Enhancing Patient-Centered Care by Transforming Clinical Handover at Bedside

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Authors (including presenting author) :
Lee MH, Lau CM, Lee PC, Chow KM, Chan MK, Ng LK
Affiliation :
Department of Surgery, Ruttonjee & Tang Shiu Kin Hospitals
Introduction :
Introduction Clinical handover is a routine of nursing communication during shift handover that plays a pivotal role in patient safety and quality agenda in daily practice. In existing practice, nurses conducted handover at nursing station away from patients. Re-engineering the operation procedure of shift changing at bedside by using ISBAR approach and patient-centered of care. Then, implementation of environmental and equipment safety scan checking which including cardiac monitoring, epidural infusion and PCA,IVAC drip rate, tube and drain securing. Aims to provide safe care and safe environment. Besides, it provides opportunities for patients contribute to their plan of care that enhances patients’ cooperation and may help to reduce length of stay.
Objectives :
Objectives 1. Develop a standardize approach for clinical handover at bedside. 2. Promote situation awareness and patient centered of care 3. Help to mentor junior staff and new comers 4. Improve patient and staff safety 5. Engage patient about their treatment and care plan
Methodology :
Methodology 1. Conduct observational audit to review existing practice 2. Set up a workgroup with different representative 3. Discuss among ward staff to obtain their opinion and consensus 4. Review literatures to gain evidenced support for implementation of change 5. Identify the barriers and improvement area 6. Develop the ISBAR Handover Prompt card and Bedside shift report 7. Prepare scenarios and conduct staff education on bedside clinical handover 8. Implement bedside clinical handover from Am shift to Pm shift 9. Collect patient satisfaction and staff opinion survey and ward KPI
Result & Outcome :
Results 1.KPI Fall incident rate decreased-Before the program-0.4, After the program-0 Pressure injury rate same- Before the program-0, After the program-0 Medication Incident rate- Before the program-0.2, After the program-0 2.Staff opinion survey Most of staff agreed that bedside clinical handover can obtain patients' the most updated condition and patients can understand their on- going treatment &care plan. In addition, increase awareness of patients’ risks and establish rapport with patients. 3.Patient satisfaction survey- Collect 40 patients data All patients are welcome clinical handover at bedside. It enhance communication and establish rapport between patients and nurses, also helpful for recovery. Conclusion Nurses agreed that patients' overall condition and risks are easily observe during handover. Their main concern is the increase of interruptions and distractions during bedside clinical handover. On the other hand, patients are welcome handover conducted at their bedside, as an opportunity for better understanding of their diseases and on-going treatments. In view of benefits, further modification of workflow and enhancement of nurses’ communication skills may be helpful to sustain the program.

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