Authors (including presenting author) :
Chan OF(1), Chiu STJ(1), Cheung SY(1), Lai KKD(1), Lai WSW(1), Lam CM(1), Woo LC(1), Sze YMS (1), Yeung TPP(2), Yuen MY(1)
Affiliation :
(1）Medicine and Geriatric Department, Shatin Hospital
(2）CND, Shatin Hospital
Introduction :
Clinical handover is a communication process whenever patient’s clinical information is transferred. Nurses have accountability to maintain adequate and accurate clinical handover. Hence, patient care and management can be ensured to be continuously followed and without missing. There was a medication incident in 2017 which related to inadequate handover of laboratory result and checking patient identity and caused a dose of syrup KCL given to a wrong patient. Further,there was no easy following framework to guide nurses handover individual patient information between shifts especially for the newly graduated nurses. In order to enhance effective communication during duty handover, two CQI programs for clinical handover were initiated for In-charge nurses and duty nurses respectively.
Objectives :
CQI Program A: Enhance an effective system of duty handover by shift in-charge nurses
(1)To prevent clinical incidents by enhancing roles of in-charge nurses through an effective shift in-charge handover framework.
(2)To enhance In-charge nurse supervisory role of infection control through adequate handover and monitoring (3) To guide in-charge nurses to carry out in-charge nurse duties. CQI Program B: Enhance an effective system of duty handover by shift duty nurses
(1)To ensure the completeness of individual patient’s information transmission during nursing shift handover to maintain continuity of care.
(2) To ensure nurses handover timely and effectively
Methodology :
CQI Program A:
All core items of patient care listed out in March,2018. Two tools: ‘Cue Card’and 'Duty Assignment and Shift in-charge Handover Book' were designed in April, 2018. The ’Cue Card’ is used to guide In-charge nurses to carry out daily duties while the ‘Duty Assignment and Shift In-charge Handover Book’ is used to assign all patient bed nos. to designated duty nurses. In-charge nurses have to assign all patient beds to each shift duty nurses and handover all core items against handover book. The next In-charge nurses have to follow and monitor core patient care thoroughly. CQI Program B:
‘HANDS’ model was adopted to guide nurses to handover individual patient’s information. They are H(History),A (Alert),N (Nursing Intervention),
D( Discharge Plan),S (Spirituality and/ or Social Support).
The ‘HANDS’ model was introduced to nurses by (1) Staff education in Sept,
2018, (2) ‘Clinical Handover Booth’ in the program of ‘Quality Care Carnival’in Oct, 2018.
Result & Outcome :
CQI Program (A)
(1) In-charge nurse’s compliance for duty assignment and handover for all patient care core items to next shift by using ‘Duty Assignment and Shift In-charge Handover Book’ was audited in July, 2018.
(2) 18 samples returned and staff compliance on all handover items was 100%. (3) The clinical incidents related to medication and laboratory results were decreased compared with those in 2017. CQI Program (B)
(1) An audit was conducted to check the compliance of nursing duty handover for individual patient in 2018. (2) 36 samples returned in Medicine and Geriatric wards. The overall compliance was 99.9%.
Co-location with:
