Weekend Medical Handover Audit at Dorset County HospitalDr S. Haque, Dr K. Lees, Dr A. Melia

BackgroundRoyal College of Physicians guidelines state the following as the minimum information required in all handovers 1:

Date Patient name, DOB and hospital number Current location For discharge over weekend? Consultant team Diagnosis / Problem list Reason for handover Aims / limits of treatment Task to be done Name + bleep of Dr handing over

Poor medical handovers at the weekend may lead to:

Inaccurate clinical assessments Delayed re-assessment/diagnoses Medication errors (e.g. warfarin) Poor progress over weekend Delayed dischargesAdverse consequences including death 2

MethodThis audit was conducted at Dorset County Hospital, which is a 400 bed district general.

The initial audit was conducted to assess how well weekend medical handover proformas were being completed, and whether they met the RCP standards, as set out above.

Based on results of the initial audit, modifications were made to the existing proforma. This was to prompt doctors to provide all the necessary information to comply with RCP guidelines.

This new proforma was promoted within the trust via a poster scheme and formal teaching sessions.

A reaudit was carried out three months later.

Previous Proforma Modified ProformaPublicity

Results & Conclusions

Initial audit of the existing proforma showed that 62% of the minimum information set out by the RCP was included on the medical handovers at Dorset County Hospital. After modification of the proforma 74% of the RCP minimum information on the medical handovers was included. The most striking improvements were shown in; inclusion of date of handover, Junior Doctor’s name and bleep number, Consultant in charge, plans for patient discharge, and aims/limitations of treatment.Overall there were improvements in all areas except patient name which was filled out on 100% of the existing and modified proformas.

References

The Future...

Limitations

Proforma now available on the local intranet.Incorporating medical handover training in the FY1 Teaching programme.Explore the use of electronic handovers in the future which should be time and cost effective. 3

Re-audit the new proforma once more to ensure standards continue to be met.

Not everyone was using the new proforma. (Exclusion criteria for re-audit was use of the existing proforma). Poor accessibility; proformas not available on the intranet. Resistance to change.

1) Royal College of Physicians Handover Referencewww.rcplondon.ac.uk/pubs/handbook/gpt/gpt_handbook_app4.htm2)Department of Health Expert Group (2000) Organisation with a memory. London:Department of Health.3)Young R, Horsley S & McKenna M (2000) The potential role of IT in supporting the workof junior doctors. The Journal of the Royal College of Physicians of London 34: 366-70.4)Medical Handover App: www.medicalhandover.com Accessed July 2011.

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Date Patient Name DOB Hospital number Ward Discharge over weekend? Consultant/ Team Diagnosis/ Problem list Reason for handover Aims/limitations Tasks to do Dr's name Bleep #

Previous Proforma Modified Proforma

How the changes were made...

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