clinical handover 250913

8/12/2019 Clinical Handover 250913

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Clinical Handover:Effective Communication

Prevent Errors

CLINICAL RISK MANAGEMENT WORKSHOP

28 & 29 April 2014

Dr. Sajaratulnisah Othman

Assoc. Professor

MBBS, MMeD (Family Med), PhD


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Communication

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Safety

Quality


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UMMC

1,100 beds

50,000 admission per year

883,000 patient visits per year

22,000 operations per year


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Risk

Hazard

Undesirable outcomes

Heavy workload

Lack of confidence

Inexperience of workingin a particular ward

Reluctance to disturb

more senior clinicians

Distractions

Interruptions


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Clinical handover

Safety and quality


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Outline

Dimensions of Clinical Handover?

Why we need it?

How to do it properly?


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Clinical handoverthe transfer of professional responsibility andaccountability for some or all aspects of care for

a patient, or group of patients, to another person

or professional group on a temporary or

permanent basis

[the Australian Commission for Safety and Quality in Health Care and the AMA]


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Transfer patient info

Accountability

Responsibility


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What goes wrong in clinical

handover?

In 458 incidents, the most prevalent failure types:

a)Transfer of patients without adequate handover28.8% (n=132)

b)Omissions of critical information about the patients condition19.2% (n=88)

c)Omissions of critical information about the patients care plan

during handover process 14.2% (n=65)

[Thomas et al. Failures in transition: Learning from incidents relating to clinical handover in acute care.

J Healthc Qual. 2012 Jan 23. doi:10.1111/j.1945-1474.2011.00189]


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Sentinel event

Unexpected occurrence involving death or serious physical

or psychological injury, or the risk thereof.


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Most frequently identified root causes of sentinel

events reviewed by theThe Joint Commission by

year


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Anatomy of poor handover

Failure to standardize

Lack of updated info

Interruptions

Limited access to computers/phone

Missing participants

Limited face-to-face verbal update (no interactive questioning & read-back)

Lack of task prioritization

Limited verification of understanding


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Limited bedside handover

PositiveFrame of reference (eyeballing patient)

Sense of ownership (intro pt to handover doctor)

Negative

Patient anxiety with jargonSensitive issues

Time consuming

Limited access to computer

Over-emphasized privacy and concerns

Patterson et al Int J Qual Health Care 2004

Lee et al JGIM 1996

Petersen et al Jt Comm J Qual Improv 1998

Van Eaton et al J Am Coll Surg 2005

ACSQHC July 2005


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Quality & Safety of Clinical Handover

depends on

Technical skills-procedural specific skills (Content)

Non-technical skills(How?)


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What drives a

good handover?


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Handover principles Lessons in action

Leadership

Task allocation

Predicting & Planning

Discipline & composure

Regular briefings

Maintain situation awareness

Use a checklist

Use technology where possible

Regularly review handover processes


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Models of Clinical Handover

SBAR (Situation, background, assessment, recommendation)

ISOBAR (Identify situation, background, agreed plan, read back)

HAND-ME-AN-ISOBAR

SHARED (Situation, history, assessment, risk, expectation,

documentation)


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SBARSituation-Background-Assessment-Recommendation

S: Situation

Identify yourself

Identify the patient (by name and the reason for your report)Describe your concern


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B: Background

Give the patients reason for admission

Explain significant medical history

Inform the consultant of the patients background: admitting diagnosis,

date of admission, prior procedures, current medications, allergies,

pertinent lab results and other relevant diagnostic tests.


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A: Assessment

Vital signs

Contraction patternClinical impressions, concerns


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R: Recommendation

Explain what you needbe specific about request and time frame

Make suggestionsClarify expectations

HAND ME AN ISOBAR


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HAND-ME-AN-ISOBAR

H Hey, its handover time!

A Allocate staff for continuity of patient care

N Nominate participants, time and venueD Document on written sheets and patient notes

M Make sure all participants have arrived

E Elect a leader

A Alerts, attention and safety

N Notice

I Identification of patient

S Situation and status

O Observations of a patient and call to MET (Medical emergency team)

B Background and history

A Action, agreed plan and accountability

R Responsibility and risk management


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Video show

SBAR:

http://www.institute.nhs.uk/safer_care/safer_car

e/sbar_handover_films.html

Trouble with handover short film:

http://www.institute.nhs.uk/safer_care/safer_care/Situation_Background_Assessment_Recomm

endation.html
http://www.institute.nhs.uk/safer_care/safer_care/sbar_handover_films.htmlhttp://www.institute.nhs.uk/safer_care/safer_care/sbar_handover_films.htmlhttp://www.institute.nhs.uk/safer_care/safer_care/Situation_Background_Assessment_Recommendation.htmlhttp://www.institute.nhs.uk/safer_care/safer_care/Situation_Background_Assessment_Recommendation.htmlhttp://www.institute.nhs.uk/safer_care/safer_care/Situation_Background_Assessment_Recommendation.htmlhttp://www.institute.nhs.uk/safer_care/safer_care/Situation_Background_Assessment_Recommendation.htmlhttp://www.institute.nhs.uk/safer_care/safer_care/Situation_Background_Assessment_Recommendation.htmlhttp://www.institute.nhs.uk/safer_care/safer_care/Situation_Background_Assessment_Recommendation.htmlhttp://www.institute.nhs.uk/safer_care/safer_care/sbar_handover_films.htmlhttp://www.institute.nhs.uk/safer_care/safer_care/sbar_handover_films.html


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Reflections

How effective clinical handover benefits youand your patients?


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clinical handover 250913

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