PROFESSIONAL
Clinical handover and patient safety Australian health care providers are being urged by peak health organisations to focus on the importance of effective clinical handover protocols in order to improve patient outcomes. The push comes at a time when, according to the World Health Organization (WHO), one in 300 patients is harmed while receiving medical care—a safety record that is worse than the aviation and nuclear industries. QNU Professional Officer Chris Jensen reports:
Peak body recommendations The Australian Commission on Safety and Quality in Health Care (ACSQH) has been appointed by the World Health Organization to identify solutions and monitor outcomes regarding patient safety across Australia as part of the High Fives—prevention of patient care handover errors initiative. ACSQH has listed the clinical handover process as one of their top priorities in reducing adverse patient events. They have recently produced protocols for bedside nursing and whiteboard handover, and they are now available on their website at www.safetyandquality.gov.au. The recently released Australian Health Care and Hospitals Association (AHHA) 2009 Issues Paper Clinical Handover—System Change, Leadership and Principles contains a number of relevant recommendations regarding clinical handover. These recommendations include a need for a minimum data set for use in public and private hospital and community settings; a need for systemic culture change within an organisation to improve clinical communication; and incident reporting. Both the WHO and the AHHA refer to the economic benefits of improving patient safety. The AHHA goes further, specifically referring to the danger of clinical handover being relinquished for perceived ‘efficiency savings’, 18 | tqn | February 2010
referring to the perception of clinical handover time being seen as better used for direct care.
starting a shift and that the content of the transferred information often lacks any standardisation.
Meanwhile the Garling Report, conducted in NSW, analysed the importance of communication and its impact on patient safety.
The use of casual, agency and pool staff, short shift changeovers, varying shift start times and patient throughput further increases the need for more accurate and timely exchanges of information in the handover process.
It determined that, in spite of a number of initiatives to improve clinical handover practices, ‘they had not yet delivered a system wide improvement’. Report recommendations included that hospital policy requires a mandatory shift handover with a minimum data set and that some parts of handover are conducted at the patient’s bedside. Other recommendations included ensuring sufficient time is rostered to allow for a complete handover and a requirement for electronic written records to be made of all handovers.
The reality
In spite of the recommendations of leading organisations and recent research confirming the significance of clinical handovers in achieving safe patient outcomes, many facilities continue to consider time spent on handover as less important than, or even separate to, patient care. As nursing professionals, we know that too often in reality insufficient time is allocated to the handover process to actually enable all the relevant information to be conveyed. We also know there is usually precious little time to review patient files when
Increased patient acuity results in the need for inclusive information to be communicated with patients and their families more often. Clinical handover is sometimes ad hoc, not reported by the actual carer, hurried to allow staff to leave on time or is a mere conversation focusing on irrelevant information.
What is required
Clinical leadership is needed more than ever before if clinical handover is to achieve the workplace significance recommended by peak health organisations. Those in charge of shifts should receive a handover about all patients within their area, not just those in their direct care. This added responsibility also needs to be recognised by the employer. Language and literacy skills also need to be considered if workplaces are seeking to use verbal handovers* or written material. Appropriate time needs to be rostered to ensure a proper handover includes the opportunity to review the relevant www.qnu.org.au
PROFESSIONAL
file and records and seek any additional enrolment nomination enrolment information information Who orcanfollow up care. attend?
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All QNU members can attend our union training courses. QNU courses aim to equip members to further develop the necessary skills and knowledge required by employees to participate in and effectively contribute to workplace change.
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Records should be kept of the actual information provided during the clinical handover as core nursing handover for future reference and all and midwifery business essential What does it cost? discussion during the handover process to safe patientthe care. industrial, ing Paid leave provisions – public sector:care. promoting and defend should be relevant to patient »»Roster staff on overlapping shifts to ensure they have adequate time A standard format should be considered professional, social, for a comprehensive handover. to ensure the most relevant information is communicated to those responsible political »and »Ensure democrthat atic efficient information Paid leave – private sector: for patient care at provisions the appropriate time and IT systems are in place to using the most effective method. support the handover. How to enrol »»Provide adequately equipped Further research is also needed in the and interests work spacesvalues for handover. area. This includes research into the of me mbers effectiveness of electronic records and »»Make sure staff are not called Child care tracking systems as well as the influence away during handover, except in of workplace cultural and clinical an emergency. Travel & accommodation contexts on the content and accuracy of »»Consider patient involvement in information contained in the handover. the handover. (07) 3840 1444 or 1800 177 273 Workplace policies regarding clinical »»Provide in-service www.qnu.org.au and training on handover need to include ongoing staff appropriate handover techniques. education as well as active research to »»Initiate a research project in your achieve best practice. workplace examining handover best practice. * In both the draft standards developed by the ACSQH and the Queensland Health Patient »»Keep the handover conversation Safety Centre’s Clinical Handover A Strategy objective. Options Paper draft report, taped handover is not »»Retain formal records of the recommended. handover information for future ** National standards for clinical handover are reference. currently under development by the ACSQH. All QNU courses recognise the needs of nurses as employees.
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Actions to take in your workplace** »»Consider the time taken for
JanUarY - JUne 2010
QNU members in management positions who are seeking information and education to further develop their understanding of industrial issues from a management perspective should contact their employer for information regarding appropriate management training programs.
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There is no cost, QNU training is included in your union membership. The following leave provisions apply.
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All nurses working in the public sector are entitled to PAID leave. This provision allows for members to attend Trade Union Training for up to 5 working days per calendar year (refer to IRM 11.5-4 Industrial Relations Education Leave).
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This leave can not be unreasonably refused by your employer. This leave is not Conference Leave, it is specifically for Industrial Relations Education Leave.
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All members are entitled to this Leave as part of their current employment conditions. If you experience any difficulty getting paid Industrial Relations Education Leave, contact your QNU Organiser or the Training Unit immediately.
Many agreements in the private sector have provisions for education for employees who are union members. For specific information about your entitlements call the QNU Member Servicing Centre on (07) 3840 1444 or the QNU Training Unit on (07) 3840 1431.
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Complete the attached enrolment form and send it to the Brisbane Office as soon as possible – GPO Box 1289, Brisbane Q 4001 OR Fax (07) 3217 2794. To ensure a place on the course send your enrolment in to the QNU now and apply for leave from your employer at the same time. Members can now enrol by logging onto the QNU website: www.qnu.org.au If you are unable to attend, please notify us promptly.
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Should child care be required, please contact the Training Unit as soon as possible on (07) 3840 1431. Child care assistance will generally only be available on the basis of reimbursement of additional costs.
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The QNU Training Unit will contact you regarding your travel arrangements.
IMPORTANT PLEASE RETURN THIS FORM TO THE QNU
AS SOON AS POSSIBLE. Enrolments should be received 10 days before commencement of the course. Should you experience delays in receiving employer advice concerning approval of paid leave, accommodation or travel assistance, contact the QNU ASAP. Send enrolments to: QNU GPO Box 1289, Brisbane Q 4001 or Fax (07) 3217 2794
Members requiring travel or accommodation assistance in order to participate should, in the first instance make application to their employer as some courses may be funded by the employer. Requests for QNU assistance with travel, accommodation or child care must be made prior to the commencement of the course, by contacting the QNU Training Unit on (07) 3840 1431 or toll free 1800 177 273. Child care assistance will generally only be available on the basis of reimbursement of additional costs.
Queensland Nurses’ Union of Employees, 187 Melbourne Street, West End Q 4101
For more information please contact Helena Dalton-Bridges, Education Officer, in the QNU Brisbane Office on (07) 3840 1431 or toll free 1800 177 273, or speak to your Union Organiser.
Authorised by G.Hawksworth, Secretary Queensland Nurses’ Union of Employees, December 2009
Want to keep nursing beyond 30 June 2010? With national registration due to commence on 1 July this year, nurses and midwives will need to register with the Queensland Nursing Council before that date to be automatically registered in the new system. If you wish to continue practising nursing and/or midwifery from 1 July then you must renew your annual licence certificate between 1 April and 30 June 2010. This licence will be recognised nationally under the Australian Health Practitioner Regulation Agency (AHPRA). It will then be renewed annually under AHPRA from 2011. Make sure your details are up-to-date for when your renewal notice is mailed in early April. You can also renew your licence online at www.qnc.qld.gov.au Nurses and midwives who renew early can win one of three prizes.
»»Renew by 30 April 2010 and go in the draw to win one of two $1000.00 cash prizes.
»»Renew by 31 May 2010 and go in the draw to win one of two $500.00 cash prizes.
»»Renew before 31 May 2010 and go into the draw to win one of 10 Family World Passes to Dreamworld & WhiteWater World.
For all renewal enquiries, please contact the QNC’s Client Service centre during office hours from Monday to Friday on 07 3223 5100 or email
[email protected] with ‘Renewals’ in the subject line. www.qnu.org.au
Knowing your entitlements and understanding the award—24-25 February; Brisbane Workplace Representatives 1—2, 3 & 4 March; Brisbane Handling grievances in the workplace—8 March; Brisbane Are Queensland Health Consulting?—How to stop the rot when they’re not!—9 March; Brisbane Workplace Representatives 1—16, 17 & 18 March; Darwin Are Queensland Health Consulting?—How to stop the rot when they’re not!—23 March;Townsville Handling grievances in the workplace—24 March; Townsville Political and Community Campaigning—How to make a difference!—25 March; Townsville Private Hospital Nurses—Current issues and how to address them!—30 March; Brisbane Creating a safe workplace (WH&S)—31 March; Brisbane QNU Branch Development 1—Establishing, developing and growing our voice—13-14 April; Brisbane QNU Branch Development 2—Establishing, developing and growing our voice—15 April; Brisbane
TO ENROL IN ANY OF THESE COURSES— »» download a nomination form from the QNU website (www.qnu.org.au) OR
»» contact your local QNU office and ask them to send you a form OR
»» ring the Training Section in Brisbane on 3840 1444 or 1800 177 273
February 2010 | tqn | 19
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