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Sophie Newhouse

on 17 September 2013

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Provides continuity of care
Allows for efficiency
Allows nurses to clarify any questions they may have about patients or clinical information
Prevents adverse effects from occuring
Types of Handover
ORAL: Staff members from both shifts in a seperate room or at the patients bedside
AUDIO HANDOVER: Left in a secured area to ensure confidentiality
Oral Handover
Most effective method of handover
Carried out between nurse from previous shift and next shift
At bedside or staff room
Allows nurses to ask questions or clarify information about patients
EXAMPLE: If one nurse finds a particular pain relief effective for a patient it is essential that the information be relayed to the next nurse
• ISBAR is a framework that signifies a standardised or universal approach to communication within the health sector and can be used in any circumstance or medical area. It includes of Introduction, Situation, Background, Assessment and Recommendation.
A report at the beginning and end of every shift
Providing information about patients to staff on different shifts
Clinical handover allows for efficiency

Audio Handover
Staff record handover at end of each shift as an audio file
Reviewed by staff member on following shift
Left in a secured area to maintain confidentiality
Can be an efficient way of recording information
Less effective as verbal handover as it can be misinterpreted as there is no ability to clarify
Why use it?
• Assists with information transfer in the workplace when there are time constraints
• Effectively organises relevant information for transfer between sources and persons.
• It is simple, memorable, quick to use
• It is transferable and portable
• Logically and clearly structured way of presenting information.
• Can be used in any situation.
• Promotes organised and logical communication
• Standardises communication for all.

• Framework that prevents information being missed
• Simple and concentrated means of setting expectations for what is to be communicated.
• Ensures recommendations are clear and professional.
• Provides confidence and assurance in communication
• Focuses on the problem itself rather than the communicators.

ISBAR Framework
Where is it Used?
• Can be used in any information handover situation. For example:
o Shift changes
o Discharge to community services
o Inter-hospital transfers
o Intra-hospital transfers
o Time-critical situations such as medical emergencies or evacuations
o Procedure documents
o Reports, dispatches and briefings

Who can use ISBAR?:
ISBAR creates a shared mental model for the transfer of relevant, factual, concise information between clinicians and health care professionals. Thus eliminating the power differences that may inhibit information flow:
• Doctor-doctor
• Nurse-nurse
• Nurse-doctor
• Doctor-allied health
• To and between ward staff, housekeeping and clerical staff.

Government Policy
Handover is an area where the risk of adverse effects is great
Much information can be missed
Policy sets a structure to reduce harm
Nursing Practice is goverened by policy
Developed by:
Australian Commission on Safety and Quality in Healthcare
Australian Medical Association
Nursing and Midwifery board of Australia
Nurses must comply with policy regardless of diagnosis, circumstances, location or time of day
Developed to improve patient's recovery and hospital experience
Policy Standards for Handover
Someone must be nominated to govern each handover
Ensures all staff participate
Ensures all participants hear the handover
Leadership ensures this occurs properly
Handover Process
Organised structure for reporting
Must be followed daily
Allows continuity
Allows for overall understanding of situation
Valuing Handover
Reviewing clinical staff rosters
Make sure the structure for handover is supported
Make sure all participants are available and present
Work around team members
Handover Participants
Must be structured to suit multidisciplinary team
Occupational Therapists
Social Work
Allow all members to be present
Make it a team experience
Handover Time
The following factors must be taken into account to ensure handover happens accurately and efficiently
Handover must happen at the same time in the same manner every day to ensure efficiency
Handover Place
Designated place
If for some reason it cannot be conducted face to face another situation must be established for it to occur
Staff Room
Handover requires effective and clear communication
If it is done poorly it can result in;
Mistakes in medication administration
Delay in treatment
Unnecessary repetition of information
Wasting time and resources
Harm to patients
Barriers to effective clinical handover is a result of poor verbal communication
Communication Barriers
Tape recorded handovers are not structured to support effective communication
Hard to understand the taped speech, especially nurses with foreign accents.
Information can be misunderstood
Wastes time as the tape has to play again
To improve this, nurses should provide written communication as well as verbal to prevent mishaps
Cultural Barriers
Values and Beliefs
Some nurses may expect a more detailed handover and some may not
Perception of illness and care
Religious and Spiritual beliefs
Can cause conflict
Can cause serious breakdown of communication
Staff with different roles may have different views of handover
Some authority figures may see themselves exempt from attending handover.
Doctor may view he has authority over a nurse
Difference in knowledge base
''Talking down'' to others
Including only information they see necessary
Personal Views
New nurse’s perception is different to experimented nurses
Status Barriers
Areas for Improvement
95% of doctors believe there was no formal procedure for handover
15.4% of patients are transferred to wards from emergency with an incomplete handover - causing adverse effects
Australian government has developed a guide to improving handover
O - Organizational Leadership
Establishing a team that is responsible for improving handover
Educating staff on multidisciplinary handover
Educating staff on rationale for change
Identifying barriers for change
Developing leadership skills and training strategies
Simple Solution Development
Develop a standardized handover solution
Engage clinicians in the design process
Engage staff in developing the procedure so it is practical and in context
Stakeholder Engagement
Encouraging involvement from staff across departments
Involving family members/patients
Delivering education and training programs
Regularly revising handover
Developing continual learning strategy
Developing innovative activities to encourage participation
Evaluation and Management
Develop evaluation plan
Ongoing resources and responsibilities
Regular revision
Read-back or Check-back technique
Developed by US department of defence
Ensures accuracy
Nurses can verify what they have heard and ensure it is correct
Other Areas of Improvement
Change in management framework
This will support the implementation of a standardized clinical framework
Group Practice - Ensure team is working together so they are all practicing in the same manner
Fatigue - Research shows that lack of sleep is a huge safety risk for handover
Revising rosters - to ensure staff are
Revising hospital policies
Using computer technology during handover
Tape Recorded Handovers
Clinical handover is a high risk area that frequently causes negative outcomes for patients
Statistics show it isn't being practiced effectively
Nurses must play an active role in constantly improving handover
Why does it Need Improvement?
Eradicating Audio Handover
Audio handover has proven to be inefficient
Too many mistakes made
Too brief and not enough detail
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