MEDICAL HANDOVER.

TAPS – TRAINING AND ACTION FOR PATIENTS SAFETY.

C. Ruprai, M. Kotlinska, C. Brewer, A. Wilson, Mrs. Jha

What is TAPS?

New training programme

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Helping multi-professional clinical teams

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Develop innovative solutions

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Address common patient safety problems

TAPS programme

• Designed by Bradford Institute for Health Research and panel of active clinicians

• Running across Yorkshire (inc. Bradford, Leeds, Sheffield, Doncaster, York)

• 10 teams in Hull (inc. Acute Medicine, Orthopaedics, Pharmacy)

• O&G team: C. Ruprai, M. Kotlinska, C. Brewer, A. Wilson, Mrs. Jha

Medical handover

Poor handover has repeatedly been implicated as a causative factor in adverse incidents

&

improvement in handover has been advocated by a number of agencies

Challenges

• EWTD• Increase patient load• Frequent movement of patients• Involvement of multiple specialist team• Corridor or inconvenient meeting room• Type, formality & information varies• Interruptions

TAPS

20 week programme

November 2011 – March 2012

4 workshops

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1st staff survey (Nov. 2011)

Results presented at Joined Obs.&Anaest. Meeting

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Handover audit (presented in PNM Dec. 2011)

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TAPS

↓ Introduction of unified handover sheet (Jan. 2012)

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Weekly audits for 10 weeks

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2nd staff survey

Your perception of handover

• 2 staff surveys (November 2011 and March 2012)• The questionnaire was randomly given to different levels of staff

• 46 participants in first one and 33 in the second one

• Obstetric, midwifery and anaesthetic members of staff

Results

• Perception of O&G consultant presence at the handover 74%

• Evident absence of the anaesthetic staff• 70% - appropriate setting of the handover • Average score for quality of the handover across all staff was 3.6 (scale 1-5)

Weekly audit

Weekly audit

Who is consistently present at handover

2nd survey

1st survey

On time start of handover

Who leads handover

Have you been pulled out of handover for non-urgent tasks

Setting (quiet and private)

Overall quality of handover

Overall 3.6

Overall 3.8

Is there consistent handover between O&G SpR and consultant

between 5-7pm

Conclusion

• Excellent morning handover involving whole MDT

• Clear improvement in many areas of the handover in TAPS process

• Audit once a year is not good enough tool in monitoring change and hence should be undertaken more frequently

Recommendations

• Evening face-face communication between obs. SpR and consultant needs to be improved, already has been communicated to senior staff

• Repeat staff survey in next several months• Share the experience with others (our ‘journey’ may be used to help improve medical handover in other clinical areas)

Thank you