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Clear, concise communication is vital when changing shifts
I’ve seen handovers from many nursing perspectives. Since starting at the Blackpool Teaching Hospitals NHS Foundation Trust as a healthcare assistant in 2005, I have been a staff nurse, sister and ward manager, and I am now a matron.
Nursing Standard. 36, 2, 38-38. doi: 10.7748/ns.36.2.38.s15
Published: 03 February 2021
I cover three care of older people wards and one general medical ward and I join in handovers three or four times a week.
Clear, concise handovers are critical for maintaining patient safety, especially when staff are working flat out. Here are my tips for making handovers as effective as possible.
This is something I’ve learned from reviewing incidents, attending coroners’ court proceedings and other formal processes. It’s important that everyone in the team takes part in handovers, even the housekeeper. It must be a whole-team affair.
Make sure everyone knows which patients are at high risk of deterioration – and highlight the risks at every handover because they can change from one shift to the next.
We’re trying to ensure we recognise deteriorating patients earlier. In the morning, for example, nurses will know if they need to undertake extra observations on a patient before they do anything else. We need to minimise harm but to do that we need to be aware of the risks to every patient.
Don’t just say, for example, that a patient has dementia – describe symptoms and behaviour. Ask ‘Have we established a baseline with the family?’ and ‘Could it be sepsis rather than dementia?’.
COVID-19 has brought many new challenges and maintaining social distance during handovers can be a problem. Balanced against that is the need to maintain confidentiality, so choose the location for handover carefully and ensure all those present can hear what’s being said but details can’t be overheard.
On one of our wards, rather than different nurses handing over a group of patients, we trialled the nurse in charge doing the entire handover.
It’s been a success and has improved communication between members of the team. All wards are different, so find a process that works for yours.
Should you include agency staff and nursing students in handover? Absolutely, yes.
Our hospital has a high number of vacancies so we’ve been supported by agency staff. The ward manager always does an induction for them. Agency nurses and students get to know how the ward works and are a crucial part of handovers.
For morning handover, we aim to be done in 20 minutes or half an hour at most, depending on whether patients have deteriorated in the night.
Sometimes it’s difficult to remember everything – and that’s fair enough. Be honest and don’t try to cover up for things you don’t know. If you’ve had a challenging shift and you’ve taken out a patient’s catheter but don’t know whether they’ve passed urine, just say so. It’s safer that way.
Healthcare assistants are valuable members of the team; be as attentive to them as to any other member of staff. Listen to what patients say too, so you can report it back to the team.
Finally – and importantly – use handovers as lessons. We need to review our processes and look for changes we can make that encourage excellent care. There’s no point in filling in a form to report an incident if you don’t learn from it.
If an incident takes place on one ward, I always share it with all our ward managers. I don’t say where it occurred because it’s not about blame, but if an incident has happened on one ward it could happen anywhere, so we must all learn from it.
Make your handovers more effective rcni.com/effective-handovers