5 tips for a better patient handover

Nursing handover is the primary method of sharing patient information between shifts and ensuring continuity of care from shift to shift.
Handover is such a delicate thing in the process of the nurse's day. It is vital to know what the patient has been doing the previous eight or twelve hours. (1)
Whether you are using a taped or verbal handover system, a good hand over report describes a client’s health status and lets staff on the next shift know exactly what kind of care the client requires. Significant facts about clients are reviewed (e.g. the condition of wounds or episodes of chest pain) to provide a baseline for comparison during the next shift.(Crisp & Taylor 2005, p. 486)
The handover of each patient is generally made up of three sections:

• 
  Past: historical info.The patient’s diagnosis, anything the team needs to know about them and their treatment plan. So you’d include things like whether they are nil-by-mouth or require barrier nursing, if they need help with eating or using the toilet. If they are newly admitted then it’s a good idea to cover the circumstances leading to their admission.
  


• 
  Present: current presentation. How the patient has been this shift and any changes to their treatment plan. Keep in mind that significant changes might have occurred before your shift that the new team are not aware of; check when they were last in and what they already know. Include physical observations and any results from assessments or investigations.
  


• 
  Future: what is still to be done. For lots of reasons, there can be jobs that have to be handed over to the next shift. Tasks that need to be completed at a certain time or something the team simply haven’t had time to do yet. (2)
  

Tips for young players

Handover is one of the most important functions in nursing and is often not part of formal training. If you are new to the process, don't feel shy about asking questions during the handover if you don't understand something or feel the nurse handing over may have forgotten to tell you something. Understanding exactly what is said and communicating clearly with other nurses will prevent many problems for both you and your patient. (3)
During handover, it is more important than ever to speak up if you are unsure, it sounds obvious but never make up what you think is happening! If you don’t know what a patient’s blood pressure is, say you don’t or better yet check their chart. Next time you’ll know to check beforehand.

When the wheels come off

According to a study commissioned by the Clinical Services Evaluation Unit at Princess Alexandra Hospital, the implications of an ineffective handover can be serious and can cause the following;

• Increased risk (3.5 fold) of preventable adverse events


• Delays in diagnosis


• Decreased patient satisfaction


• Increased LOS and tests


• Delays in test ordering and increased in-hospital


• complication

Organisation is key to a good handover

Think of the report in terms of sections – demographics, history, pathology, assessment – and stick with the pattern. This way, both you and your listener know you didn't miss anything.
Organisation is next to godliness in nursing. You cannot go five feet in nursing without being able to organise yourself. If you jump around in your handover, you are setting you and your listener up for confusion. You need to be organised enough so that you move smoothly from one section of your report to another. Occasionally, you will have to backtrack. It's only human, but this should be the exception, not the norm.
If you are constantly telling path results in the middle of your head to toe assessment or giving pieces of history at the end of the report, you are not organising your report well enough. This is frustrating for nurses who follow you because they cannot be sure they have all the important information, and they cannot follow you well enough to know what is going on with the patient. (1)
Here’s a simple handover layout from Nurse in Australia that will become second nature when you practice it a lot:

• Patient Details


• Presenting Complaint


• Significant history


• Treatment


• Plan

1. Patient Details – this is a brief intro to the patient and can also include introducing yourself or the oncoming nurse to the patient. An example would be, “This is Jacob, a 65 year old man who presented by ambulance at 4pm today…”


2. Presenting Complaint – Any relevant details about the presentation should be conveyed, keep in mind this does not need to go on and on and on about details that can be read in the chart. It should be clear, succinct, and allow for any questions from the oncoming nurse. “Today around 10am Jacob’s breathing became worse than normal, he became laboured and distressed at home and his wife called the ambulance.”


3. Significant history – this should be relatively brief, but can be very helpful, particularly if it gives context to the current presentation.  An example would be, “Jacob has a history of emphysema for the last 15 years, he is under treatment by the respiratory team and is on home oxygen 24hrs a day….”


4. Treatment – what treatment has already been given, and what are we doing now? This is a brief rundown on where we are up to with the patient – are we treating with antibiotics? Waiting on chest xray? Waiting for blood results? Any important details should be noted here also, like allergies, family dynamics or phobias.


5. 
   Plan – where are we heading in our treatment for this patient, and do any tasks need to be handed on to the next nurse? Read the full article here.
   

References
(1) Lynda Lampert. Nursing handover best practice. http://www.ausmed.com.au/blog/entry/nursing-handover-tips-and-best-practices
(2) Fran Entwhistle. Nursing Times http://www.nursingtimes.net/student-nt/what-makes-a-good-handover/5038664.fullarticle
(3) Patient handovers. School of Nursing and Midwifery. Flinders University. http://nursing.flinders.edu.au/students/studyaids/clinicalcommunication/page.php?id=11