HLTENN036 Clinical Handover PDF

HLTENN036-APPLY COMMUNICATION SKILLS IN NURSING PRACTICE Lesson 4 : Clinical Handover RMIT Classification: Trusted Objective Brief overview of NSQHS standard 6: Communicating for Safety. Understand what Clinical Handover is Understand principles of Clinical Handover Discuss and Practice ISOBAR mnemo...

HLTENN036-APPLY COMMUNICATION SKILLS IN NURSING PRACTICE Lesson 4 : Clinical Handover RMIT Classification: Trusted Objective Brief overview of NSQHS standard 6: Communicating for Safety. Understand what Clinical Handover is Understand principles of Clinical Handover Discuss and Practice ISOBAR mnemonic for clinical handover RMIT Classification: Trusted Communication for Safety Transfer of patient care between health care providers or location – high risk situation due to lapse in communication/s. The Australian Department of Health sentinel event reports that communication was the root cause for 20% of sentinel events in Australia (Department of Health, 2010) Communication failure has been reported to be a major factor in 60-70% of serious incidents (Marshall, Harrison & Flanagan, 2009). Each year: Approx. 7,068,000 clinical handovers occur in Australian hospitals About 26,200,000 clinical handovers are carried out in community care settings RMIT Classification: Trusted Clinical Handover Standard 6 in the National Safety and Quality Health Service Standards. o “Clinical Handover is to ensure that a timely, relevant and structured clinical handover occurs that is appropriate to the clinical setting and context of the handover” (NSQHS, 2010). Aim: The aim of clinical handover is to ensure the accurate and timely transfer of information, responsibility and accountability. Handover practices are highly variable resulting in discrepancies in the content and accuracy of information provided. Hence standardisation of handover process improves patient safety by ensuring that all critical information is accurately exchange. RMIT Classification: Trusted Clinical Handover Poor or absent clinical handover, or a failure to transfer information, responsibility and accountability, can have extremely serious consequences for patients. It can result in: o Delays in diagnosis, treatment and care o Tests being missed or duplicated o Incorrect treatment or medication The key principles include: RMIT Classification: Trusted Traditional nursing handover “Clinical Handover refers to the transfer of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another person or professional group on a temporary or permanent basis.” (Australian Commission on Safety and Quality in Health Care, 2009) RMIT University©2017 Bedside handover School of Vocational Engineering, Health & Sciences RMIT Classification: Trusted Principles of Handover 1. Patient and Carer Involvement o Patients and carers can provide information that is not necessarily available to clinicians as carers are more familiar with the patient and may spend more time at the bedside. o Encourage patient participate in their own care of plan. o Ensure patients and carers understand current progress, treatment options and the plan of care o Explaining the patient and carer role in clinical handover, and encouraging them to raise questions and concerns with the health care team o Ensure there is a system for early identification of cultural needs. RMIT Classification: Trusted Principles of Handover 2. Handover requires preparation o Occur at allocated time and place to enable all necessary staff to attend. o Document and progress notes should be updated o Verbal handover should be supported by documentation such as handover sheet. Why? 3. Handover needs to be well organized o Led by a designated staff member o Timely transfer of information is vital for patient safety. RMIT Classification: Trusted Principles of Handover 4. Handover should provide environment awareness o Incoming team should be notified of any environment issues such as OH&S or behaviours of concerns which might impact on the shift. o Handover should include notification of – higher acuity patient, deteriorating patient, any infectious diseases etc. o Potential or schedule patient transfer or discharge 5. Handover must include transfer of accountability and responsibility for patient care RMIT Classification: Trusted Clinical Handover – ISBAR/ISOBAR What is ISOBAR? ISOBAR is an acronym. It stands for: I – Introduction S – Situation O – Observation (most recent) B – Background A – Assessment R – Recommendation/Request RMIT Classification: Trusted Clinical Handover Why should we use ISOBAR? Provides a STRUCTURED framework for clinical conversations. STANDARIDSED tool use by all clinical to communicate patient information Allows to present information CLEARLY and ACCURATELY in any situation Helps you to ORGANISE what you’re going to say Portable, memorable and easy to use Useful when trying to convey information about patient care. RMIT Classification: Trusted Clinical Handover Where can ISOBAR be used? The ISOBAR framework may be used in any information handover situation. For example: o Shift changes o Discharge to community services o Inter-hospital transfers o Intra-hospital transfers o Time-critical situations such as medical emergencies or evacuations o Procedure documents RMIT Classification: Trusted Clinical Handover Who can use ISOBAR? All clinical staff are encouraged to use ISBAR. This allows more effective communication. Doctor to Doctor Nurse to Nurse Nurse to Doctor Doctor to Allied Health Nurse to Allied Health Allied Health to Allied Health To and between ward staff, housekeeping and clerical staff. RMIT Classification: Trusted ISOBAR - Handover I – Introduction Your name Your role/position Your ward/Unit and Hospital/health Service location Identify your patient (Name, DOB and UR number) Confirm you are communicating to the intended person and ensure that the recipient is able to receive the communication. Examples “I am …… (name and role)” “I am calling from…….” “I am calling because……..” RMIT Classification: Trusted ISOBAR - Handover S – Situation Current medical diagnosis Acute/current problem or symptoms State deterioration clearly. For eg: acute pain, drop in BP Reason for call (if telephonic) Stable/unstable Examples: “I have a patient (age and gender) who is stable, yet I have concerns unstable with rapid/slow deterioration” “The presenting symptoms are…..” RMIT Classification: Trusted ISOBAR - Handover O – Observation State most recent vital signs of patient. For Eg: Hr 90bpm, BP 160/90mmHg pain 8/10 etc. Examples: “Patient’s BP is….” “Pt HR has dropped from 130 to 70..” RMIT Classification: Trusted ISOBAR - Handover B – Background Past or relevant medical history (PHx) or co-morbidities Current medication and allergies Give pertinent information which may include: Date of admission/ presenting symptoms on admission / medications/ test results/ status changes. For Eg – 3 days hx of nausea and vomiting, hx of abdo pain etc… This step also includes a brief synopsis of treatment to date and assessments/ tests that are pending. Late eat and drink Example: “This is the background of ….” “has cardiac history, stent inserted 10 years ago” RMIT Classification: Trusted ISOBAR - Handover A – Assessment State patient assessment using systems approach or head to toe Understanding of what problems are being treated If telephonic/verbal, what do you think is occurring? Example: On the basis of all of the above I believe the: The patient’s condition is …… And they are at risk of …… And in need of ….. Patient’s blood results show ….. Patient’s recent vital signs are ….. RMIT Classification: Trusted ISOBAR - Handover R – Recommendation/Request/Result Be clear about what you are requesting or recommending State any pending result State any pending care of plan for patient Examples: “This patient needs transfer to / review …." "Patient needs shower this afternoon” "In the following time frame …." RMIT Classification: Trusted RMIT Classification: Trusted Let’s look at an example of handover using ISOBAR format… How would you communicate with a doctor if your patient had a fall and you need doctor to come and review your patient RMIT Classification: Trusted Sample telephone call using ISOBAR format I = Hello Dr Robert. This is Sarah, the enrolled nurse on ward 2E. I am calling about a patient Mary Thompson an 83 year old woman on ward 2E S = Mary was walking from her bed to the shower when she slipped and fell 10 minutes ago. She states she has a headache 8/10 on the pain scale which is mainly on the right side of her head. Bruising is appearing on the right side of her face and her right arm. No other injuries are evident. O = The vital signs taken since she fell show a pulse of 110 and drop in BP from 165/100 at 0630 to 90/50 B = Mary was admitted yesterday with chest pain for investigation. She has had no episodes of chest pain since admission. Her vital signs show that her BP has been elevated since admission A = I am concerned that she might have internal bleeding and that she is in shock R = Could you please come and review her as soon as possible. What would you like me to do until you arrive? RMIT Classification: Trusted Let’s Watch following Videos How not to handover…how to handover (4:35mins) https://www.youtube.com/watch?v=Rn6r_hFWP0Q ISOBAR is for everyone (4:02 mins) https://www.youtube.com/watch?v=AmZKJ3JAPsE&t=79s Discuss medical terms you don’t understand with your teacher! RMIT University©2017 School of Vocational Engineering, Health & Sciences RMIT Classification: Trusted Handover 1 – 15 mins Breakdown following scenario using ISOBAR format. Jason Thompson is a 64-year-old gentleman with COPD. He was admitted yesterday via ambulance with an exacerbation of shortness of breath. He has a past Hx of being a heavy smoker, chronic bronchitis and congestive cardiac failure. On admission his respiratory rate was 32 respirations per minute and his oxygen saturations were 91%. He has been ordered 4 litres of oxygen per minute. He has difficulty doing most activities of daily living so requires full assistance. He is currently stable, and his respiratory rate has settled at 24 respirations per minute. His O2 sats are 95% on 4 litres. He is having 4 hourly ventolin nebs and I have commenced a fluid balance chart to monitor his fluid input. He complains of being thirsty. Transfer to 2N when stable. Look up medical terms you don’t understand and discuss with teacher! RMIT University©2017 School of Vocational Engineering, Health & Sciences RMIT Classification: Trusted Handover 1 – Class Discussion Teacher to discuss ISOBAR break down on Mr Jason Thompson! RMIT Classification: Trusted Handover 2 – 10 mins Call doctor to seek review based on following scenario: Break down scenario using ISBAR format. You performed a wound dressing at 9 am on Mrs Margaret Fisherman, in bed 3 on ward 2E. The wound was oozing yellow pus and had odour. It looked inflamed. The client was grimacing and saying that it hurt when you tried to change the dressing. The client said it was more painful than yesterday and there is more pus. Her pain post dressing is 8/10 and would like to have something for it. She is more febrile (high temp) than yesterday. You got the wound specialist nurse to look at the wound. He tells you to change the dressing to alginate, get a swab to send to pathology and get the doctor to come to review the patient. You think she will need to started on antibiotics. Look up medical terms you don’t understand and discuss with teacher! RMIT University©2017 School of Vocational Engineering, Health & Sciences RMIT Classification: Trusted Time to Handover – 25 mins (15mins) Student to get into pairs for the handover exercise Pick a scenario that you would like to handover. Students to provide feedback to each other on their performance. (10mins) Once complete, please write progress note on your patient using principles of documentation. RMIT Classification: Trusted Handover 3 – 10 mins Listen to the following recording and fill out your ISOBAR template form. AIM: Complete ISOBAR Recording 1_ISOBAR_Mr Chambers.mp4 Recording 2_ISOBAR_Mr Chambers.mp4 Look up medical terms you don’t understand and discuss with teacher! RMIT University©2017 School of Vocational Engineering, Health & Sciences RMIT Classification: Trusted References: Australian Commission on Safety and Quality in Health Care (2010). OSSIE Guide to Clinical Handover Improvement. Sydney. ACSQHC, 2010. Australian Institute of Health and Welfare (2006). Australia’s Health 2006. Retrieved from; https://www.aihw.gov.au Berman, A., Kozier, B., and Erb, G. (2015). Kozier and Erb’s Fundamentals of Nursing Vol 3. (3rd Ed.). Pearson Australia, Melbourne, Australia. Dempsey, J., and French, J. (2009) Fundamentals of Nursing and Midwifery A person-centred approach to care. Lippincott Williams & Wilkins Pty Ltd, Broadway, NSW. Funnel, R., Koutoukidis, G., and Lawrence, K. (2005). Tabbners Nursing Care (4th Ed.). Elsevier Churchill Livingstone, Sydney, Australia. Johnstone, K. (2007). Impro: Improvisation and the theatre. Bloomsbury, London. RMIT Classification: Trusted References: Koutoukidis, G., Stainton, K., & Hughson, J. (2013). Tabbner’s Nursing Care Theory and Practice (6th ed.), Chatswood, Australia: Elsevier. Lemone, P., and Burke, K. (2015). Medical-Surgical Nursing: Critical thinking for person-centred care. (2nd Australian Ed.). Pearson Australia, Melbourne, Australia National Patient Safety Agency (2004). Seven steps to patient safety. London: National Patient Safety Agency, 2004.