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Clinical Handover 0
The Victorian Department of Health is making this document freely available on the internet for health
services to use and adapt to meet the National Safety and Quality Health Service Standards of the
Australian Commission on Safety and Quality in Health Care. Each health service is responsible for all
decisions on how to use this document at its health service and for any changes to the document. Health
services need to review this document with respect to the local regulatory framework, processes and
training requirements
The author disclaims any warranties, whether expressed or implied, including any warranty as to the
quality, accuracy, or suitability of this information for any particular purpose. The author and reviewers
Clinical Handover 1
cannot be held responsible for the continued currency of the information, for any errors or omissions, and
for any consequences arising there from.
Published by Sector Performance, Quality and Rural Health, Victorian Government, Department of Health
February 2014
Acknowledgements
The Department of Health Victoria acknowledges the contribution of medical and health specialists,
Victorian health services, and members of the National Safety and Quality Health Service Standards:
Educational Resources Project project team, Steering Group and Advisory Committee.
The Steering Group members comprised:
Associate Professor Leanne Boyd, Steering Group Chair; Director of Education, Cabrini Education
and Research Precinct, Cabrini Health
Ms Madeleine Cosgrave, Project Manager
Ms Susan Biggar, Senior Manager, Consumer Partnerships, Health Issues Centre
Mr. David Brown, Consumer representative
Dr Jason Goh, Medical Administration Registrar - Cabrini Health
Mr Matthew Johnson, Simulation Manager, Cabrini Education and Research Precinct, Cabrini
Health
Ms Tanya Warren, Educator, Cabrini Education and Research Precinct, Cabrini Health
Ms Marg Way, Director, Clinical Governance, Alfred Health
Mr Ben Witham, Senior Policy Officer, Quality and Safety, Department of Health Victoria
Clinical Handover 2
Contents
Clinical Handover 3
Introduction 3
Learning outcomes 3
National Standards 3
Aim of Standard 6 3
Policies and procedures 3
Background 4
Principles of clinical handover 4
Clinical Handover 3
Structure of clinical handover 5
Your role in clinical handover 6
Engaging with patients and carers 7
Audit and evaluation 7
Reporting adverse events 8
Summary 9
Test Yourself 10
Answers 11
References 12
Clinical Handover 4
Clinical Handover
Clinical Handover 5
Health service organisations establish mechanisms
to include patients and carers in the clinical handover
processes.
Clinical Handover 6
Background Principles of clinical handover
Clinical handover is practised every day, in a The aim of clinical handover is to ensure the accurate
multitude of ways, in all health care settings. and timely transfer of information, responsibility and
accountability. The key principles include:
Poor or absent clinical handover, or a failure to
transfer information, responsibility and PATIENT AND CARER INVOLVEMENT
accountability, can have extremely serious Where possible, clinical handover should actively
consequences for patients. involve the patient and carer as well as clinicians.
Patients and carers can provide information that is
It can result in: not necessarily available to clinicians.
delays in diagnosis, treatment and care It is important that clinicians listen to patients and
tests being missed or duplicated carers to gain an understanding of this information.
It is also essential that patients and carers
incorrect treatment or medication understand current progress, treatment options and
ACSQHC, 2011 the plan of care.
The risk of a patient experiencing an adverse event is
Current handover practices are highly variable and
reduced by actively involving them in their own care.
unreliable across all disciplines. This can lead to ACSQHC, 2012
discrepancies in the content and accuracy of
information provided.
HANDOVER REQUIRES PREPARATION
Other barriers to communication within health care Handover requires preparation prior to handover
organisations include hierarchy, gender, ethnic time.
background and differences in communication styles.
These inconsistencies in communication cause
considerable risk to patient safety and care.
Clinical Handover 7
Handover should occur at an allocated time and
venue which enables all necessary staff to attend. Handover should always include notification of:
Documents and progress notes should be updated
patients who may require significant levels of
and available at handover time. It is recommended
care or immediate attention
that verbal handover is supported by documentation
such as handover sheets. high acuity patients
patients who are deteriorating or at risk of
Staffing levels and allocations should ensure that
deterioration
patient care is attended to while handover is
occurring. patients who require extra safety measures
ACSQHC, 2010 e.g. infective or bariatric patients
potential or scheduled patient transfer or
HANDOVER NEEDS TO BE WELL ORGANISED discharge
Handover should be led by a designated staff staffing numbers and arrangements e.g.
member who is responsible for ensuring the allocations and activities
exchange of all relevant communication in a timely
ACSQHC, 2010
manner.
Punctuality is important as handover is: HANDOVER MUST INCLUDE TRANSFER OF
ACCOUNTABILITY AND RESPONSIBILITY FOR
crucial to patient safety
PATIENT CARE
paid and protected time for employees Patient handover must ensure the transfer of
ACSQHC, 2010 responsibility and accountability between clinicians
and health services.
Clinical Handover 8
A standard structure and content for clinical
when a patient’s condition warrants it
handover assists in accurately communicating critical
information between clinicians. CLINICAL HANDOVER TOOLS
ACSQHC, 2010
A number of handover tools have been developed to
assist health care professionals to conduct clinical
handovers in a structured and comprehensive way.
Structured handover tools are used to ensure that
staff are sharing relevant, concise and focused
information.
They also:
encourage patient assessment
Structure of clinical handover
facilitate effective communication
All clinical handover processes need to be structured
reduce the need for repetition
and documented. This ensures that all participants
know the purpose of the handover, the required save time for clinicians
information and documentation they need to share. NHS, 2013
Clinical Handover 9
patient handover tool and supported by a summary GIVING HANDOVER
of updated patient information. If you are giving handover ensure you have:
Using only verbal handover is high risk because it Communicated with the patient and carer
relies heavily on memory. The addition of supportive
tools and documentation can: Discuss details of planned transfers and discharges
with the patient and carer.
minimise the risk of omitting information
Communicated with the receiving clinician
improve retention of information
It is important that the receiving clinician and
minimise repetition department are prepared to accept the patient and
reduce the length of handover are aware of the estimated time and details of
ACSQHC, 2010 patient arrival.
It is important to ensure that the person receiving Checked and assessed your patient
handover has understood correctly.
Confirm your patient’s identification details and
assess your patient to ensure they are stable and
A written handover is suitable for patients who are prepared for handover, transfer or discharge.
stable, but the sending clinician should be available
to provide clarification of patient information if
required to do so by the receiving team. Completed documentation
All required documentation needs to be updated and
completed. This includes:
Your role in clinical handover
preparation of handover forms
There are some important points to consider when
giving or receiving handover. updating progress notes
It is vital to maintain the confidentiality of patient completing any transfer or discharge forms
information and patient privacy at all times. including information regarding:
o treating doctor
o admission date and diagnosis
If the patient is to be escorted to a department by a
non-clinical staff member a clinician must provide a o key events during admission
verbal handover to a nominated member of the
o discharge summary
receiving department. This staff member will then
assume responsibility and accountability for the o risks and prevention strategies
patient. o referrals
Clinical Handover 10
Ensure all necessary documentation is kept with the Responsibility and accountability for the patient
patient. must be accepted at the completion of clinical
handover.
RECEIVING HANDOVER
If you are receiving handover, ensure you have: Engaging with patients and carers
Patients and carers should be educated about the
Communicated with the patient and carer need for clinical handover and their role in the
Introduce yourself to the patient and carer and process.
orientate them to the environment.
This collaboration enables an opportunity for
Communicated with the clinician providing patients, carers and clinicians to share information
handover which may impact on the effectiveness of treatment
and care and raise any issues of concern.
You should be aware of the estimated time of patient
arrival and have the environment prepared to You should consider the following when discussing
receive the patient. Ensure you understand all clinical handover with patients and carers:
relevant patient details and clarify anything you are
patients and carers can provide information
unsure about.
that is not necessarily available to clinicians
as carers are more familiar with the patient
Checked and assessed your patient and may spend more time at the bedside.
On arrival, you should perform a baseline head-to-
ensuring patients and carers understand
toe assessment on the patient and document
current progress, treatment options and the
findings in the progress notes.
plan of care
Any areas of concern or points that require explaining the need for clinical handover
clarification should be discussed with the clinician
providing handover before accepting responsibility explaining the patient and carers role in
for the patient. clinical handover, and encouraging them to
raise questions and concerns with the health
Completed documentation care team
Ensure that all necessary documentation has arrived offering information in languages other than
with the patient. All documentation, including English and not assuming literacy
medication and fluid charts, should be checked for
accuracy and completion. providing an opportunity for patients and
carers to ask questions and have them
answered
Clinical Handover 11
Summary
You should ensure that the patient and carer protocol and equipment improvements and
understand the course of the care and have up to education and training activities.
date information about the discharge date and plan. ACSQHC, 2012
ACSQHC, 2012 Clinical handover is the focus of Standard 6 in the
National Safety and Quality Health Service
Standards.
Audit and evaluation
You may be required to participate in audit activities The key messages are:
which could include examination of: 1. Clinical handover is practised every day, in a
patient clinical records multitude of ways, in all health care settings.
Clinical Handover 12
handover must include transfer of
accountability and responsibility for
patient care
7. Structured handover tools are used to
ensure that staff are sharing relevant,
concise and focused information.
8. Minimum datasets are required for all forms
of handover. This is the minimum
information and content required for a
particular type of handover.
9. Face to face handover is recommended
wherever possible as it allows interaction
and clarification of information.
10. It is vital to maintain the confidentiality of
patient information and patient privacy at all
times.
11. Patients and carers should be educated
about the need for clinical handover and
their role in the process.
12. All adverse events relating to poor or absent
clinical handover should be reported in the
risk or incident management system.
Clinical Handover 13
Test Yourself
Answers
Clinical Handover 14
References
1. content, consistency
2. actively
3. patients, information
4. verbal, documentation
5. care, attention
6. responsibility, accountability
7. structured, relevant
8. all, minimum
9. interaction, clarification
10. accurately, critical
Australian Commission on Safety and Quality in Health Care (2010). OSSIE Guide to Clinical Handover
Improvement. Sydney. ACSQHC, 2010.
Australian Commission on Safety and Quality in Health Care (2012). Safety and Quality Improvement Guide
Standard 6: Clinical Handover (October 2012). Sydney. ACSQHC, 2012. Sydney. Commonwealth of Australia
Australian Commission on Safety and Quality in Health Care (2013). Clinical Handover, Standard 6: Fact Sheet
(October 2012). Sydney. ACSQHC, 2012. Sydney. Commonwealth of Australia
NHS Institute for Innovation and Improvement, 2013. SBAR Overview. Accessed at
http://www.institute.nhs.uk/safer_care/safer_care/situation_background_assessment_recommendation.html#
why
The Victorian Quality Council: Safety and Quality in Health (2012). Guide to patient transfer: Principles and
minimum requirements for non-time critical inter-hospital patient transfer. Victorian Government Department
of Health, Melbourne, Victoria. Accessed at
http://docs.health.vic.gov.au/docs/doc/Guide-to-Patient-Transfer-Principles-and-Minimum-Requirements-for-
non-time-critical-inter-hospital-patient-transfer-December-2012
Clinical Handover 15
Appendix 1: Examples of structured clinical
handover tools
iSoBAR
iSoBAR was initially developed for use during inter-hospital transfer, specifically where handover occurred over
the phone. Please refer to Table 2 for details of the iSoBAR acronym. iSoBAR was trialled in Western Australia
and remains in use for many handover scenarios because it was found to be easy to adapt and integrate into
existing work processes (ACQSHC, 2010).
I = IDENTIFCATION OF PATIENT
This step should include positive confirmation of the patient’s identity using at least three identifiers: for
example patient name, date of birth and medical record number.
O = OBSERVATION
This step ensures the incoming team is informed of the latest observations of the patient and when they were
taken. It serves as a checking mechanism to identify deteriorating patients for emergency response assistance.
Unit members need to be aware of local emergency response call criteria and processes.
Clinical Handover 16
period of hours, including across shift handover. The explicit introduction of ‘O’ is therefore designed to ensure
that if patients meet call criteria for an emergency response team or process that handover at least will trigger
that call.
Clinical Handover 17
ISBAR
ISBAR was trialled for interhospital transfer within NSW. Health professionals reported the tool was simple,
memorable and portable (ACQSHC, 2010) and has since been implemented in a number of hospitals within
NSW. In Victoria, a partnership between the VMIA and Southern Health developed resources to assist in
implementing ISBAR in Health Services. These resources are available at: http://www.vmia.vic.gov.au/Risk-
Management/Risk-partnership-programs/Projects/ISBAR.aspx
There is an ISBAR application available to download free from ITunes app store. The application provides health
professionals with handover prompts for a variety of clinical handovers including:
medical
Clinical Handover 18
surgical
mental health
obstetrics and gynaecology
paediatrics
deteriorating patient
The app facilitates the development of individual handover prompts for other specialties, consistent with the
flexible standardisation implementation methodology.
Clinical Handover 19
SBAR
This handover tool has been used in many communication situations, including executive briefings and
incident reports and was trialled in SA, WA and Vic. The tool was utilised to facilitate shift to shift handover
and nurse to doctor communication. Results supported its utilisation with 80% of respondents noting that
handover had improved and reporting more confidence when communicating with doctors (ACSQHC,
2010). SBAR reduces the incidence of missed communications that occur through the use of assumptions,
hints, vagueness or reticence they may be caused by the authority gradient.
1. It helps to prevent breakdowns in verbal and written communication, by creating a shared mental
model around all patient handovers and situations requiring escalation, or critical exchange of
information.
2. SBAR is an effective mechanism to level the traditional hierarchy between doctors and other care
givers by building a common language platform for communicating critical events, thereby reducing
barriers to communication between health care professionals.
3. As a memory prompt, it is easy to remember and encourages prior preparation for communication.
4. Used during handover SBAR can reduce the time spent on this activity thereby releasing time for
clinical care (NHS Institute for Innovation and Improvement, 2013).
S Situation
What is the situation? (Chief complaint, current status)
B Background
What is the clinical background? (Previous history)
A Assessment
What is the problem? (Results of assessment, vital signs and symptoms)
R Request/ Recommendation
What do I recommend/request to be done? (Suggested and anticipated changes, critical monitoring)
Clinical Handover 20
SHARED
The SHARED handover tool was trialled in Queensland to address the communication issues associated
with the critical time around the following points of care within maternity services:
Referral from the midwife to the doctor when a change in the woman’s condition is diagnosed.
Referral from the doctor to the recovery nurse/midwife post Caesarean section.
The project found that the SHARED tool provided a standardised approach that defined the minimum
dataset. Improvements in accuracy and appropriateness of information were noted (ACSQHC, 2010).
Details of the tool can be found in Table 4.
S Situation
H History
A Assessment
R Risk
E Expectation
D Documentation
Clinical Handover 21
Progress notes; care path; relevant electronic health record/database
HAND ME AN ISOBAR
The major principles of clinical handover have been combined with the ISOBAR handover tool to form the
acronym “HAND ME AN ISOBAR”. This reflects what needs to occur and what information needs to be
exchanged during shift to shift nursing handovers.
Clinical Handover 22
HAND ME AN ISOBAR
The major principles of clinical handover have been combined with the ISOBAR handover tool to form the
acronym “HAND ME AN ISOBAR”. This reflects what needs to occur and what information needs to be
exchanged during shift to shift nursing handovers.
Clinical Handover 23
Clinical Handover 24
Clinical Handover 25