Being smart is not enough by Jean Robson

Reflections on Safer Handover Week (24/11/14 – 28/11/14)

Handovers occur many, many times every day; and we know from the evidence that communication failures at handover are responsible for problems in every department in every organisation Worldwide. The Dumfries and Galloway handover group is now established with the aims of:

  • supporting improvements in handover at transitions in care as patients pass through our health care services
  • supporting improvements in handover at shift changes as our staff pass on responsibilities

The group ran a safer handover week, aiming to raise awareness in all staff of the importance of handover, but also of the strategies which may be employed to ensure effective handover. What did we learn?

Monday 24th November               

  • Passing appropriate information at shift changes and transitions of care is a personal responsibility for everyone.
  • Organisations have the responsibility to facilitate this by developing good handover practices
  • SBAR-R is a good tool only if used well!

Tuesday 25th November               

  • Using a structured format results in a vastly improved handover. Think:
  • WHO should be involved in each handover
  • WHAT information should be passed
  • WHEN it should happen
  • WHERE each handover should happen
  • HOW it should happen

Wednesday 26th November       

  • A formal structure (WHO,WHAT, WHEN, WHERE, HOW), advance planning and good quality leadership of handover meetings result in staff having clear prioritised goals for their work, a greater shared understanding of information, AND time savings at handover.
  • CORTIX can be a useful tool in evolving and structuring our handovers

Thursday 27th November             

  • Planning care in advance is valued by patients and carers and can result in much more effective and person centred care, and may result in reductions in admissions and lengths of stay
  • Ceilings of care are dynamic and need reviewing regularly
  • Discussions of ceilings of care can be challenging for staff but we have a responsibility to share decisions
  • Survivors of cancer need support in returning to the “New Normal” of life after cancer

Friday 28th November                   

Jean R 1Friday was the day we aimed to put the learning from the week together and develop some plans. Brian Robson reminded us that,

“It’s all about the people that we aim to serve. Being smart is not enough. We need to work in effective teams where safety culture is supportive, and use available tools.”

 

Jean R 2We heard about some early work on handover problems, and enjoyed spending time considering how we want our handovers to look before addressing barriers. The “yellow hat thinking” got teams off to a good start by dedicating time to planning for the ideal world. There was a real buzz in the room, with teams from a variety of departments working together, and talking to other groups to resolve barriers. It was a fantastic to see primary care teams helping secondary care, theatre teams helping psychiatry, and many others.

The next step

We have a great sense that we are at the beginning of a journey to improving handovers. We know that there will be challenges. Yet, across the board there is a willingness to engage in this work and an enthusiasm for making a difference. The commitment of our executive team was clear from the time they spent supporting the events of the week. Many staff from the shop floor voiced belief that they will be listened to and supported to make changes when they come up with ideas that make care safer at transitions. The handover group are keen to provide support to groups who want to start implementing changes. We would love to hear about the steps you are making to improve your handovers, so contact us to let us know what you are doing!

Jean Robson is a General Practitioner and Director of Medical Education for NHS Dumfries and Galloway

 

 

 

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