Clinical Handover at the bedside

Abstract

Background: Clinical nursing shift handover is a process whereby the patient's care and treatment plan is being passed over by the preceding nurse to the on-coming nurse in a structured and standardized way. In March 2014, Joanna Briggs Institute's recommended evidence on clinical handover and ‘ISHAPED’ were implemented in a medical ward, and all the nurses used the ‘ISHAPED’ acronym to hand over patients’ care and treatment plan. The acronym, ‘ISHAPED’ stands for “Introduction, Story, History, Assessment, Plan of care, Error prevention and Dialogue”. However, a sustaining audit showed that the handover process was not consistently practiced. Thus, this project is the follow-up phase conducted to monitor and sustain the implemented practice. Objective: The follow-up phase aims to achieve 80% compliance rate of RNs on a general medical ward to ISHAPED handover process. It also aims for the handover process to take place at the patients’ bedside and update patients about the plan of care by involving them during shift handover. Methods: This follow-up phase was conducted in three phases after the last post implementation audit. At the first phase, the sustaining audit was conducted at 6 months to monitor the nurses’ compliancy rate to the practice change. The audit criteria were adopted from Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI PACES). The data were gathered from 20 shift handovers on an adult medical ward. Data was analysed and, using JBI Getting Research Into Practice (GRIP) online programme, strategies were designed to close the gaps. One of the strategies was to incorporate the acronym ‘STRIPS’ which stands for surveillance, tubes, referral, intervention, plan, and special note into the Trendcare, an online tracking of patients’ acuity care. The second phase started with sharing of the audit results and implemented the strategy by educating nurses on how to apply the ‘STRIPS’ in addition to the ‘ISHAPED’ structure during handover. Another audit was conducted 4 weeks post implementation and data were analysed in PACES and disseminated to the nurses. Results: The sustaining audit after 6 months of the new practice, found that nurses were inconsistent to perform handover report at patient's bedside and patient was not involved in the plan of care. The results of the post implementation follow-up project showed that the compliance rate had improved for three criteria: an improvement of 90% compliance rate for verbal communication between nurse and patient during nursing handover; compliance rate for patient identification achieved 100% and 75% for the plan of care. Whereas, the compliance rate for relevant history and detail observations remained 100% and 95% respectively. Discussion/Conclusion: In order to sustain a practice change, monitoring compliant to the process and adhering to the practice has to be continuously carried out. Involving patients in the shift handover process and plan of care ensures the continuity of care and has improved the communication between nurses and patients and also between the nurses.