Influence of clinical bedside handover on patient's recovery and health.

Author: Iloka Benneth Chiemelie
Published: 28th April 2018

The issues

By definition, clinical bedside handover is used to reference the transfer of professional responsibility and accountability of some or all aspects of a patient’s care, or a group or patient, to another professional or personnel for a temporal or permanent basis. (Chaboyer, et al., 2012) For instance, is a patient is under a hospital that features nurses working different shift (morning and night), and the patient is expected to stay in the hospital for the two shifts, behind handover means how the morning shift nurse will be able to accurately transfer all information about the patient to the evening shift nurse in order to ensure that the patient continues to get desired and required treatment (McMurray, Chaboyer, & Wallis, 2009).

It has been identified both in the context of the UAE and internationally that clinical handover is a high risk step in the course of a patient’s hospital journey (Bradley & Mott, 2010). Handover of care in hospitals is one of the most perilous and critical process in medicine, and if it improperly carried out, it can serve as a major contributory factor for further errors and harms to the patient.

A number of practices have been identified in past survey as resulting to such variation in clinical handover, and they include human factors like culture, views, beliefs and poor communication that bring about differences in professional nursing practice when it comes to clinical handover. On the side of the patients, a number of factors have also been found to hinder good clinical handover by healthcare professions based on the understanding that there is a continuing increase in the complexity of care and profile of diseases produced by new treatment and longer life expectancy and creating higher burden for illness (Australian Department of Health, 2015).

No matter the course of setting, the fact is simple and straightforward. If clinical handover is not properly done, it does create numerous issues for both the professionals and patient, and this will result to other issues - complexity of illness and treatment, as well as increased medicate care fee – for the patient. Potentially, it could go beyond fixing damages and actually effect overall life expectancy of such patient.

Why is it an issue?

Bedside handover is a big issue in the nursing profession due to the fact that it result to numerous risks for the patient. The risks associated with bedside handover (whether it comes as part of a handover in shift or as part of inter-departmental clinical handover or as part of communication and information flow) does result to deterioration on the health conditions of the affected patients and this is why such risks make this process a big issue (Chaboyer, McMurray, & Wallis, Bedside Bedside Handover: Standard Handover; Standard Operating Protocols, n.d.). The risks are somewhat similar and they are as discussed below:

It has the potential to create inappropriate and delayed treatment for the patient and this can include delay in critical referrals. The resulting outcome is a heightened threat to the life of such patient within an acute setting. Due to poor bedside handover, a patient that is supposed to get surgery within 30 minutes might end up getting such in over 1 hours and this has high level of threat to the life of such patient;

Considering that poor bedside transfer practice can result to inaccurate or incomplete information, once the patient notices the difference in terms of information communicated with different professionals on their personal health, it can result to loss of trust and confidence between the patient and staffs;

This issue can also bring about inefficient use of resources and time, which will eventually result to breakdown in the continuity of care. For instance, if a machine has bene prepared for surgery within the next 2 hours and the machine is forced to function over 4 hours due to poor bedsides handover, efficiency of such machine could be reduce  - resulting to higher chances of breakdown in the process; and

Additionally, this can increase hospital bills as patients might end up getting treatment for illness not suffered or being treated more than is expected (Chaboyer, McMurray, & Wallis, Implementing Nursing Bedside Handover, 2012).

As such, it is evidently clear that the risk associated with poor bedside handover practice does put patients at higher health risks and negatively impacting on the trust between patients and staffs (as well as professionals in general). If the staff notices that there is a poor communication and inaccurate flow of information between healthcare professionals as it relates to the patient’s health, the patient will find it difficult sharing more information or trusting the treatment received. Thus, it can lead to further damages bedsides the issue of health. It can also impact negatively on overall quality of services received and trust between the patient and healthcare practitioners (McMurray, Chaboyer, & Wallis, 2009).

Critical reflection from experience in nursing practice

From personal experience, this is a big issue. I has this experience as a patient. In one of the hospitals in UAE, I was feeling feverish and was admitted in the process. Unfortunately, I arrived just few hours before handover and while the nurse was just getting to understand my health issues, she handed over to another nurse who instead of asking me question (as I was expecting more questions considering that I have note answered all that were asked by the previous nurse), proceeded it treatment.

In the course of the treatment, I noticed that some of the medications were not related to what I was feeling. My ability to spot the difference is basically because I am in the medical setting. Thus, it would generally be difficult for a normal patient to spot the difference in medication – further highlighting the need for proper bedside handover. It was only after I demanded for a proper recheck that the healthcare professional started afresh to study my health – resulting to time and resource inefficiency as discussed above.

From the professional level, risks associated with poor bedside handover practice are normally compounded by a number of factors such as those discussed below.

The structure of hierarchy in the health service systems, which generally increase bureaucracy and reduce time efficiency.

Boundaries created in the disciplinary functions that hinder proper communication between the healthcare practitioners. For instance, a medical laboratory scientist dropping medical results on the receptionist table instead of going directly to the doctor to discuss all findings.

Resistance of the professional to change. Sticking with what is conventionally obtainable even if it does not guarantee quality of patient’s health.

 Lack of standardized practice in clinical handover, bringing about healthcare professionals adopting gut feelings instead of established facts. 

Research findings bedside handover

(National Nursing Research Unit, 2012) conducted a research six wards of two hospitals in Western Australia and Queensland between 2007 to 2008, over 500 cases of bedsides handover were observed and more than 30 nurses interviewed. It was discovered that there are numerous cases of poor handover, and a change management process when used with bedsides handover leads to successful implementation in different forms of clinical settings. The major discovery here is that nurses acknowledge that bedsides handover practice does bring about high level of information accuracy during exchange, and provide nurses with greater opportunity of working in partnership with their patients (Clemens, 2008). Additionally, it was noticed that bedside handover does not increase the time required for actual handover as about 1.5 minute was found to be spent on average on bedside handover. In fact, it was found to save incoming nurses time considering that bedside handover is much comprehensive, and prompted patient visualization that lead to easier identification of care practices (Hada, n.d.). On coming nurses are more of active participants and they do not passively receive information, leading to higher degree of patient safety as safer scan and medical review re prompted through questioning of outgoing nurses and patients in the process. Finally, the major concern here is how the privacy of patient can be effectively managed.

In a similar study within the UAE, it was also found that bedside handover was more effective than normal handover but complexity arise based on the complication of case being made. Additionally, there are instances where the patient was asleep during the handover and could not monitor overall process (Chaboyer, et al., 2012). On the same note, some handovers initiated at the bedside were actually completed out of bedside – hindering patient’s full participation in the whole process. Thus, there is an obvious need for proper bedside handover practice in order to ensure that information between the staffs are accurate and quality of healthcare practice is maintained in the process. Based on literatures, the benefits and challenges of bedside handover are as discussed below:

Benefits

Study of staffs view does indicate that bedside handover improve efficiency and safety of case due to the fact that staffs communicate and interact in a more structures way. It also helps to improve the quality of information and access based on the understanding that patients also participate. In the process, nurses feel that they are part of a more effective working environment and they are supported by the staffs – improving overall work experience in the process (Chaboyer, McMurray, & Wallis, Standard Operating Protocol for Implementing Bedside Handover in Nursing , 2008).

From the patients view, it has been discovered that it allows patients to discover more information about their health and interact with the staffs. They feel that the staffs are focused on them and are concerned about their needs. It allows them to work better with staffs and be fully involved in the decision making process. Finally, staffs spend vast amount of time with them in the course of understanding their personal health condition.

Challenges

It requires accurate documentation in order to support overall communication, avoid cases of information being lost and allow the staffs that are not present at the handover to access necessary information. Sometime, the staffs can be uncertain about what to include in the bedside handover and how to get the patients involved. Anxiety can also arise from the patients and the families in cases where they don’t understand the information being communicated or the language being used (Chaboyer, McMurray, & Wallis, Standard Operating Protocol for Implementing Bedside Handover in Nursing , 2008).

Recommendation

In recommendation, bedside handover practice should follow the following principles. 1) the outgoing nurse should introduce the incoming nurse to the patient, sharing vital information (such as present medical condition, past medical history, test and procedures conducted, areas assistance are needed, and discharge plan) with each other at the attention of the patient; 2) the nurses should review the patient’s medical chat together, checking on any drips or drain that the patient might have, and the patient should be asked to comment on the information being discussed where necessary; and 3) the nurses should adopt discretion whenever they are discussing sensitive information about the health of the patient (Valep, n.d.). In essence, their focus should be on patients healthcare, adopting necessary measure to ensure that the patients are treated right and the quality of services provided is in line with set standards.

References

Australian Department of Health. (2015, 11 11). Communication (Clinical Handover) in Acute and Children’s Hospital Services. Retrieved from Australian Department of Health: http://health.gov.ie/wp-content/uploads/2015/12/NCG-No-11-Clinical-Handover-Acute-and-Childrens-Hospital-Services-Full-Report.pdf

Bradley, S., & Mott, S. (2010). Handover: Faster and safer? Retrieved from AUSTRALIAN JOURNAL OF ADVANCED NURSING: http://www.ajan.com.au/vol30/issue1/bradley.pdf

Chaboyer, W., McMurray, A., & Wallis, M. (2008). Standard Operating Protocol for Implementing Bedside Handover in Nursing . Retrieved from Australian commission on safety and quality in healthcare: https://safetyandquality.gov.au/wp-content/uploads/2012/02/SOP-Bedside-Handover.pdf

Chaboyer, W., McMurray, A., & Wallis, M. (2012). Implementing Nursing Bedside Handover. Retrieved from Australian Commission on Safety and Quality in: https://safetyandquality.gov.au/wp-content/uploads/2012/02/Bedside.pdf

Chaboyer, W., McMurray, A., & Wallis, M. (n.d.). Bedside Bedside Handover: Standard Handover; Standard Operating Protocols. Retrieved from Australian Commission on Safety and Quality in Health Care: https://www.health.qld.gov.au/psq/handover/docs/ch_presentation1.pdf

Chaboyer, W., McMurray, A., Johnson, J., Hardy, L., Wallis, M., & Chu, S. (2012). Bedside Handover; One Quality Improvement Strategy to “Transform Care at the Bedside” . Retrieved from Griffith University: http://www98.griffith.edu.au/dspace/bitstream/handle/10072/29476/59352_1.pdf

Clemens, T. (2008). Bedside handover – implementing and evaluating change . Retrieved from Royal Children’s Hospital: http://www.awch.org.au/pdfs/conferences/2008/10_CLEMENS_Teresa_2.pdf

Hada, A. (n.d.). Shift-to-fhist nursing bedside handover education package in a geriatric and rehabilitation unit. Retrieved from Princess Alexandra Hospital: http://www.arna.com.au/ARNA/Documents/Hada_Shift_to_shift_Nursing_bedside_handover.pdf

McMurray, A., Chaboyer, W., & Wallis, M. (2009). Implementing Bedside Handover: Strategies for Change Management. Retrieved from Journal of Clinical Nursing: http://www98.griffith.edu.au/dspace/bitstream/handle/10072/34146/64540_1.pdf?sequence=1

National Nursing Research Unit. (2012, 11 12). What are the benefits and challenges of ‘bedside’ nursing handovers? . Retrieved from King's College London: https://www.kcl.ac.uk/nursing/research/nnru/policy/By-Issue-Number/Policy--Issue-36.pdf

Valep, M. (n.d.). Bedsie clinical handover information for patients. Retrieved from Mary Valep Hospital: http://www.maryvaleph.com.au/wp-content/uploads/2016/07/Bedside-Clinical-Handover-Information.pdf