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Clinical Handover Hospital policy What does your hospital p

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on 26 April 2014

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Transcript of Clinical Handover Hospital policy What does your hospital p

NSQHSS
Conclusion
Research advises excellent communication and good quality handover is essential for patient safety
References
Reviewed Policy

No reference to a multidisciplinary team
(Epworth Heathcare, 2011)
Other recommendations

Multidisciplinary team inclusion where possible
(Jeffcott et al, 2009 p. 272; Manser, et al. 2013;
Australian Commission on Safety and Quality in Health Care
2012)

Clinical Handover Hospital policy
What does your hospital policy recommend?
Does this policy align with the other recommendations?
Conclusion
Primary objective is a clear and concise handover policy which includes:

Multidisciplinary involvement recommended
Senior clinician involvement
Shift overlaps and mandatory attendance
Effective handover is critical to patient safety


The Hospital policy reviewed is not aligned with other recommendations in the following areas:
Reviewed Policy
- the “receiving clinician/s” indicate their understanding of care needs and accept responsibility
(Epworth Healthcare, 2011).

Other Recommendations
- both outgoing and incoming clinician are responsible and accountable for the information contained in the handover
(Thomas, et al. 2013).


Reviewed Policy
– “sufficient time” is allowed for clinicians to complete the required checks and clarify unclear information
(Epworth Healthcare, 2011).
Other Recommendations
– mandatory attendance for clinicians with shifts overlaps
(Staggers & Blaz, 2013; Johnson, et al. 2011 p. 139).

Reviewed Policy
- recommends “required staff” for handover
(Epworth Heathcare, 2011)
Other recommendations
– specify Senior Clinician involvement
(Johnson, et al. 2011 p. 138; ACSQHC, 2012)

The Hospital policy reviewed recommends that handovers are
Timely – when care is transferred from one health clinician to another
Relevant – change in patients condition or treatment
Structured – Incorporating four standard requirements - Preparation, Patient participation,
Transfer of information (using ISOBAR )and transfer of accountability /responsibility
Applicable to multiple handover situations – change of shift, change of clinician responsibility, patient transfer
Designed to minimise risk – supports safe patient care and a positive patient experience
Reviewed by a committee – Reported to advisory council & Quality Committee
Based on evidence based best practise: Delegation, Responsibility and Accountability

Australian Commission on Safety and Quality in Health Care 2012, OSSIE guide to clinical handover improvement, Australian Commission on Safety and Quality in Health Care, viewed 23 March 2014, www.safetyandquality.gov.au/wp-content/uploads/2012/01/ossie.pdf

Epworth Healthcare, Clinical Handover Policy, 2011

Jeffcott, S, Evans, S, Cameron, P, Chin, G, & Ibrahim, J 2009, 'Improving measurement in clinical handover', Quality & Safety In Health Care, Vol. 18, Iss. 4, pp. 272-277, MEDLINE Complete, EBSCOhost, retrieved 25 March 2014.
Johnson, J, Arora, V, Bacha, E, & Barach, P 2011, 'Improving communication and reliability of patient handovers in pediatric cardiac care', Progress In Pediatric Cardiology, Vol. 32, Iss. 2, pp. 135-139, Academic Search Complete, EBSCOhost, retrieved 31 March 2014.

Manser, T, Foster, S, Flin, R, & Patey, R 2013, 'Team Communication During Patient Handover From the Operating Room: More Than Facts and Figures', Human Factors Vol. 55, Iss. 1, pp. 138-156, Applied Science & Technology Source, EBSCOhost, retrieved 31 March
Staggers, N, & Blaz, J 2013, 'Research on nursing handoffs for medical and surgical settings: an integrative review', Journal Of Advanced Nursing, Vol. 69, Iss. 2, pp. 247-262, Academic Search Complete, EBSCOhost, retrieved 30 March 2014.

Thomas, M, Schultz, T, Hannaford, N, & Runciman, W 2013, 'Failures in Transition: Learning from Incidents Relating to Clinical Handover in Acute Care', Journal For Healthcare Quality: Promoting Excellence In Healthcare, 35, 3, pp. 49-56, CINAHL Complete, EBSCOhost, viewed 25 March 2014.

2006
WHO released the High 5’s project designed to address patient safety
2008
WHO placed their focus into other areas. Australia continued working on clinical handover improvements
2009
Patient safety research publication named Clinical handovers
the number one priority in developing countries
2010
Australia released the National Clinical Handover Initiative and the OSSIE guide to handover improvements

(Australian Commission on Safety and Quality in Health [ACSQH] 2011a, p. 15)

The Beginning of Change

Aim to improve the quality of healthcare within Australia
Ensures a nationally standardised level of care
that consumers can expect to receive

(ACSQH n.d)

National Safety and Quality Health Service Standards

6.1 “Health service organisations implement effective clinical handover systems”


(ACSQH 2012, p. 44-46)

Clinical Handover -Standards 6


6.5 “Health service organisations establish mechanisms to include patients and carers in clinical handover processes”


(
ACSQH 2012, p. 44-46)
(ACSQH 2011b)

Standard 6.2-6.4 “Health service organisations have documented and structured clinical handover processes in place”




(ACSQH 2012, p. 44-46)


Clinical Handover Standards
-Annually over seven million clinical handovers occur in Australian hospitals

-In community care settings the number of clinical handovers is in excess of twenty six million

-Breakdown in communications is the major contributing factor in 70% of sentinel events in hospital


(ACSQH 2012, p. 44-46)


So why are the NSQHS standards needed?

Clinical Handover Standards
ACSQH – see Australian Commission on Safety and Quality in Health Care
Australian Commission on Safety and Quality Health Care 2011a, External Evaluation of the National Clinical Handover Initiative Pilot Program, ACSQH, retrieved 28th March 2014,
< http://www.safetyandquality.gov.au/wp-content/uploads/2012/02/National-Clinical-Handover-Initiative-Pilot-Program-Evaluation-Final-Report-Website-Ready-Version-February-2011.pdf>.
--2011b, Implementation Toolkit for Clinical Handover Improvement, ACSQH, retrieved 28th March 2014,
< http://www.safetyandquality.gov.au/wp-content/uploads/2012/02/ImplementationToolkitforClinicalHandoverImprovement.pdf>
--2012, National Safety and Quality Health Service Standards, ACSQH, retrieved 28th March 2014,
< http://www.safetyandquality.gov.au/wp-content/uploads/2011/09/NSQHS-Standards-Sept-2012.pdf>
--n.d, Health Service Standards and Accreditation, Retried 21st March 2014,
< http://www.safetyandquality.gov.au/our-work/accreditation/>


References

ACORN
Medscape, ISBAR image, retrieved 6th April 2014, <www.medscape.com>.

Healthcare Quarterly, SBAR image, retrieved 6th April 2014, <www.longwoods.com>.

System, MH, IPASS the BATON image, retrieved 6th April 2014, <www.health.mil>.





References

Australian Commission on Safety and Quality in Health Care, retrieved 15 April 2014, <www.safetyandquality.gov.au>.

Botti, M, Bucknall, T, Cameron, P, Johnstone, MJ, Redley, B, Evans, S & Jeffcott, S 2009, 'Examining communication and team perfomance during clinical handover in a complex enviroment: the private sector post anaesthetic care unit', Medical Journal of Australia, vol. 190, no. 11, pp. S157-S60.



References

Good quality handover essential.
Recommendation of standardized approach.
Evidence based handover tool essential.
Further research required.

Final word

http://www.youtube.com/watch?v=H6BSace51Zg&sns=em
http://www.youtube.com/watch?v=aYZx1l8rkXA&sns=em


ISBAR and SBAR

AORN – Healthcare communications toolkit to improve transitions in care.
I PASS the BATON tool.

Perioperative handover tools

ISBAR

Numerous available.
Used world wide and in various settings.

Handover tools

Standardized approach.
Structured and up to date.
Limited interruption, clear language.
Receiver verification.
Review of data and opportunity for receiver to ask questions.
Use of technology.




Recommendations

Many factors that contribute to adverse patient outcomes.


Contributing factors

3000 sentinel events between 1995-2004.
65% from poor communication.
Increase to 70% in 2005.
50% occurred during handover.

Statistics

Can be complex.
High potential for error.

Perioperative handover

Limited research in perioperative area.
Majority of research ward based/shift to shift.

Data base search

ACSQHC

Internationally

Good quality handover essential.
Recommendation of standardized approach.
Evidence based handover tool essential.
Further research required.

Final word

ISBAR

Standardized approach.
Use of evidence based handover tool.
Structured and up to date.
Limited interruption, clear language.
Receiver verification.
Review of data and opportunity for receiver to ask questions.
Use of technology.



AORN
Recommendations

Can be complex.

High potential for error.

Multiple transitions through the perioperative
phase.
Perioperative handover

Limited research in perioperative area.

Majority of research ward based/shift to shift.

Research primarily focused in postoperative phase.
Data base search

Medscape, ISBAR image, retrieved 6th April 2014, <www.medscape.com>.

Healthcare Quarterly, SBAR image, retrieved 6th April 2014, <www.longwoods.com>.

Nagpal, K, Abboud, M, Manchandra, C, Vats, A, Sevdalis, N, Bicknell, C, Vincent, C, Moorthy, k 2009,
'Improving postoperative handover: a prospective observational study', The American Journal of Surgery,
Vol. 206, no. 4, pp. 494-501

System, MH, IPASS the BATON image, retrieved 6th April 2014, <www.health.mil>.





References

Australian Commission on Safety and Quality in Health Care, retrieved 15 April 2014, <www.safetyandquality.gov.au>.

Association of Perioperative Registered Nurses, retrieved 30 March 2014, www.aorn.org

Botti, M, Bucknall, T, Cameron, P, Johnstone, MJ, Redley, B, Evans, S & Jeffcott, S 2009, 'Examining communication and team perfomance during clinical handover in a complex enviroment: the private sector post anaesthetic care unit', Medical Journal of Australia, vol. 190, no. 11, pp. S157-S60.

Squires, S, Annells, M 2010, 'Barriers to effective PARU handover', ACORN, vol. 23, no. 4, pp. 16-22.

References

http://www.youtube.com/watch?v=H6BSace51Zg&sns=em
http://www.youtube.com/watch?v=aYZx1l8rkXA&sns=em


ISBAR and SBAR

ACSQHC

AORN – Healthcare communications toolkit to improve transitions in care.
I PASS the BATON tool.
Based on the department of defense team STEPP training tool modified
for the perioperative setting.
Perioperative handover tools

Internationally

Numerous available.

Used world wide and in various settings.

Handover tools

Many factors that contribute to adverse patient outcomes.

Poor communication.
Noisy units.
Time delays.
Variability of handover and approachability of doctors.
knowledge base of nursing staff.

Contributing factors

3000 sentinel events between 1995-2004.

65% from poor communication.

Increase to 70% in 2005.

50% occurred during handover.

Statistics

Research
National Health and Quality Safety Standards
Group 2
Clinical Handover

Lidia Li
Claire Phelps
Gayle Beckett
Louise Hack

ACORN emphasizes on communication throughout its standard to optimize safe patient care
The NSQHS standards were designed to ensure health organisations have set guidelines and policies on clinical handover that are regularly reviewed and updated to maintain best practice. By following these guidelines patient safety is improved as important information will be handed over appropriately between health professionals.

In order for clinicians to abide by the safety precautions and to uphold good quality patient care, hospital policies need to be clear in how this information is communicated.
Full transcript