Handover is an essential part of any clinician’s job.
For nurses, poor handover means starting the shift with a lack of knowledge, making the following hours ineffective, stressful and potentially dangerous for patient care.
Effective handover in nursing is accurate, methodical and consistent, leading to improved continuity of care, better outcomes for patients and a reduced work burden for staff and the wider healthcare organisation.
What is handover?
Handover in healthcare is the process where information is shared between nurses who are responsible for the care of a patient. Handover commonly takes place at the beginning and end of shifts and whenever a patient moves to another team. The information includes the patient’s history, current condition, and future treatment plans and other pertinent details.
Why is handover important in nursing?
Handover is important in nursing because it allows nurses to share information about the patient’s care and treatment, understand their needs in the context of the wider ward or organisation and ensure timely attention to priorities. This helps ensure that the patient receives continuity of care and that all healthcare professionals are aware of the patient’s condition and treatment plans.
What is a good nursing handover?
A good nursing handover is one that is:
1. Focused
2. Concise
3. Timely
4. Complete
5. Organised
It ensures that all healthcare professionals who are responsible for the care of a patient are aware of the patient’s condition and treatment plans.
The dangers of inadequate nursing handover
Research has shown clearly that a rushed or incomplete handover delays patient care, patient discharge and increases the number of preventable medical errors. While most nurses will feel that they can ‘do handover’, the best of us still need a framework and process to not make mistakes.
Inevitably, you will also be called on by doctors, other allied healthcare professionals and relatives for an immediate update. This communication can only happen smoothly and promptly if the information is to hand.
The basics of handover are simple. Unfortunately in the modern medical environment there are simply too many handover methods and mediums. Many still rely on bits of paper, some whiteboards and few leverage digital systems to keep track of patient needs and updates.
Handing over using two systems or mediums is a recipe for disaster.
Safety and efficiency can be protected by utilising one method and if possible one medium (i.e. digital vs paper). This makes it easier for information to be communicated to the new team or shift without risking important facts and updates being missed.
The Benefits of Good Nursing Handover
While handovers between staff and teams take place hundreds of times a day in hospitals they represent a high risk to patients.
The team due to handover is typically rushing to complete tasks, tired from the day and may struggle to remember key points if they have not been properly recorded.
A good and effective handover is key to maintaining integrity of information and patient safety. This includes not only on the ward handover between day and night shift but also between ward teams and other institutions.
Any time handover is ineffective, for example to another hospital, clinicians waste time trying to get up to speed on pertinent events. Not only is the handover of pure information important, but also the handing over of responsibility and accountability for the patient. When all of these aspects are transferred patients are much more likely to receive the best care possible.
There is a wide ranging impact not only for patients but at a staff and organisational level as well. These include but are not limited to:
- Reducing avoidable harm
- Reducing patient history repetition
- Better support for doctor’s clinical decision making
- Reassurance for relatives with the latest, relevant information
- Reduce stress
- Reduce time reviewing patient records
- Maintain consistent, accurate records and audit trail
Barriers to effective Nursing Handover
While the task – transfer of patient information – seems singular, nurse handover is complex. This inherent complexity is where the danger of incomplete or omitted information arises.
As well as the transfer of patient information, handover is the shifting of responsibility to another team or team member. The process therefore relies on the communication methods of both parties, their individual work cultures and differing workloads and priorities.
This introduces a significant amount of variables that are difficult to account for with casual or poorly organised handover. Each variable will not only dictate to an extent both the efficiency and the effectiveness of handover, but also the level of risk to patient safety for the upcoming shift.
These barriers can be overcome somewhat with an approach that is both supportive and consistent in method, modality and culture.
This means both parties benefiting from modern methods of information recording and transmission. Rather than scribbling on loose bits of paper or reading smudges on a whiteboard, digital clinical systems can be used to reliably log and transfer information when required.
This also means engaging in the same routine and process, at a known setting. Setting time and private space reduces interruptions, attending staff delays and provides the base framework to operate from.
Routine and process ensures that despite differences in work culture, priorities and workload the input and output of each meeting remains consistent.
Clearly ‘conversations in corridors’ are the antithesis of effective nursing handover. We know that without a focus on good handover, incomplete information, distractions, and errors in communication during the nurse handover are the principal causes of adverse events, such as medication errors, prolonged hospital stays with unnecessary diagnostic tests, and patient dissatisfaction.[1]
What are the 5 key principles of clinical handover?
To summarise, the five key principles of clinical handover are:
1. Focused
2. Concise
3. Timely
4. Complete
5. Organised
However these are clearly the basics concepts of handover. For it to be effective there needs to be boundaries set in place to ensure consistency.
Remember that effective handover is easiest to achieve when it is:
- Consistent – method, process and outcome
- Private – protecting patient confidentiality and reducing distraction
- Understood – parties know expected inputs and outputs
Now that we live in 2022, it is no longer acceptable to rely on unstructured communication, bits of paper and memory when looking after patients. All staff should leverage tools and technology that is made available to reduce cognitive load and improve patient care.
How do you improve patient handover?
There are several ways to improve patient handover:
1. Establish a standard process for clinical handover and ensure that all healthcare professionals follow the same process.
2. Train healthcare professionals on how to carry out clinical handover effectively.
3. Implement a digital system where nurses can record and track patient handover information.
4. Conduct audits to ensure that patient handover is carried out effectively.
5. Quality monitoring: The NMC code of conduct instructs nurses to work with colleagues to monitor the quality of their work and maintain the safety of those in their care.
While the main function of handover is safe continuity of care, effective handover is about risk management and risk reduction. The clinical environment is and will always be busy and chaotic to an extent.
It is the responsibility of clinicians to work mindfully to reduce risk, especially at the most vulnerable part of any shift: handover.
