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  • ROYAL HOBART HOSPITAL

    National Clinical Handover Initiative:

    Nursing and Medical Handover in General Surgery, Emergency Medicine and General Medicine at the Royal Hobart Hospital

    Overarching

    Standardised Operating Protocol (SOP)

    Submitted to:

    September 2008

  • 2

    Acknowledgements • The Australian Commission on Safety and Quality in Health Care for funding the

    collaborative RHH-UTAS Clinical Handover Project at the Royal Hobart Hospital.

    • Dr Christine Jorm for her intellectual contribution to the draft standardised operating protocol framework.

    • Staff from the Royal Hobart Hospital and University of Tasmania for their support in the

    Clinical Handover Project

  • 3

    Table of Contents 1 Introduction .......................................................................................................7

    1.1 Project Background ....................................................................................7 1.2 Project Aims ...............................................................................................8 1.3 Frameworks................................................................................................9

    1.3.1 User-centred frameworks.................................................................9 1.3.2 Adult educational theory.................................................................10 1.3.3 Iterative feedback frameworks .......................................................10

    1.4 Local considerations.................................................................................11 1.5 Tools and guidance..................................................................................12 1.6 Time-resource considerations ..................................................................14 1.7 Establishment of a team...........................................................................16

    2 Preparation phase...........................................................................................17 2.1 Objectives.................................................................................................17 2.2 Issues for consideration ...........................................................................18

    2.2.1 Context of handover.......................................................................18 2.2.2 Process of handover ......................................................................20 2.2.3 Content of handover.......................................................................21

    2.3 Frameworks and techniques ....................................................................26 2.3.1 User-centred process.....................................................................26 2.3.2 Observations ..................................................................................26 2.3.3 Interviews .......................................................................................27 2.3.4 Content analysis.............................................................................28 2.3.5 Professional development and skill development ..........................28

    2.4 Local considerations.................................................................................28 2.4.1 Preparation techniques ..................................................................28 2.4.2 Time frame .....................................................................................29 2.4.3 Resources requirements ................................................................29 2.4.4 Skill mix and training ......................................................................29 2.4.5 Academic rigor versus practicality..................................................29

    2.5 Tools and guidance..................................................................................29 3 Design phase...................................................................................................36

    3.1 Objectives of this phase ...........................................................................36 3.2 Issues for consideration ...........................................................................37

    3.2.1 Process flowchart...........................................................................37 3.2.2 Process tools..................................................................................37 3.2.3 Content: through minimum data set adaptation .............................38 3.2.4 Information tools.............................................................................38 3.2.5 Education and training program .....................................................39

    3.3 Frameworks..............................................................................................40 3.3.1 User-centred framework.................................................................40 3.3.2 Iterative feedback framework .........................................................40 3.3.3 Adult educational theory.................................................................40

    3.4 Local considerations.................................................................................41 3.4.1 Design technique and end-users involvement ...............................41 3.4.2 Time frame and iterative cycles .....................................................41 3.4.3 Resources requirements ................................................................41 3.4.4 Skill mix and training ......................................................................41 3.4.5 Theoretical Design arguments versus practicality..........................42

    3.5 Tools and guidance..................................................................................42

  • 4

    Table of Contents (cont) 4 Implementation phase ....................................................................................48

    4.1 Objectives of this phase ...........................................................................48 4.2 Issues for consideration ...........................................................................49

    4.2.1 Project implementation team..........................................................49 4.2.2 Project implementation work plan ..................................................50 4.2.3 Risk registry and risk management strategies ...............................51 4.2.4 Pilot testing.....................................................................................52 4.2.5 Spread methodology ......................................................................53 4.2.6 Communication and engagement plan ..........................................54 4.2.7 Inter-disciplinary, inter-departmental continual learning strategy...55

    4.3 Framework ...............................................................................................56 4.3.1 Iterative feedback framework .........................................................56

    4.4 Local considerations.................................................................................56 4.4.1 Alignment with the organisational strategic plan ............................56 4.4.2 Time frame .....................................................................................56 4.4.3 Resources requirement and allocation...........................................56 4.4.4 Skill mix and training ......................................................................57 4.4.5 Evidence-based debate versus practicality....................................57

    4.5 Tools and guidance..................................................................................57 5 Evaluation phase.............................................................................................65

    5.1 Objectives of this phase ...........................................................................65 5.2 Issues for consideration ...........................................................................66

    5.2.1 Evaluation framework.....................................................................66 5.2.2 Pre-implementation and post-implementation consideration .........66 5.2.3 On-going analysis during the implementation phase .....................66 5.2.4 Evaluation content..........................................................................66 5.2.5 Evaluation techniques ....................................................................67 5.2.6 Evaluation plan...............................................................................67 5.2.7 Dissemination of evaluation data ...................................................67

    5.3 Framework ...............................................................................................68 5.3.1 Iterative feedback framework .........................................................68

    5.4 Local considerations.................................................................................68 5.4.1 Alignment with local needs.............................................................68 5.4.2 Time frame .....................................................................................68 5.4.3 Resource requirements and allocation...........................................68 5.4.4 Skill mix and training ......................................................................69 5.4.5 Traditional evidence-based concept vs iterative outcome concept69

    5.5 Tools and guidance..................................................................................69 6 Maintenance phase .............

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