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'Shift-to-shift handover: are we clear on what is it designed to achieve?'

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I’ve recently been privileged to work on an elderly rehabilitation ward to reconnect me with care in the front-line; it has been an amazing experience.

I have always thought of myself as a secondary care nurse but have been away for a while doing lots of other things. Returning to practice makes you reflect on why you do things and my additional insights from working in nursing informatics gave me a new perspective.

I have been reflecting on ‘shift handovers’, what it is it that we are trying to achieve and how we do them. I guess what surprised me was how they were the same as my experience of nursing 15 years ago. The only real difference was a structuring of the information: we have a printout of the information from the previous shift team, but essentially the process is the same in that we sit at the nurses station and go through each patient one-by-one and discuss their condition and planned care.

This experience made me reflect on whether we are always clear about what a shift-to-shift handover is designed to achieve.

A quick review of the literature was reassuring in that there is a lot about patient safety and the importance of the transfer of care, but perhaps as a profession we need to be more alert to emerging priorities and themes. For instance, the greater empowerment of patients through access to their own information and the ‘right to know’ surely means we should be considering how we can put each patient at the heart of handover in ways that maybe we don’t do now, doesn’t it?

This will need new skills in communication and information management. We also perhaps need to think about how technology can help us with this task: certainly, clinical content management (the way we collect information and structure it) can help to maintain safety.

Do nursing colleagues have any thoughts about the purpose of handovers and how we can we better manage safety during this process? And, how best we can transition to a time when patients have more right of access to information held about them and build this into handovers and other aspects of our nursing practice?

Anne Cooper is National Clinical Lead for Nursing at the Department of Health Informatics Directorate.

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