Monday, May 14, 2007

Shift handover in the NHS

Publication from the BMA has some useful information about shift handover that may apply to industry. (I think it ironic that a 38 page document is used to discuss good communication, but I guess that is how things work in the NHS).

It makes the point that good handover does not happen by chance. It requires work by all those involved (organisations and individuals):
* shifts must coordinate
* adequate time must be allowed
* handover should have clear leadership
* adequate information technology support must be provided.

Sufficient and relevant information should be exchanged to ensure patient safety:
* the clinically unstable patients are known to the senior and covering clinicians
* junior members of the team are adequately briefed on concerns from previous shifts
* tasks not yet completed are clearly understood by the incoming team.

Handover is of little value unless action is taken as a result:
* tasks should be prioritised
* plans for further care are put into place
* unstable patients are reviewed.

The document includes a list of handover pitfalls, including:
* Giving verbal handovers at the same time as the team taking over the patient’s care are setting up vital life support and monitoring equipment - valuable information will be lost. The importance of written handover information must be stressed.
* Roles and responsibilities are not always clear during handover and this can lead to omissions.
* Checklists and written updates are important and often under-utilised. When such information is incomplete or omitted it has a knock on effect of increasing the
workload of the staff who have taken over the patient's care because they have to spend a significant proportion of time chasing information.
* It is important that nursing staff are made aware of critical features in the medical management of a patient that will affect care during the next shift.
* Fragmentation of information at the point of handover is a major problem. It is important to avoid multiple concurrent conversations between individuals and let one person (a nominated lead) speak at a time to everyone. This reduces the opportunities for conflicting information to be given.
* Handover is a two way process. Good handover practice is characterised by the team who are taking over the patient’s care asking questions and having the opportunity to clarify points they are uncertain of. They should not be passive recipients of information.

This document gives some practical examples of how handover is being dealt with in NHS holspitals.

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