The EPIC Project (Excellent Practice in Communication) Nursing Clinical Handover Practices:

A Best Practice Implementation Project.

Kylie Wright Quality & Accreditation Manager on behalf of the CNC Research Group

Liverpool Hospital Falls Prevention Network Forum 20th May 2016

Clinical Handover

The nursing handover normally occurs at the beginning of a nurse’s shift and is considered an important nursing ritual and essential for continuity of care.1-8

Clinical communication problems are a major contributing factor in 70% of hospital sentinel events leading to an increased risk for adverse events.13

Clinical Handover

Standard 6

Best Practice Implementation Project

•Audit of nursing clinical handover practices

•Implement evidence based practice recommendations

•Increase staff compliance with nursing clinical handover best practice recommendations

The Joanna Briggs Institute

The International Research and Development arm of

the School of Translational Science based within the

Faculty of Health Sciences at the

University of Adelaide.

JBI Best Practice Recommendations Nursing Clinical Handover

4 x observational studies

2 x systematic reviews

2 x observational studies

1 x prospective pre/post interventional clinical study

6 x non-analytic studies or articles based on expert opinion

1 x guideline

Methods

Phase 1 - A baseline audit was conducted measuring 7 best practice recommendations

Phase 2- Implementation of targeted strategies

Phase 3 - A follow up audit.

7 Criteria Best Practice

Recommendations

Phase 1 -Baseline audit

Audit Criteria (7)

1. Verbal (face to face) communication has occurred 2. Standardised documentation has been used 3. The patient has been identified 4. Relevant History of the patient has been stated 5. Detailed observations of the patient have been

stated 6. The handover process includes an agreed plan of

care for the patient 7. Transfer of responsibility of the patient from

one nurse/shift to another nurse/shift has occurred

Criteria 1 Verbal (face to face) communication has occurred This criteria is deemed met if:-

• The handover has occurred at the bedside in the presence of the patient (and family members if applicable).

• The nurse/s from the concluding shift must communicate face to face to the nurse/s on the preceding shift

• Engage in discussion about care coordination with the patient/family members in a face to face manner.

Criteria 2 Standardised documentation has been used This criteria is deemed met if handover has been delivered using standardised documentation including one of the following: • electronic nursing handover tool • ISBAR • pVITAL • clinical pathway • NICU handover tool & flow chart • Emergency flowchart • ICU flowchart

Criteria 3 The patient has been identified

This criteria is deemed met if:-

• the patient’s full name has been stated clearly in the handover communication and the patient’s identification (ID) band has been checked.

Criteria 4 Relevant History of the patient has been stated

This criteria is deemed met if the reason for hospital admission and relevant medical/clinical history has been clearly stated. This must include: • Presenting symptoms/events on admission and

provisional diagnosis • A brief synopsis of treatment to date / test results

– including recent MET & CRC calls, Falls etc • Relevant medical history and co-morbidities

Criteria 5 Detailed observations of the patient have been stated

This criteria is deemed met if:-

• reference to the patient’s vital sign status, frequency and relevant observations have been stated

• bedside observations charts are checked together

* Falls Risk Assessment

Criteria 6 The handover process includes an agreed plan of care for the patient This criteria is deemed met if:-

• the nutritional status is mentioned

• the care required for the following shift is clearly described, and

• assessments / tests/ procedures / medications / documentation

• This included falls prevention strategies /

FRAMP

Criteria 7 Transfer of responsibility of the patient from one nurse/shift to another nurse/shift has occurred

This criteria is deemed met if

• time has been provided to clarify and ask any questions (nurse and/or patient, parent, family member) and

• the nurse/s receiving handover accepts responsibility and accountability for care.

Phase 2 - Implementation of targeted strategies

• Identify barriers underpinning the gap between actual practice and best practice

• Implement tailored strategies

Phase 3 – Follow up phase

• Identify improvement in compliance with best practice

• Establish if improvement (if any) had been sustained

• Identify remaining areas of improvement

No variations to criteria, sample size, characteristics

or location

Conducted over a 4 week period

Approval by SWSLHD Research Ethics Committee

RESULTS

Results Phase 1 – Baseline Audit

Results Phase 2 – Interventions

Clinical Handover Education Bundle

•Video

•Posters listing the 7 criteria

•Lists for bedside notes

•ID cards

•Generic PowerPoint presentation

•Ward handover champions

(worked with Falls Champions)

Video – Incorrect vs Correct Handover

https://youtu.be/Rn6r_hFWP0Q

Results Phase 3

Follow-up Audit (6 months)

There were improved outcomes in the follow up audit.

Discussion

Incorrect vs Correct

handover video

Governance

Consumer participation

Conclusion •Clinical communication problems are a major contributing factor in hospital sentinel events.

•The findings showed how audit may be used to promote best practice and that focussed education can have an immediate impact on clinical practice.

•Some criteria measured did not improve to a great degree leaving plenty of room for improvement sustainability audits

•Transferable to multidisciplinary clinical handover

practices

No conflicts of interests to declare

The research team Kylie Wright, Q&AM Craig Wainwright, CNC Amanda Chapman, CNC Cecilia Astorga, CNC Charmaine O’Connor, CNC Kelli Flowers, CNC Louise Smith, CNC Nevenka Francis, CNC Tanghua Chen, CNC Anna Thornton, DN&MS Gia Vigh , Librarian Ros Sleeman, Consumer Representative

Kylie Wright, Quality & Accreditation Manager

Liverpool Hospital Kyliem.wright@sswahs.nsw.gov.au

References

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2. Evans AM, Pereira DA, Parker JM. Discourses of anxiety in nursing practice: a psychoanalytic case study of the change-of-shift handover ritual. Nurs Inq. 2008;15(1):40-8. (Level IV)

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2004;12(1):37-42. (Level IV) 6. Davies S, Priestley MJ. A reflective evaluation of patient handover practices. Nurs Stand. 2006;20(21):49-52. (Level IV) 7. Hopkinson JB. The hidden benefit: the supportive function of the nursing handover for qualified nurses caring for dying

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2010;8(4):121-172. (Level I) 11. Wong MC, Yee KC, Turner P. Clinical handover literature review. eHealth Services Research Group, University of Tasmania,

Australia. 2008 (Level IV) 12. Australian Commission on Safety and Quality in Health Care . The OSSIE guide to clinical handover improvement. Sydney,

ACSQHC. 2010 13. ACSQHC. Safety and Quality improvement guide Standard 6 – Clinical Handover. Australian Commission on Safety and

Quality in Health Care. 2012. 14. Clinical Handover-Standard Key Principles Policy Directive 2009_060, New South Wales Ministry of Health 2009 15. SWSLHD Clinical Handover Policy Document Number SWSLHN_PD2011_007, South Western Sydney Local Health

Network, 2011.