty of Medicine, Nursing and Health Sciences Introduction “Whenever the art of medicine is loved, there is also a love of humanity.” states Hippocrates, (460 B.C – 377 B.C) a Greek Physician, also popularly known as the ‘Father of Medicine’ (Patsy Stevens, 2014). For doctors and nurses, rendering care it is not just an occupation, but a true calling, and as such comes with a wide range of responsibility because they are dealing with the lives of humanity. The above quote is so apt in explaining that one can do justice, only if one loves the job they are doing as well as humanity. When there is a sincere combination of the two, there prevails commitment. Among the many responsibilities of a nurse, I would be discussing about ‘Handover’ in a specific medical scenario. A clinical handover follows a ‘Standardized Operating Protocol’ (SOP) for better patient outcomes by achieving safer clinical health care. (NSW Dept. of Health, 2009, p. 15) Julie, K. Johnson and Vineet, M. Arora (2009, p. 244- 245) define Clinical handovers as the ‘transferring of responsibility and accountability of patient care from out going to incoming teams across shifts, across disciplines and across care settings.’ According to them, in caring for patients, handovers are a very vulnerable time and as such have to be handled with acute focus and caution. In training to be a good nurse, the Standardized Operating Protocol’ (SOP) proves indispensable. The salient objectives of the SOP is to bring about standardized solutions for a smooth integration for an effective clinical handover, to provide tools to both clinicians and managers for improvement in different areas, for better clinical handovers, to reduce the gaps in communication between the patient and medical staff, to allow learning and adaptation and implementation of the SOP and helps in evaluating the information and communication protocol for better patient outcomes. For my Communication Event Analysis, I have chosen to discuss safe ‘Clinical Handover’ which is highly indispensable in Health Services and Patient Care. There are many scenarios for a clinical handover and these include – 1) General practice to hospital and vice versa, 2) Emergency departments and wards, 3) Multidisciplinary team handover, and 4) Shift to shift handover. The scenario I have chosen is shift to shift handover. A Clinical handover is also defined as the ‘transfer of professional responsibility and accountability’ (Australian Commission on Safety and Quality in Health Care, 2009, p. 5) in the various aspects of patient care. In any Clinical handover scenario, it is not enough if only the paper work is done. It requires mapping the handover process, identifying areas that could be improved, developing a suitable plan of action to implement it and lastly, evaluating the entire process for better clinical handover in the future. Every individual rendering health care is responsible and accountable for the safe and uninterrupted delivery of care to patients. However, the Clinical handover, which is a key process in this aspect, is often undervalued for its importance, considering the extremely busy health system. According to the health agenda of the NSW, (New South Wales) the standardization of Clinical handover has to be given the highest priority (NSW, 2009, p.5) for good patient outcomes because any negligence would directly result in a high risk situation for the patient. To achieve this, the Standard Key Principles are used in different health care scenarios. These key principles are highly recommended and appropriate for all types of health care situations. Improper handover due to inadequate communication is believed to be a high risk factor contributing to incidents. In fact, according to the RCA, (Root Cause Analysis) improper handover is one of the three issues contributing to incidents in patient care. Any Clinical handover is crucial and fundamental to patient care and as such should be treated as a top priority. hift to Shift handover of patient In the shift to shift handover scenario, there is a high percentage of risk involved, if carried out in a hurry or if done carelessly. Most of the time, the night staff are in a hurry to get off duty after a busy night’s work and often, very important information about the patient is not conveyed. Due to the urgency of leaving work, the night staff are not keen enough to pass on crucial information about the medication to be given and the details of other information on the charts. The day staff that come in to take over, sometimes don’t get the opportunity to gather all the necessary information about the patient’s care. According to Poot, E.P., et al., (2014, pgs. 165 – 175) “Loss of situation awareness (SA) by health professionals during handover is a major threat to patient safety…” The general public always believes that hospitals are quite safe for undertaking medical treatment, however, “currently, a wide range of safety issues has challenged the health care delivery system and therefore, many personal and organizational strategies have been developed for promoting patient safety. (WHO, 2009, p. 177) The chief aim of a shift handover is to pass on vital information about the patient’s clinical condition and to ensure high- quality care and safety. “Effective handover facilitates the continuity of care and enhances patient safety.” (Riesenberg L, et al., 2010, pgs. 24 – 34) Process of Shift to Shift Clinical Handover In order that the handover process should be absolutely accurate and be carried out without a hitch, there are certain key principles that have to be observed – Patient Identity – One of the most vital observations to be made is the exact identity of the patient that is about to be handed over. There should be no mistake in the keen observing of the patient’s name, date of birth, their medical record number and also their bedside number. (NSW, 2009, p.15) Patient Handover – The person who is in the process of taking charge and receiving the handover should be well aware of your delivery of the patient in a safe manner. In case the patient is of a different culture and speaks a different language than you, it is better to have an interpreter if there is a requirement. Explicit condition of the patient – A brief but to the point explanation of the actual status of the patient should be given to the person undertaking the handover. These vital points include – 1) Deteriorating or stable, 2) Resuscitation status, 3) Crucial patient- centered requirements such as medication etc. Current Important observations – Close observation of the patient is crucial at all times, but more so during handovers. Identifying recent changes in the patient’s condition and passing on this important information to the person taking over, is crucial to safe patient handover. Such important observations include – observing the vital signs of the patient and the level of assistance needed for mobility. (NSW, 2009, p. 16) Clinical History of the Patient – Before handover, it is crucial to sum up and give a gist of the patient’s present medical condition such as examinations, diagnosis and further patient management. Assessment and action to be taken – The person receiving handover is responsible and accountable for the continued care of the patient and therefore sharing a good understanding with the outgoing nurse could be highly beneficial to enhance patient care. Prioritizing tasks would be the ideal way to go because it would make it easier for planning the care of the patient as well as for enhancing better interpersonal communication with senior physicians. (NSW Health, 2009, p. 16) Identifying time frames and cross- checking vital information – The time frame for a handover should be fixed well in advance, immaterial of whether the patient is undergoing lower or higher acuity of health care. It is also necessary to make proper arrangements according to the patient’s requirement for progress. A patient’s record could be incorporated into the handover process if and when it is practically possible, so that direct cross – checking of vital information can take place during the process of handing over. The Ossie Guide has made significant improvements to the Clinical handover process for better patient outcomes. According to the guide a verbal handover is insufficient because a great deal depends on one’s memory skills. However, it is recommended that besides verbal handover, it is better to have a proper documented handover such as handover records, check- lists and other electronic media, with all the necessary information to reduce patient risk considerably. (Ossie Guide to Clinical Handover Improvements, 2009, p. 17) References Australian Commission on Safety and Quality in Health Care, 2009, The OSSIE Guide to Clinical Handover Improvement. Sydney, ACSQHC. Julie K. Johnson and Paul Barach, Australian Commission on Safety and Quality in Health Care, 2009 ‘Clinical Handover: Critical Communications,’ Medical Journal of Australia Supplement, Vol. 190 (11) p. 1-3) Julie, K. Johnson & Vineet M. Arora, 2009, ‘Improving Clinical Handovers: Creating Local Solutions for a Global Problem,’ BMJ of Quality Safe Health Care, Vol. 18, Iss. 4, p. 244 – 245. Patsy Stevens. 2014, Hippocrates Father of Medicine, Garden of Praise, Web, Accessed on May 25th, 2014 www.gardenofpraise.com/ibdhipp.htm NSW Department of Health, Implementation Toolkit, 2009, Standard Key Principles for Clinical Handover, p. 15 & 16 www.archi.net.au/documents/resources/qs/.../implementation-toolkit.pdf Poot, E. P., de Bruijne, M. C., Wouters, M. G. A. J., de Groot, C. J. M. and Wagner, C. 2014, ‘Exploring Perinatal shift-to-shift Handover Communication and Process:’ an observational study. Journal of Evaluation in Clinical Practice, Vol. 20: Iss. 2, 166–175. Riesenberg L, Leisch J, Cunningham J.2010, ‘Nursing handoffs:’ A Systematic Review of the Literature. American Journal of Nursing, 110 (4):24-34. World Health Organization, 2009, ‘Nine Patient Safety,’ Accessed on May 26th, 2014, from: http://www.who.int/patientsafety /solutions/patientsafety/Preamble.pdf YEE, K.C & TURNER, P. 2008, National Clinical Handover Initiative – Australia. A Pilot Study, Australia, Accessed on May 24th 2014. www.safetyandquality.gov.au/.../public-report-of-pilot-study-nursing-an Read More