VOL: 96, ISSUE: 42, PAGE NO: 44
Jane Currie, BSc, RGN, is a staff nurse at Selly Oak Hospital, University Hospital Birmingham NHS Trust
The ward on which I work consists of 33 single rooms and is divided according to specialty - orthopaedic or surgical. There is a separate nursing team for each specialty. At the time of the audit (October 1999) there were eight nursing shift patterns in operation. It was common for nurses to give at least two verbal handovers each shift at the bedside.
This was very time-consuming. Moreover, information was often poorly communicated and inaccurate due to omission of detail. For this reason we decided to conduct an audit of nursing handover on the ward.
Before beginning the audit, permission was obtained from the hospital manager and matron. Nursing staff on the ward all chose to participate. The clinical development nurse was also kept informed of the audit process and findings. The audit was conducted over a random two-week period, one week in each specialty. The data was collected as part of a ‘normal’ working day. Ten handovers were audited, five in each specialty.
The handover was timed from the moment the name of the first patient was introduced, to the last word spoken about the last patient. The content of the handover was audited using a checklist (Box 1), which was developed following a review of the available literature regarding handover, in particular the work of Hesse (1983).
Following each handover, time was taken in private to complete the audit checklist. Although this procedure was carried out following each handover, only one handover each shift was audited. In an attempt to prevent audit bias, the other members of staff were not informed which handovers were subject to the audit procedure.
A pilot study was undertaken for one week to test the relevance and workability of the audit checklist. No modifications were made to the audit tool following this study. The pilot study provided an opportunity to develop accuracy when timing handover and to get familiar with the procedure.
The length of handover was analysed using measures of dispersion as described by Burns and Grove (1993). The mean length of handover between the two specialties was 20 minutes. The shortest handover took 14 minutes, and the longest 40 minutes - a range of 26 minutes. The audit also revealed the frequency of communication of the information about the patient (Box 2).
One of the most striking findings of the audit was that only 20% of handovers took place in the patient’s room. The purpose of bedside handover is to facilitate patient-centred care (McMahon 1990). Sherlock (1995) argues that patients feel more involved in their care as a result of bedside handover because it offers closer contact with nurses and medical staff and a chance to raise questions, as well as fostering a sense of partnership. These benefits may be wasted if handover is not conducted at the bedside.
In some circumstances it may be necessary to have a second nurse-to-nurse handover away from the patient’s bedside if sensitive or distressing issues need discussion (Howell, 1994)
The time taken to conduct handover, and the content, varied considerably. The audit revealed that an average of 20 minutes was spent in each specialty to conduct handover. This compares favourably with a study by Matthews (1986), who found that handover of 34 patients took up to 50 minutes. If handover is too lengthy, Matthews found, information and sensory overload may occur and nurses may be left feeling confused.
The audit discovered that only 60% of the sample group used the nursing documentation as part of the handover. Sherlock (1995) argues that using the nursing documentation as a structure for handover may improve the accuracy of information reported. Greater use of documentation would give a better framework and perhaps more consistency to the nursing handover.
Kennedy (1999) studied the benefits of non-verbal handovers: when nurses began their shift they read the patients’ documentation instead of receiving a verbal handover. Kennedy found this reduced the length of handover and meant nurses received relevant and accurate information, which also allowed flexibility in shift patterns. Receiving relevant information meant nurses could prioritise their shift work accurately, so improving patient care and the management of nursing hours.
The audit highlighted the need for the patient’s involvement. Handover should be carried out using relevant information from up-to-date patient care plans/pathways to ensure content is accurate. The length of time spent on handover was appropriate for the number of patients.