In a clinical setting, the term “handover” may be used interchangeably with shift change, handoff, sign out, cross coverage or shift report.
According to Australian Medical Association (2006), clinical handover refers to 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.
Handover report (verbal and written) is a tradition in Nursing profession that must be sustained and emphasized from time to time. It is worthy of note that handover report must be communicated verbally alongside a well written documentation of the report (written). And one must not contradict the other. This usually takes place at the end of every shift or during patient transfer.
A good handover is centered on enhancing continuity of patient’s care and ensuring patient’s safety. The link/connection is that continuity of clinical information is vital to patient’s safety, hence a need to be deliberate and proactive about it.
Clinical nursing handover must be seen beyond just the transfer information, but also as the transfer of responsibility and accountability of patient’s care from the outgoing nurses to the incoming nurses. Thus, effective communication is a sine qua non to attaining a good handover practice. And effective communication in turn helps in the delivery of high quality care and ensures patient’s safety.
Evidence shows that ineffective shift handover increases the risk of medication error and sentinel events, delays the course of treatment, decreases patient satisfaction, prolongs the length of hospital stay, thus increases expenditure.
The nurse, being a major stakeholder in the healthcare team, is saddled with the responsibility of mastering the dynamics of effective communication in passing across vital clinical information about the patients to her professional colleagues as well as other professionals in the healthcare team involved in patient’s care.
It is important to note that the group of nurses who are just resuming duty do not know what has happened in the previous shift. Hence, a need to be proficient in communicating and transferring clinical information in a clear, simple and unambiguous manner. Rapt attention is needed so as not to miss out on the information being passed across. Handover time must be seen as sacrosanct for all nurses because it determines how the subsequent shift would go. Incomplete tasks that need to be completed, treatment plan that is yet to be executed, investigations that must be carried out, medications that have been discontinued, patients that have been discharged – these and many others are communicated during handover.
Handover report must be detailed yet concise. The nurse must avoid beating about the bush. A well structured tool (such as ISoBAR and the likes) must be devised to help cluster and organize information to be passed on. The nursing process is another very good tool that enhances a structured handover report, as it gives a step by step (systematic) approach to the report being given and helps in prioritizing the patient needs. When a report is detailed and organized, the listeners will not be bored. If it’s brief, it’ll be interesting too.
Also, a detailed report minimizes questions since almost all relevant information pertaining to patient has been given. There will be little or no question to be asked, except for clarification.
The nurse must also endeavour to be audible. It’s frustrating to keep straining the ears during handover report. It delays the report because the listeners will always demand that the nurse recapitulates. Some may decide to keep mute so as to avoid being tagged “troublesome”. And this will not benefit the patient.
During handover, the environment must be serene. Traffic must be well controlled to avoid distractions. Patients environment must look tidy and sparkling. It’s psychologically soothing! It is therapeutic too.
Questions should be asked and clarifications made. No assumption should be made about patient’s care. Any doubt or assumption must be clarified at the time of report. Remember, it’s patient life we are talking about here, not an object!
Lastly, unnecessary interruptions must be avoided and discouraged. It disrupts the flow in communication and may destabilize the person giving report. All comments and questions should wait till the end of the report. And if any interruption must come in, it must be relevant and be in consonance with the information being shared at that particular time. The incoming nurses are advised to jott down their questions and/or comments, and ask after the report of the patient is completed.
NOTE: ISoBAR means –
Agree a plan