After 2 years and 99 posted blogs, addressing 68 different subject areas, I appear to have inherited the slightly daunting task of writing blog number 100 for dghealth. In that very first blog on 19th March 2013, Ken Donaldson encouraged us to open our ears, embrace and not be frightened of communication, interaction and feedback between service providers and service users.
Ken’s vision for the future was to achieve “one blog a week from dghealth for a long time to come” and the evidence that this has been met is clearly demonstrated in the widespread engagement, diverse variety of subjects and immense learning that these blogs have generated.
Despite so many differing categories being listed for these blogs, communication is arguably a subject more frequently visited than most and this topic intertwines into every aspect of our professional practice and service delivery. Communication is an area where the effectiveness of its application has a direct impact on the outcome. We have all had situations, both professional and non-professional where ineffective communication has had a negative impact on our experience and when this involves healthcare provision, the effect can be profound.
One essential aspect of clinical communication involves handover and with the publication of NHS Dumfries and Galloway’s new handover strategy, there is an increasingly important focus on this fundamental area of care provision.
Furthermore, the senior endorsement of handover as a key area within NHSDG and the addition of this to our 9 point of care priorities has demonstrated that handover improvement work has significant support and advocacy at all levels throughout the organization.
But how do we improve the quality of handovers whilst maintaining our focus and energy on all the other priority areas competing for our professional attention? We work in an environment that can sometimes feel like we’re on a hamster wheel without the money to upgrade to first class travel!
Despite these challenging times, making tangible improvements in our work environment is easier than we might think and this is no less applicable to developing our approaches to handover. Asking 5 simple questions provides the structure required to build a foundation for improvement in handover practice.
- WHO – who should be involved, who are our essential attenders?
- WHEN – when should our handover take place?
- WHERE – Where should this handover happen?
- HOW – How are we going to structure this handover?
- WHAT – What needs to be handed over?
Developing a local protocol for your department based on these 5 standards allows the identification and development of areas of handover whether they relate to shift handovers or transfers of patient care and the effect can be significant.
The protocol clearly identifies fundamental, locally specific details such as which personnel are essential to making the handover fully effective and the appropriate location and time of the handover being addressed. The manner in which the handover will be undertaken is also outlined and the details that need to be included are prioritized. An appendix can then be added to highlight the structure to be applied to the actual handover procedure and this standardizes the process by ensuring transparency and consistency with the way the handover is undertaken on a continual basis.
Over the last 6 months, the Hospital at Night (H@N) ANP team, based in DGRI, have been developing and enhancing their handover process beginning with the handover from dayshift to nightshift at 2145 hours and evaluation of this work is demonstrating impressive results.
So, how have we achieved this? We initially identified that the handover we wanted to improve was the nighttime meeting at 2145 hours since evidence has indicated that this represented a period of increased significance when care is transferred from dayshift to on-call teams. We then began by formulating a H@N handover protocol based on the 5 handover standards and we identified our target as being 95% compliant as indicated in the NHSDG handover strategy. We then used this local protocol to guide our development of essential elements such as the handover procedure and our improvements measurement.
During this time, we also evaluated our baseline position so we could clearly measure effectiveness and areas for improvement. Once our new handover protocol had been developed and finalized, we set implementation and review dates, publicized the improvement project and undertook team education before implementing and measuring the project.
Although the achievements we have been able to make are clear, we still have challenges in meeting our 95% compliance target in some areas, namely our attendance by essential personnel (WHO) and our punctuality (WHEN). Additionally, this work highlighted that whilst we could measure the handover procedure itself, we had no measurement process for the quality of clinical information handed over and this was felt to be an area of significant concern.
Therefore, the team has developed a quality measuring score for patients handed over using an SBAR-R format which was adapted from an SBAR scoring system implemented within the day surgery unit in DGRI. The aim of this H@N SBAR-R quality score is to measure the quality of clinical communication as well as guiding practice and providing a communication structure. It is also anticipated that this SBAR-R quality measurement can be used to underpin multidisciplinary training and education in relation to clinical communication.
Initial and ongoing engagement has been crucial to delivering the improvements demonstrated and this will also be vital in addressing the challenges which still remain. Nonetheless, the handover improvements the H@N team have implemented and achieved, are easily transferrable across any specialty, discipline and clinical area. This presents the opportunity for shared learning and collaboration to assist and encourage areas who may be considering similar improvement work and practice developments across NHSDG.
The H@N ANPs have some challenges ahead to achieve 95% compliance in all 5 standards whilst also implementing quality measurement for handover communication but this is innovative work that we are proud to be sharing. With support from senior management, the improvement team, the handover group and clinical staff, the H@N team is able to progress these developments and participate in an exciting project that NHSDG is leading the way on nationally. It is hoped that data collection will continue to demonstrate the value of this work and its benefit upon delivering safe, reliable, effective, patient-centered care.
After all, isn’t that what we are all here for?
Barbara Tamburrini is an Advanced Nurse Practitioner for NHS Dumfries & Galloway