clinical handover 250913
TRANSCRIPT
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Clinical Handover:Effective Communication
Prevent Errors
CLINICAL RISK MANAGEMENT WORKSHOP
28 & 29 April 2014
Dr. Sajaratulnisah Othman
Assoc. Professor
MBBS, MMeD (Family Med), PhD
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Communication
3
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Safety
Quality
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UMMC
1,100 beds
50,000 admission per year
883,000 patient visits per year
22,000 operations per year
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Risk
Hazard
Undesirable outcomes
Heavy workload
Lack of confidence
Inexperience of workingin a particular ward
Reluctance to disturb
more senior clinicians
Distractions
Interruptions
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Clinical handover
Safety and quality
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Outline
Dimensions of Clinical Handover?
Why we need it?
How to do it properly?
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Clinical handoverthe transfer of professional responsibility andaccountability for some or all aspects of care for
a patient, or group of patients, to another person
or professional group on a temporary or
permanent basis
[the Australian Commission for Safety and Quality in Health Care and the AMA]
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Transfer patient info
Accountability
Responsibility
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What goes wrong in clinical
handover?
In 458 incidents, the most prevalent failure types:
a)Transfer of patients without adequate handover28.8% (n=132)
b)Omissions of critical information about the patients condition19.2% (n=88)
c)Omissions of critical information about the patients care plan
during handover process 14.2% (n=65)
[Thomas et al. Failures in transition: Learning from incidents relating to clinical handover in acute care.
J Healthc Qual. 2012 Jan 23. doi:10.1111/j.1945-1474.2011.00189]
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Sentinel event
Unexpected occurrence involving death or serious physical
or psychological injury, or the risk thereof.
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Most frequently identified root causes of sentinel
events reviewed by theThe Joint Commission by
year
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Anatomy of poor handover
Failure to standardize
Lack of updated info
Interruptions
Limited access to computers/phone
Missing participants
Limited face-to-face verbal update (no interactive questioning & read-back)
Lack of task prioritization
Limited verification of understanding
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Limited bedside handover
PositiveFrame of reference (eyeballing patient)
Sense of ownership (intro pt to handover doctor)
Negative
Patient anxiety with jargonSensitive issues
Time consuming
Limited access to computer
Over-emphasized privacy and concerns
Patterson et al Int J Qual Health Care 2004
Lee et al JGIM 1996
Petersen et al Jt Comm J Qual Improv 1998
Van Eaton et al J Am Coll Surg 2005
ACSQHC July 2005
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Quality & Safety of Clinical Handover
depends on
Technical skills-procedural specific skills (Content)
Non-technical skills(How?)
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What drives a
good handover?
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Handover principles Lessons in action
Leadership
Task allocation
Predicting & Planning
Discipline & composure
Regular briefings
Maintain situation awareness
Use a checklist
Use technology where possible
Regularly review handover processes
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Models of Clinical Handover
SBAR (Situation, background, assessment, recommendation)
ISOBAR (Identify situation, background, agreed plan, read back)
HAND-ME-AN-ISOBAR
SHARED (Situation, history, assessment, risk, expectation,
documentation)
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SBARSituation-Background-Assessment-Recommendation
S: Situation
Identify yourself
Identify the patient (by name and the reason for your report)Describe your concern
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SBARSituation-Background-Assessment-Recommendation
B: Background
Give the patients reason for admission
Explain significant medical history
Inform the consultant of the patients background: admitting diagnosis,
date of admission, prior procedures, current medications, allergies,
pertinent lab results and other relevant diagnostic tests.
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SBARSituation-Background-Assessment-Recommendation
A: Assessment
Vital signs
Contraction patternClinical impressions, concerns
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SBARSituation-Background-Assessment-Recommendation
R: Recommendation
Explain what you needbe specific about request and time frame
Make suggestionsClarify expectations
HAND ME AN ISOBAR
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HAND-ME-AN-ISOBAR
H Hey, its handover time!
A Allocate staff for continuity of patient care
N Nominate participants, time and venueD Document on written sheets and patient notes
M Make sure all participants have arrived
E Elect a leader
A Alerts, attention and safety
N Notice
I Identification of patient
S Situation and status
O Observations of a patient and call to MET (Medical emergency team)
B Background and history
A Action, agreed plan and accountability
R Responsibility and risk management
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Video show
SBAR:
http://www.institute.nhs.uk/safer_care/safer_car
e/sbar_handover_films.html
Trouble with handover short film:
http://www.institute.nhs.uk/safer_care/safer_care/Situation_Background_Assessment_Recomm
endation.html
http://www.institute.nhs.uk/safer_care/safer_care/sbar_handover_films.htmlhttp://www.institute.nhs.uk/safer_care/safer_care/sbar_handover_films.htmlhttp://www.institute.nhs.uk/safer_care/safer_care/Situation_Background_Assessment_Recommendation.htmlhttp://www.institute.nhs.uk/safer_care/safer_care/Situation_Background_Assessment_Recommendation.htmlhttp://www.institute.nhs.uk/safer_care/safer_care/Situation_Background_Assessment_Recommendation.htmlhttp://www.institute.nhs.uk/safer_care/safer_care/Situation_Background_Assessment_Recommendation.htmlhttp://www.institute.nhs.uk/safer_care/safer_care/Situation_Background_Assessment_Recommendation.htmlhttp://www.institute.nhs.uk/safer_care/safer_care/Situation_Background_Assessment_Recommendation.htmlhttp://www.institute.nhs.uk/safer_care/safer_care/sbar_handover_films.htmlhttp://www.institute.nhs.uk/safer_care/safer_care/sbar_handover_films.html -
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Reflections
How effective clinical handover benefits youand your patients?
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