Bedside Bedside Handover; Standard Handover; Standard .
2011/3/18PEEL HEALTH CAMPUSBedside Handover; StandardOperating Protocols”Professor Wendy ChaboyerProfessor Anne McMurrayP fProfessorMarianneM iWWallislliFunded by the Australian Commission on Safety and Quality in Health CarePartners: Ipswich Hospital and Peel HealthResearch Centre for Clinical and Community Practice InnovationPEEL HEALTH CAMPUSResearch AimsTo describe bedside handover in nursing in terms of:1. Structures;2. Processes;3. Outcomes.ExpectedpOutcome Development of a toolkit of standard operating protocols(SOPs) that can be used by wards wanting to implementbedside handover.Research Centre for Clinical and Community Practice Innovation1School, Centre or Element Name – To edit this field select View Header and Footer, Notesand Handouts1
2011/3/18PEEL HEALTH CAMPUSMethod Research Design: Case study with nested ‘cases’ at each site (i.e each ward). Sample: 6 wards in 2 Australian hospitals (Qld and WA) Data Collection: Observation of bedside handover for 5 days in each ward In-depth interviews with various nursing staff Clinical indicator data on medication errors, pressure ulcers,and falls 16 months prior to and 16 months after bedsidehandover implemented.2Research Centre for Clinical and Community Practice InnovationPEEL HEALTH CAMPUS Data Analysis: DescriptiveDi ti statisticst ti ti (SPSS) Thematic content analysis Statistical process control charts (P charts) Ethics Approval: Two universities and two hospitals approved this study Consent was obtained from all participantsResearch Centre for Clinical and Community Practice Innovation3School, Centre or Element Name – To edit this field select View Header and Footer, Notesand Handouts2
2011/3/18PEEL HEALTH CAMPUSResults 532 bedside handovers were observed Average length of handover 1 minute 16 seconds ( 51 sec) 34 in-depth interviews were conducted4Research Centre for Clinical and Community Practice InnovationPEEL HEALTH CAMPUSHospital A Frequency (%)N 263Hospital B Frequency (%)N 269Total Frequency (%)Medical186 (71%)103 (38%)289 (54%)SurgicalN/A93 (35%)93 (17%)CombinedN/A73 (27%)73 (14%)77 (29%)N/A77 (14%)Situation171 (65%)Not usedN/ABackground148 (56%)ObservationsN 532Type of WardRehabilitationReport Content (SBAR)Assessment118 (45%)RRecommendationsd ti156 (59%)Active patient involvement85 (32%)154 (57%)239 (45%)Mean ( SD)Mean ( SD)Mean ( SD)# of staff at the bedside4.0 (1 .23)3.7 ( 1.17)3.8 ( 1.2)Time for Handover (sec)119 ( 0.78)120 ( 0.95)76 ( 51) secResearch Centre for Clinical and Community Practice Innovation5School, Centre or Element Name – To edit this field select View Header and Footer, Notesand Handouts3
2011/3/18PEEL HEALTH CAMPUSInterview ParticipantsCharacteristicHospital AHospital BTotalN 15N 19N 34EN4 (27%)3 (16%)7 (21%)Level 18 (53%)7 (37%)15 (44%)Level 23 (20%)4 (21%)7 (21%)05 (26%)5 (15%)Full-time10 (67%)6 (32%)16 (47%)Female15 (100%)17 (90%)32 (94%)NUM6Research Centre for Clinical and Community Practice InnovationPEEL HEALTH CAMPUSOverview of ver sheet44.B d id chartBedsideh t1.2.3.Prior to handoverDuring handover Content Safety scan ConfidentialityAfter handoverResearch Centre for Clinical and Community Practice InnovationOutcomes1.2.StaffClinicalindicators:harm vs noharm7School, Centre or Element Name – To edit this field select View Header and Footer, Notesand Handouts4
2011/3/18PEEL HEALTH CAMPUSStructuresStaff 2-3 teams pper ward with H/O ggiven in each team Team leader of outgoing team and all oncoming team members Shift coordinator attends 1 team H/O then gets short reportfrom other team leadersPatients Condition may limit participation (asleep, LOC, isolation)HandoversheetComputer generated and updated each shiftContains pt history ( social),social) discharge planningplanning, changes incondition; other priority information, sensitive informationBedsidechartObservation record, medication record, fluid balance, riskassessments (falls, pressure ulcers)8Research Centre for Clinical and Community Practice InnovationPEEL HEALTH CAMPUSProcesses – Prior to Handover Patient allocation completed by outgoing charge nursenurse. Handover sheet contains information on all patients on theward; 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’patients consent.consent Visitors asked to wait in the ‘lounge’ or other waiting area.Research Centre for Clinical and Community Practice Innovation9School, Centre or Element Name – To edit this field select View Header and Footer, Notesand Handouts5
2011/3/18PEEL HEALTH CAMPUSProcesses – During Handover Outgoing staff introduce patient to oncoming staffstaff. Content: reason for admission, history, tests, treatments, ADL, nursingcare 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.questions Patients presence prompts other key issues to be discussed. Confidential/sensitive information on the handover sheet or shared awayfrom patients and visitors.10Research Centre for Clinical and Community Practice InnovationPEEL HEALTH CAMPUSProcesses – After Handover Team leaders give the charge nurse a short handover if thecharge nurse did not attend the bedside handover. Handover sheet is key component of this handover. Staff who start ‘between handovers’ join teams, using thehandover sheet as a guide for tasks to be undertaken underthe directions of the team leader.Research Centre for Clinical and Community Practice Innovation11School, Centre or Element Name – To edit this field select View Header and Footer, Notesand Handouts6
2011/3/18PEEL HEALTH CAMPUSOutcomes (interview data) Patients feel part of the handover process and have input into their care. More accurate information is communicated. Better understanding of patients’ conditions is gained. Patients are visually ‘seen’ sooner in the shift. Continuity of care is improved. Patient can prompt recall of important events and issues. Improves communication among staff at change of shift. More opportunities for teaching and modelling behaviours. Can be less time-consuming.12Research Centre for Clinical and Community Practice InnovationPEEL HEALTH CAMPUSP-Chart: Harm to Total Med Errors (3 wards combined)PProportionPostinterventionMean 0.541Mean MonthsResearch Centre for Clinical and Community Practice Innovation13School, Centre or Element Name – To edit this field select View Header and Footer, Notesand Handouts7
2011/3/18PEEL HEALTH CAMPUSImplementation Issues Move to bedside handover must be driven by need to improve handover. Buy-in from staff is required. Change management process is crucial: ex. Lewin’s 3 Step Model –Unfreezing, Moving, Refreezing. Avoid ‘talking over’ patients; limit the use of medical jargon. Explicit encouragement of patient involvement is needed. Numerous start times make implementation difficult.14Research Centre for Clinical and Community Practice InnovationPEEL HEALTH CAMPUSStandard Operating Protocol Focus is on what occurs at the bedside Other ward issues require handover1. Preparation2. Introduction3. Information exchange4. Patient involvement5. Safety scanResearch Centre for Clinical and Community Practice Innovation15School, Centre or Element Name – To edit this field select View Header and Footer, Notesand Handouts8
2011/3/18PEEL HEALTH CAMPUS1. PreparationA ti itiActivitiesCConsiderationsidtiPatient allocationPatient is comfortable to proceed withhandoverUpdate handover sheetFamily are present with patient’sconsentInform patientsPrivacy is securedRequest visitors other thanfamily to leaveResearch Centre for Clinical and Community Practice Innovation16PEEL HEALTH CAMPUS2. IntroductionActivitiesConvene ParticipantsOutgoing staff greet patientOutgoing team leaderOutgoing staff introducesoncoming staff to patientIncoming staffPatient and familyShift coco-ordinatorordinatorResearch Centre for Clinical and Community Practice Innovation17School, Centre or Element Name – To edit this field select View Header and Footer, Notesand Handouts9
2011/3/18PEEL HEALTH CAMPUS3. Information ExchangeActivitiesConsiderationsClinical conditionAcronyms to prompt information sharingTests and proceduresChanges in the patient’s conditionADL assistanceChanges in patient managementDischarge planningStaff unfamiliar with patientQueries from oncoming staff18Research Centre for Clinical and Community Practice InnovationPEEL HEALTH CAMPUS4. Patient InvolvementA ti itiActivitiesCConsiderationsidtiAsk patients if they havequestions or commentsPatient confidentialityInvite patient to confirm orclarify informationSensitive information is shared in aprivate locationSensitive information may be recordedon the handover sheetResearch Centre for Clinical and Community Practice Innovation19School, Centre or Element Name – To edit this field select View Header and Footer, Notesand Handouts10
2011/3/18PEEL HEALTH CAMPUS5. Safety ScanActivitiesActivitiesCall bell within reachTubes and lines checkedEquipment functioningMedication chart reviewedAccess to mobility aidsBedside chart reviewAny final questions?20Research Centre for Clinical and Community Practice InnovationPEEL HEALTH CAMPUSConclusion1. Bedside handover can improve content accuracy, andprovides staff with learning opportunities.2. Including patients in the handover acts as another safetymechanism in addition to the ‘safety scan’.3. Bedside handover can be successfully implemented if astructured approach to change is adopted.4. Two drivers are needed for a change to bedside handover;top-down and bottom-up; One without the other increasesthe difficulty of successful adoption.Research Centre for Clinical and Community Practice Innovation21School, Centre or Element Name – To edit this field select View Header and Footer, Notesand Handouts11
2011/3/18PEEL HEALTH CAMPUSAcknowledgementThis study was funded by the AustralianCommission for Safety and Quality in HealthCareSupport of the nursing staff of two hospitals isgratefully acknowledgedResearch Centre for Clinical and Community Practice Innovation22School, Centre or Element Name – To edit this field select View Header and Footer, Notesand Handouts12
Shift coordinator attends 1 t eam H/O then gets short report from other team leaders Patients Condition may limit participation (asleep, LOC, isolation) Handover sheet Computer generated and updated each shift Contains pt history ( social) discharge planning changes in Research Centre for Clinical and Community Practice Innovation 8
Handover notes assist following up on issues if necessary. Handover notes help provide a measure of quality of life of the care home resident. Handover notes were crucial in charting a resident's progress and enabling the family of a resident to request a review of a care package (which one participant complained would not occur
6.3 Time 6.4 Place 6.5 Method 6.6 Information that must be included in Handover 6.7 Delegation of duties 7 Consultation 8 Controls and Archiving 9 Implementation and Monitoring 10 Training and Support Appendix A Clinical Division Handover Procedure Template Appendix B Clinical Audit Standards Appendix C Nurse Handover between shifts template
as Archibus and Oracle including asset register requirements. 2.3 RIBA Work Stage 5-6 Construction, Handover and Close Out, Soft Landings Stage 3 Pre-Handover 6-3 months ahead of Handover 2.3.1 Develop and agree handover programme with key end-users, ke
Bedside Shift Report is a brief, standardized method for conducting the transfer of accountability (or TOA) during the nursing shift change. Bedside Shift Report moves the location of the shift report from the report room to the patient’s bedside, and involves the patient and their
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Clinical Handover Audit Tools Instructions . it is up to each facility / health service to determine the audit questions for review. Questions and responses can be adapted to suit the requirements of each facility / health . National Safety and Quality Health Service Standard 6 Clinical Handover How t
Handover-Document Brussels 28 November 2011 Content Handover-Document ACARE Presentation at ICAS summarizing the Work of ACARE (Sept. 2010) Executive Summary Strategic Research Agenda 1 (Oct. 2002) . Job Preparation by involvement in industrial European research
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