Dr. Dorothy Breen FFARCSI, FCICM, FJFICMI, MD Consultant in intensive Care, Cork University Hospital Director of Education, ASSERT, University College Cork

Acknowledgements All the patients and staff who participated in the qualitative research

All those who provided feedback Members of the GDG

Ms Eilish Croke, Co-Chair, Ms Celine Conroy, Project Manager, Dr. Colm Henry, National Clinical Advisor, Group Lead Acute Hospitals, HSE (GDG Sponsor) Ms. Emma Benton, Therapy Professions Advisor & Portfolio Manager (Diagnostic/Support Services), Clinical Strategy & Programmes, Dr. Katherine Browne , Forum of Irish Postgraduate Medical Training Bodies - trainee nominee (surgical SpR), Ms. Claire Browne, National Clinical Programme for Paediatrics and Neonatology, Prof. Garry Courtney, NCL, National Acute Medicine Programme, Dr. Eva Doherty, Director of Human Factors and Patient Safety RCSI, Prof. Gerard Fealy, Associate Dean for Research and Innovation UCD, Dr. John Fitzsimons, Paediatric & Neonatology Programme, Quality Improvement Division, HSE, Ms. Maureen Flynn, National Lead Clinical Governance Development, Ms. Noelle Gallery, Front line clinical nurse representing children’s hospitals services, Ms. Mary Godfrey, Clinical Risk Adviser, State Claims Agency, Dr. Miriam Griffin, Faculty of Pathology, RCPI, Mr. Macartan Hughes, Head of Education & Competency Assurance, National Ambulance Service, Ms Catherine Killilea, Area Director, NMPDU, HSE South, Ms Tanya King, IADNAM Representative, Director of Nursing (Mater Misericordiae University Hospital), Mr Louis Lavelle, NAMP Programme Co-ordinator, Dr. Gerry McCarthy, Emergency Medicine Programme, Consultant in paediatric emergency medicine, Professor Eilis McGovern, Rep from trainees division RCPI (HR), Ms. Colette Murray, Front line clinical nurse representing acute hospitals, Dr. Alan Moore, Consultant in Geriatric Medicine in Beaumont Hospital, Forum of Irish Postgraduate Medical Training Bodies -consultant nominee, Ms. Bridie O’Sullivan, Chief Director of Nursing and Midwifery – representing Group CEO, Dr. Michael Power, NCL, Critical Care Programme, Ms. Melissa Redmond, Patient/Service user Representative, Dr. Anthony Ryan, Chair of the Quality and PCS committee of the Faculty of Radiologists, RCSI, Prof. Oscar Traynor, National Clinical Programme for Surger, Ms. Angela Tysall Open Disclosure, Project Manager National Advocacy Unit, Quality Improvement Division, HSE, Ms. Kathleen Wals, Professional Officer, Standards of Practice and Guidance, NMBI, Dr. Margo Wrigle, National Clinical Programme for Mental Health

3

The importance of communication

What is Clinical Handover?

“The transfer of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another person or professional group on a temporary or permanent basis” BMA 2004

Why do we need to change?

Several drivers…. •Patient Safety

•Change in work patterns •Coroners reports

•Increasingly complex patients and treatments

NCEPOD -2009 Review of patients in the UK who died < 4 days after admission

State Claims Agency Closed Claims- Root Cause Analysis 2012

Why do we need to change?

Handover of care is “one of the most perilous procedures in medicine…and can be a major contributory factor to subsequent error and harm to patients….its importance is escalating with the requirement for shorter hours for doctors and an increase in shift patterns of working” Professor Sir John Lilleyman, Medical Director, National Patient Safety Agency (NHS 2004)

“an opportunity that could be optimised to enhance patient safety“ (DOH 2014)

Why do we need to change? Clinical Handover “bundle” across 9 paediatric sites •10, 740 medical admissions before/after bundle implementation •Bundle – introduction of standardised mneumonic, handover training, faculty development and sustainabilty programme •23% reduction in the rate of medical errors (24.5 vs 18.8/100 admissions p<.001)

•30% reduction in the rates of preventable adverse events (4.7 vs 3.3/100 admissions p<.001) NEJM 2014; 371: 1803 -12, Starmer et al

Clinical Handover

• Shift-to-shift • Interdepartmental • Deteriorating patient

Shift and Interdepartmental Handover General Recommendations

Clinical Handover should • Be face to face (where possible) • Be supported with relevant up to date information • Be a two way process • Aim to involve the patient/guardian/carer if appropriate • Take priority over over all other work except emergencies • Be conducted using the ISBAR 3 tool customised to the local

context of the ward, unit or department

Communication Tool- Shift Handover

Communication Tool- Inter-departmental Handover

Shift to shift Clinical Handover Recommendations

• Designated time • Designated space • Designated staff

– Junior and senior staff – Nominated lead to manage the handover – Multidisciplinary

The Deteriorating Patient Communication Tool

Education and Training Recommendations

• Mandatory education and training using a variety of techniques including workshops and simulation

• Incorporate human factors training • Part of orientation and ongoing in-service • Higher Education Institutions providing professional education

should include Clinical Handover training as above in their curricula

Governance Recommendations

• National Implementation Group should be established to support Guideline Implementation in Acute Hospitals

• Health care institutions – Review Clinical Handover policies in relation to attendance, roles and

when transfer of responsibility occurs – Lead Clinician within the institution – Audit practices, recognise Clinical Handover on risk register – Provide infrastructure- space, electronic supports etc – Education and Training

THANK YOU

“Where the knowledge required exceeds that of any individual and unpredictability reigns-efforts to dictate every step from the centre will fail. People need room to act and adapt. Yet they cannot succeed as isolated individuals. They require a seemingly contradictory mix of freedom and expectation” Atul Gawande