266 Clinical Notes

Intershift report: oral communicationusing a quality assurance approach

CATHERINE TAYLOR MEPA, BAppSc. (Adv.Nsg.), Dip.CNE,RCNT, RGN, FRCNAAssociate Professor of Nursing, Deakin University, BurwoodCampus, 221 Burwood Highway, Burwood, Victoria 3125, AustraliaCorrespondence: 82 Fulton Road, Mount Eliza, Victoria 3930,Australia

The nursing handover is still a ritual for nurses, however,it is important that regardless of the method used, thecommunication between shifts relating to patient progressneeds to be consistently good. This paper reviews onemethod implemented in an acute medical/surgical wardand discusses the use of a quality assurance project toensure a consistent approach to the handover.

Today more than ever there is a compelling need forcommunicating high-quality patient information accur-ately, completely and in the most timely and effective way(Reiley & Stengrevics, 1989). Nurses regularly maintainsome system for communicating patient information fromone shift to another, however, the number of timessomething important is missed, suggests that this is an areaworth reviewing.

On a 40-bed acute medical/surgical ward the chargenurse decided to review the nursing handover. The prob-lems experienced were not new, the handover was takingtoo long and information was sometimes missed. The off-going shift were constantly leaving late while the on-coming shift often started their other duties behind sched-ule. Although the nurses in the ward were allocated aspecific number of patients to care for each shift, they stillhad to care for other patients over meal breaks. Thehandover up until now encompassed all on-coming nursessitting in a room and the various registered nurses incharge of a group of patients, rotating through the processof giving a verbal report which comprised the situationsthey felt or remembered needed to be handed over to theon-coming shift.

All nurses took down all details of all the patients.Although this gave an overview of the ward it did notengender particular interest in the individual patient groupfor the shift, the result of which was no specific questionswere asked and valuable time was wasted at a later time intrying to have particular questions answered.

A variety of change of shift handovers were reviewedand eventually it was decided that the nurse in chargewould give all the on-coming staff a brief overview of thestatus of all patients in the ward, this would allow all

nurses to be at least aware of all patients in the ward. Thenurses were then given their allocated patients for the shiftand went to meet with the off-going nurse who cared forthe same patients.

The one-to-one verbal report provided the detail thenurses needed to know to care for their allocated patients.Unlike Young et al. (1988), who recommended a silentreport where the on-coming nurse reviews all patientcharts then discusses the care with the off-going nurse, itwas decided that the handover would be one to one at thebedside, which could involve the patients in their own carewhere applicable.

At the bedside the charts were reviewed by both nurseswith any questions being asked and answered at this stage.Other information exchanged at this time included whathad transpired during the previous shift, any new ordersreceived, test results, or changes in the care plan, as well asnursing assessment and intervention information. Thepatient was also involved in the handover.

As valuable information was still not communicated tothe on-coming shift on occasions it was decided that aquality assurance project to review what was actuallyhappening should be initiated.

The audit tool developed required questions to be

Table I Sample of audit questionnaire

Did the handover take place at each bedside?Did each nurse speak to the patient regardingintroduction and greetings?Did each nurse review and discuss the relevant chartswith implications for the nursing care on the shift justcommenced?How was this carried out?Was the patient encouraged to input to the plannedcare?Was the care carried out on the previous shiftdiscussed?If not, why not?Comments:

,ri()) oh ol !Were new or changed priorities emphasized?Did the nunse coming on to the shift, check:—the IV rate?— any other equipment being used?Were the results of tests noted in the charts?Would the recorder describe the handover asprofessionally conducted?If not, why not? State,Comments:

Any other relevant comments.

Yes No

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answered on what was happening at that moment regard-ing handover techniques. The audit was therefore to beconcurrent. The advantage of this approach was that ifcertain aspects were identified as a problem then some-thing could be done about it while the patient was still inhospital.

It was decided that a random audit was appropriate overa 1-month period and this would occur over all three shifts.The audit questions were developed by identifying themajor requirements of the handover, which were deemedessential for accurate communication regarding patientprogress (Table 1).

The results of the concurrent audit on the nursinghandover revealed an improvement in the communicationbetween staff with less time wasted in accessing informa-tion. However, some nurses felt the patients should not

Clinical Notes 267

overhear their conversation, so the handover took place atthe ward door and not at the bedside. Information regard-ing patient progress, in particular accurate charting wasoften missed as a result of this.

The majority of staff, however, felt that to conduct thehandover at the bedside provided a more informativeapproach to patient care at the beginning of each shift andthe consensus of opinion was to persevere with the newmethod, and that all staff should conform to ward practicewith a review in 6 months.

References

Rciley P.J. & Stengrevics S.S. (1989) Change of shift report: put it inwriting. Nursing Management 20(9), 5-4—56.

Young P., Maguire M. & Ovitt E. (1988) Implementing changes incritical care shift report. Educational Dimension 7(6), 374—376.

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