Authors (including presenting author) :
KO YTP(1), TSE KM(1), YEUNG MF(1), CHAN LP(1), WOO MC(1), TANG SW(1)
Affiliation :
Department of Medicine & Rehabilitation, Tung Wah Eastern Hospital (TWEH)
Introduction :
Clinical handover is an important issue to consider when facilitating the continuity of patient care1. Accurate information during handover is crucial to ensure patient safety. Poor or absent clinical handover, or failure to transfer responsibility and accountability, can have extremely serious consequences for patients. It can, for example, result in a delay in diagnosis or treatment, tests being missed or duplicated, and administration of the wrong treatment or medication to the patient1,2. However, variations in the patterns of communication and content during nursing handover have been identified in TWEH, leading to undesirable impacts on clinical handover. Thus, a designated programme, “Clinical Handover Programme” was initiated to facilitate structured clinical handover and ensure safe and high-quality healthcare delivery to achieve better patient outcomes.
Objectives :
1. To evaluate the clinical handover system of the Department of Medicine & Rehabilitation (M&R) in TWEH. 2. To identify areas of improvement in the current clinical handover system 3. To ensure that standardized the clinical handover tools are in place to promote the continuity of patient care. 4. To enhance effective communication amongst multidisciplinary healthcare professionals on the transfer of accountability and responsibility for patient care.
Methodology :
Standardized Clinical Handover Process The workgroup of the Clinical Handover Programme was formed to standardize the clinical handover process, including handover flow, content and tools3 to unify the practices of nurses in different wards. The integrated Nursing Reminder” was also developed to strengthen communication amongst nurses and ensure the continuity of care. The handover flow was redesigned to minimize the distractions during handover. Training on Clinical Handover A Clinical Handover workshop was organised for all M&R nurses in TWEH. Good handover practices, the new handover flow and rearranged work patterns were illustrated to facilitate effective and efficient transition of patient care information. A training video and materials were also uploaded to the M&R web for the nurses’ easy reference. On-site Clinical Handover Supervision Periodic Clinical Handover supervision was performed by nurse supervisors with frontline nurses to strengthen their handover process and practices. Supervision mainly focused on nursing handover of patient management and continuity of care, so that proper, clear, concise and comprehensive clinical handover is ascertained and unified.
Result & Outcome :
Some progresses were observed after implementation of the Clinical Handover Programme. The overall time spent on handover significantly decreased from 45.71 minutes to 36.75 minutes, and consensus on the clinical handover of patient’s information/treatment plan increased in consistency from 4.1% to 25%. Standardized clinical handover tool use improved from 50% to 83.33%; however, only a 16.67% improvement in distractions during handover was recorded, due to the constant transfer of patients to and from the radiology and physiotherapy departments for simultaneous investigation and treatment. Overall despite agreeing on the need to improve the workflow change during handover, 84.90% of the nurses were satisfied with the developed programme. THE WAY FORWARD: Since nurses are accountable and responsible for all aspects of care delivered, quality nursing handover is very essential to the whole patient care process4,5. Handover reflects effective communication amongst multidisciplinary healthcare profession on the transfer of accountability and responsibility for patient care. Thus, regular handover supervision with implementation of suggested improvement strategies should be continued to ensure the high quality of clinical handover.
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