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Clinical handover

Clinical handover is a vital event in nursing practice and hospitals and occurs at different times and settings. It involves transfer of professional responsibilities and accountability for care of groups of patients temporarily or permanent situations. Hand over occur in hospital corridors, over coffee, at patients bedsides, in ward rounds or in meeting rooms. Proper communication and explanation of handed over responsibilities is better done on face-to-face styles where handovers are schedule between doctors in formal shift changes

Title: Clinical handover critical review

Abstract

            Clinical handover is the responsibilities transfer as well as accountability from clinicians to patients, as well as caring for them. Although it is beneficial to the patients by prolonging their life, is a risky event of communication in hospital practices. As a result, Australia departments of health and management of hospitals have established standard protocols for use during hand over processes.

            The paper concentrates on ISBAR tool as an introduced protocol and finds its problems that may affect proper handover practices. It analyzes audio-recorded shift-change clinical handovers conducted between clinicians. The paper identifies various modes of communication that lead to poor handover. It explains the importance of concentrating on proper open communications. In addition, the paper stresses on safety and quality of interaction sin healthcare organizations. Qualitative methodology with Semi-structured observations and interviews conducted on clinicians on duty and incoming. Iterative review analyzed observed data by research team members. Content analysis analyzed interviews. Results indicated that although ISBAR tool is effective it concentrates on the outgoing nurses without giving room for incoming nurses to give their suggestions. As a result, various modifications require to be done on ISBAR tool as well as establishment of other more efficient tools.

Phenomenon of interest

The study aims to evaluate proper face-to-face communication during scheduled handovers in doctors shift-to-shift practices.

Structuring of the study

Research questions

Do various interactional practices affect negatively or positively the effective nature of clinical practices. Moreover are there additional overhead costs in relation to such practices.

Design

The paper shows interdependence between interactional and informational dimension aimed at achieving effective handovers. In addition, the paper gives suggestions on strategies that clinicians could use to effectively handover. The major argument is that improvement in communication during handover will occur after handover is perceived as an inherent interactive practice and the consequences of the interaction permitted to mediate in handover processes, trainings, protocols, and practices.

Participants

Participants of the study included junior medical officers and medical registrar in an Australian public hospital. Data collection team was from the University of Technology Sydney (UTS) and funded by state health department and UTS. The main purpose of the study was to investigate the effectiveness of ISBAR protocol by junior medical officers in an Australian hospital. There were prior trainings, encouragements done by the team to the officers.    

Background

            Importance of clinical handover process

            Handover process ensures efficient communication of higher quality in clinical information and transfer of responsibility for patient care. It assists in prioritization of tasks, enables planning for future care and their management, and ensures that unstable patients are attended in a timely manner. Moreover, unstable patients are reported to the senior clinicians on time. In addition, junior team members are briefed adequately on previous shifts and the incoming teams properly understand incomplete tasks.

            Significance of the study

            The study on scheduled handovers was done because of the high nature of risk present when changing responsibilities of patients among clinicians. In addition, there was the urge to improve on the area to better care given by clinicians in hospitals. Lastly, shift changing and handover of patient care often leads to discontinuity of care, malpractice, and greater adverse effects (Bost et al., 2012). Such factors may be caused by lack of enough to effectively communicate the care being passed over and enough space left for such vital tasks. Frequent nurse interruptions are the greatest cause of careful handover practices. As a result, most nurses have expressed problems with handover practice.

 ISBAR communication protocol

            ISBAR protocol of communication outlines various stages that exchanging clinical officers have to follow and help the incoming nurses on duty to understand. The protocol requires the outgoing nurse to identify himself or herself, give the situation of the patient, age and other important aspect. In addition, the nurse is asked to explain the background of the present problem, assess the patient present condition, and state the risks and urgent needs (Pascoe, 2014). Finally, the nurse should offer recommendations for patient care by outlining the treatment plan supposed. The protocol could assist in use of proper communication strategies when conducting handover procedures. However, few nurses practice the protocol due to lack of enough time space to pass enough information to incoming nurses. In addition, factors such as culture and institution as well as language barrier contribute to reluctant nature of its uptake.

            Language

            Most nurses complain that they always get incomplete and unstructured information. A study conducted on handovers from emergency departments in 2007 indicates 15.4% cases transferred inadequate information, which resulted in adverse events (Eggins and Slade, 2012) There were omissions in pending tests, medications, and active problems. Moreover, there lacked proper face-to-face discussions on the ommitions.as a result the incoming clinicians found it difficult to take over care of patients. 95% of the nurses did not believe in formal handover processes (Eggins and Slade, 2012). The rest complained of a lack of structured and consistent approaches of handovers from emergency departments and ICUs. Language was a barrier to record protocol offered due to lack of a collaborative social activity (genre) passed through language.

            ISBAR protocol has two limitations in that it is momologic in nature. First, it concentrates on the contribution of the person handing over while no space to indicate the role of the person taking over the roles. Secondly, it majors on the informational handover content without considering interactive communication dimensions (Jones, 2010).

Methodology

            A team from the University Technology Sydney (UTS) conducted a survey on uptake and communication effectiveness of handover ISBAR protocol offered to medical officers in an Australian Public Hospital. Prior to the survey, clinicians had undergone training and encouragements to appreciate the use of handwritten handovers. A qualitative methodology was conducted through audio recording of ten handover events that involved shift changing. The findings were transcribed and de-identified (Mark et al., 2014). There were doctors in each event who handled over four to eight patients to the other incoming team. The discussion involves two extracts from one morning shift handovers. The extracts represent different types and ranges of communicative behavior recorded in the hand over corpus. In addition they can be used to shed light on communication behavior since they show contrasting ways of managing handover interactions.

Data collection

            Semi-structured observations and interviews were conducted on clinicians on duty and incoming. Patients were included in the data collection procedures to get their perspectives. Audiotaped in depth interviews were conducted together with inclusion of purposive sampling in the handovers (Wood et al., 2014). Questions majored on issues related with communication in the handover processes and the perceived outcomes.

Data analysis

            Iterative review analyzed observed data by research team members. Content analysis analyzed interviews which involved grouping of data around central and recurring ideas (Farhan et al., 2012). The analysis was iterative in that team members examined the interview data in a recursive way in search of similarities over all cases. Identical ideas were grouped into processes, structures as well as perceived outcomes.

Findings

            The team found that communication on emergency departments was frequently interrupted as clinician competed for attention. The levels of noise were high and time pressure was extreme. There were interactions between patients and clinicians and among senior and junior clinicians. Nurses were interrupted by their mobile phones making them play no care or obligation at all. Others have a shared conversation at one time in the shift (Arain et a., 2010). The interruptions brought unprepared handovers since they lacked proper attention.

            Although most nurses are present during the handover, few are absent and inactive at the time. A large number of doctors use a monologue style of handing over, through use of fluent communication style and confidence. In addition, they take handover process serious and avoid any interruptions. Other uses the structured presentation such as ISBAR protocol to record clinical information logically (Chaboyer, 2011).

            A larger proportion of outgoing nurses records the present situation of their patient in a hurry without being concise with the information given. Nurses reporting in exchange check the provided information and seek clarification of the location of the patient, procedures to be taken, advice and implications. Such clinicians are not confident of their work and assertive on their roles.

Conclusions

            The team concluded that most nurses bury important events that should have been done on the patients in the handover process. Other do not offer follow up statements on the outcomes. As a result, they give wrong recommendations for ongoing care. Other s provide tentative and vague care due to lack of knowledge in facts establishment process. Lack of confidence and poor presentation of information causes the incoming nurses to rely of dialogic elicitation through other interact ants. In addition, poor communication and interaction skills deteriorate relationships at work.

Management in turn taking

            Institutions require strict handover processes that are specific on context and ones that allows interactions other than casual communications. The handover protocols for use should focus on the goals of the organization, accountability, and responsible patient care. Communication skills that help a clinician give a stronger handover

            A strong handover should involve nurses who are assertive to retain the floor. The handing over nurse should introduce the patient and ensure that they have handed responsibilities and attention to the nurses in the next shift. They should use expressions and signals in their communications (National clinical guideline, 2014). They should avoid frequent hesitations and hold their breath to deliver proper information. In addition, they should be fluent in their delivery of information. Proper information skills require that before end of handover process the nurse should clarify the name and location of the patient, diagnosis, and recommendations on the patient. All nurses should ask for clarifications on the information offered.

Recommendations

            ISBAR protocol assists outgoing clinicians in structuring information, thus offering useful tools for junior staffs. However, clinicians require to be trained on multi-party interactions to achieve effective purposes during the clinical handovers. Moreover, they should engage in benchmarking activities. Australian Commission on safety and quality in healthcare (2012) recommends development of underpinning policies and procedures that ensure present clinical handover that is active in various levels within the organization.

References

Wood, K., Crouch, R., Rowland, E., & Pope, C. (2014). Clinical handovers between pre-hospital             and             hospital staff. Literature Review. Emergency medicine journal, 10(1136), 1-16.

Mark, S., Spurgeon, P., Kim, M., Rudd, M., & Fitton, L. (2014).clinical handover within the emergency care pathway and the potential risks of clinical handover failure (ECHO): primary         research. Health services and delivery research, 5(2), 1-170.

Anderson, J., Malone, L., Shanahan, K., &Manning, J. (2014). Nursing bedside clinical handover-an integrated review of issues and tools. Journal of clinical nursing, 24(5-6), 1-10.

Bost, N., Crilly, J., Patterson, E., &Chaboyer, W. (2012).Clinical handover of patients arriving by ambulance to a hospital emergency department: A qualitative study. International emergency nursing, 3(20)133-141.

Machaczek, K., Whitefield, M., Kilner, K.,&Allmark,P.(2013).doctors and nurses perceptions of barriers to conducting handover in hospitals in the Czech republic.American journal of nursing research,1(1),1-9.

Australian Commission on safety and quality in healthcare. (2012).Safety and quality improvement guide standard 6: clinical handover. Sydney.

Chaboyer, W. (2011). Clinical handover. Griffith University, 1-23.

Eggins, S. & Slade, D. (2012). Clinical handover as an interactive event: informational and interactional communication strategies in effective shift-change handovers. Communication and medicine, 9(3), 215-227.

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