Nursing Times blogger Stuart Young reflects on his efforts and the resultant impact of bettering his own handover practice this week.
After the hectic nature of last week it was nice to be back on placement this week, getting into a routine again and having patient contact - although on Wednesday I did have my critical care examination, so I have my fingers crossed as I type!
Whilst spending time with my mentor we discussed the relevance and importance of a good clinical handover; we identified several reasons why handover of a patient - either from theatre to recovery, recovery to ward, ward to ward, or emergency departmetn to critical care - is often rushed, and seen as a cumbersome task to staff rather than an imporant part of a patients ongoing care.
At the weekend I attended the Royal College of Nursing’s Emergency Care Association Conference in Cardiff, which included fascinating presentations from the military personnel, who looked at two very different roles of the services out in Afghanistan.
There was another presentation that sparked my interest; Mark Gillespie and Brian McFetridge - two senior nurses from Western Health and Social Trust in Northern Ireland - had completed a study on the process of nursing handover from the emergency department right through to ITU.
During the study they found that there can often be a lack of consistency and structure to the handover and it will often depend on the nurse who is handing over as to the type and level of detail that is passed on.
The study identified that often, we do not ask all of the questions we need to when patients are handed over to us and that, at times, information is missed.
The research identified a number of key recommendations, including the recognition of nursing handover as an important event in ensuring continuity of care for the patient, and a need for a structured framework and supporting documention for handing over a patient, without adding to the already high amounts of paperwork nurse are already required to complete.
This all made me reflect on my own practice: how often had I handed over a patient in the last few weeks of recovery and may not have given a ‘full picture’? How often had the handover from the ward to theatre been missing a piece of vital information such as infections or allergies? How could I do things differently?
So this week I took the advice of the senior nurses who presented at the ECA Conference and took an extra five minutes in all of my handovers, giving basic information over the phone prior to transferring the patient, giving a brief account in front of the patient once on the ward/HDU and then asking the recieving nurse (away from any distractions) if there was anything further that they wanted to know.
This proved to be of great value, both for me – having the knowledge that I had passed on a complete and accurate handover – and, more importantly, for the patient, as it ensured that their ongoing care was based upon decisions made by members of staff who were properly informed. This has improved my clinical practice no end.
For me, the handover process is best described below by a member of the focus groups from the research project I mentioned earlier:
“Well basically, it’s a process; it is like handing a baton over in a race. I have taken the patient so far and now I am handing the patient over to you. So I will exchange all the information I have up to the present moment in time so that you have the same amount of information that I have for you to continue on in the process of patient care”.
If you have an interest in emergency care, then follow this link to the RCN’s Emergency Care Association.
About the author
Stuart Young is a third year student nurse and RCN student member of council