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The steps you can take to improve handovers

What to consider, who to engage and how to enhance communication with staff – and patients

Readers responded to a recent Nursing Standard article by asking for more help with handovers. Clinical research manager Jane Bruton offers tips on what to consider, who to engage and how to enhance communication


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In my clinical and research experience, all nurses want to improve the way we do handover. For many of us, it often feels pressured, too long and repetitive, we stress about forgetting something crucial and we work beyond our hours to complete it.

Communication

Handover is a critical point of communication between nurses that affects patient care and clinical outcomes, and poor communication is a major factor in clinical errors.

‘Unlike other areas in nursing, it is hard to find a best practice guide for handovers and there is little or no training’

Yet, unlike other potential risk areas in nursing, it is hard to find a best practice guide for handovers and there is little or no training; we just learn on the job.

Responses to a recent Nursing Standard article highlighted readers’ concerns. Some said they are being told that leaving late due to the handover is down to poor time management.

Others raised issues such as: how do we take the stress out of handover?; how do we speed up the process without compromising safety and confidentiality?; and how do we engage managers in the process of reviewing handover practices?

Start with brainstorming

The solutions are not easy, but here are some tips for improving the process:

  • First, start a discussion with the nursing team about ward handover. Brainstorm all the problems and pressure points as you see them.
  • Acknowledge what is ‘non-negotiable’ – that is, the length of the overlap of shifts. In most wards this is about 30 minutes. Handover has to work within the time parameters.
  • Acknowledge, along with the whole ward team, that this is not just a nursing issue. Effective handover is dependent on the quality of communication with doctors, patients and allied health professionals. For example, do ward rounds clash with handover times? If so, what other points in the day do or could we communicate formally with the ward doctors or patients?Talk to other healthcare professionals and patients on the ward about problems and possible solutions.

Agree your goals

Next, agree the key principles for your ward handover practice:

  • What is the purpose of handover, based on your ward values? Is it simply communication between nurses or is it also to promote patient-centred care?
  • Given the specialty of the ward, what level of communication is required about your group of patients to ensure safe practice?
  • What style and structure of handover best suits the ward? This is too often the preference of an individual nurse rather than an agreed practice, leading to inconsistencies and confusion. Make sure the preferred style and content is a team decision. Different wards will require different styles.
  • RELATED: Making bedside handovers work for patients and staff

Consider the practicalities

There are also practical points to consider:

  • Decide where handover will take place: bedside, office or both.
  • Will patients have an opportunity to contribute to the handover and if so at what point? Make sure the patient understands their role. Keeping them informed can save you time and give them confidence in the care they are receiving.
  • A computer-generated handover sheet (and/or a mnemonic to guide the content, such as SBAR or ATMIST) can help to avoid unnecessary repetition. Try not to repeat what your colleagues can read.
  • If you are using a ward handover sheet, keep it safe and updated. Handover is a continuous process, not a one-off event.

Pilot and refine your plan

Once you have come up with an agreed plan, make sure it is disseminated to the whole team. Start a staff training programme and make sure the patients know what to expect. Then run a pilot and evaluate against the problems and goals identified originally. Tweak the pilot if need be and roll out the new-style handover.

The research that I was involved with, which looked at patient and staff experiences of nurse handovers, showed that handovers rarely start on time. For handover to work consistently, every nurse must be at work on time and ready to start. This is what each one of us wants when we are tired and ready to go home. We must do the same for our colleagues when we come on shift.


 

 

Jane Bruton, clinical research manager, Patient Experience Research Centre, Imperial College London


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