Ms. Simone Comiskey.

Quality & Safety Manager ,

St. Mary's Hospital

Quality Improvement Through

Effective Clinical Handover.

Aims for today's presentation

To describe the rationale, background and how

The Elms Ward implemented the Productive

ward, clinical shift handover project

Discuss effective clinical handover process with

patient goals and improved outcomes as central

to the communication process.

Outline supporting resources to support

communication in handover.

Rationale for project

Clear communication & clear accountability was

identified as a recommendation following a

systems analysis review of a serious reportable

event in 2015.

Communication was a key common theme for all

the recommendations that emerged from the

systems analysis review.

Focus of the project

Releasing Time to Care – Productive Ward -

adoption of the productive ward series.

Empowering staff to make positive changes to the

way they work

Improving efficiency & enhancing the patient

outcomes & experiences

improving staff morale.

Genuine MDT synergy & collaboration to improve

patient care and safety

Funding & How we applied the

productive ward funding

St. Mary’s Hospital applied to Nursing & Midwifery Planning & Development , HSE Dublin North , Nursing and Midwifery Innovation funding to support the productive ward project .

The productive ward licence purchased for 23 beds @ cost of 1380.

A external facilitator delivered a 1 day introduction to productive ward series to Multidisciplinary staff .

Training was beneficial & motivated staff to begin the series & examine current practices that contributed to patient care.

Handover boards designed www.visualsystemshealthcare.co.uk

Patient bed boards with assigned nurse identified for the shift.

Hand over project – preparation Deep diagnostic assessment of work practices.

Ward Handover audited for a base line assessment /starting point .

A list of what subject matter handed over was noted. This list was presented to staff & asked to dot vote what they felt was important to hand over from shift to shift.

Staff education :The HSE/shift handover training programme for nurses and Health Care assistants Midlands Regional Hospital , Tullamore, Co. Offaly (2014) www.HSE.ie/shifthandover.ie

Consensus was sought for all changes to ward practices.

Nursing forum: met every 2 months , led by Director of Nursing. This gave the project the urgency for change .

Made the project a priority.

Made a significant impact to boost the change process

Mapped the change process.

www.hse.ie/shifthandover.ie

“On the move”(NHS, 2008)

Concept incorporates 3 components relating to

a) location of handover

b) Receiving handover standing at the patient

communication board.

c) Meet and greet : opportunity to introduce staff

and patients, while exchanging relevant

information at the bedside while facilitating a

person centred approach.

Preparation for handover

The nurse giving handover ensures

that the white board is updated

Ensures that all care plans , assessments and

nursing notes are up to date and accurate .

Any care plan/ assessments that are not up to

date and the nurse cannot complete before the

end of shift time is communcated to next shift on

the white board .

Preparation for shift – allocation of

staff

Identify specific roles and responsibilities ,

Staff are fully aware of where they are allocated

to , who they are working with , who is the nurse

in charge.

Clear allocation of staff nurses and HCAs to

named patients and allocated rooms .

Each HCA Is allocated to a named nurse

New Clinical Handover process

Where :Ward handover commences at white board.

Who: All Nursing & Health Care Assistants

When : At allocated shift handover times

What : information is to be handed over

ISOBAR Communication tool used for handover sheet

Safety Pause :Identifies specific safety issues “heads up” for the forthcoming shift &High alerts handed over.

Key priorities for this shift clearly communicated to staff using the ISOBAR Communication tool.

Structured standardised approach to

handover to achieve key objectives

Improved patient outcomes

Reduced near miss/adverse events

Reduce repetition

Improved patient satisfaction rates

Enhanced safety and effectiveness in the delivery

of care

Enhanced education within handover

Improved quality of information disseminated

Reduced length of handover time