Safe Handover : practical guidance
We read your article in the BMJ published on 14th October 2017, Safe handover: practical guidance with great interest.1 As a trainee doctor, I found this article very helpful.
I recently presented an audit in the clinical governance meeting regarding clinical handover in acute medicine and I would like to take this opportunity to share my audit findings with the wider audience.
While working in the Emergency Assessment Unit (EAU) in Dudley, I noticed a few incidents, which were primarily due to a lack of proper handover practice and ineffective communication between doctors and the nursing staff. Based on these incidents I audited the handover process when patients were transferred from EAU to other medical wards.
The standards for my audit were based on NICE guidelines, which state that healthcare organisation’s policy on communication (clinical handover) is explicit about when and to whom the transfer of responsibility occurs, during and following interdepartmental and shift clinical handover.2 NICE also emphasises on the provision of validated training to the staff by the healthcare organisation and monitoring of the handover process.2 The Royal College of Physicians recommendations for good clinical handover state that, handover should be tailored to the local unit needs. The handover should be recognised as a multi-professional team activity.3
This was a retrospective audit; data were collected from 50 case notes using a data collection form. The handover section in the clerking pro forma for doctors and the nursing transfer checklist were audited. These were the tools currently being used by the trust for the handover process.
The results showed that the doctors completed only four percent handover pro formas, whereas 32% of the nursing transfer checklists were completed. These results were quite concerning, hence I did a survey amongst the junior doctors and physician associates working in EAU. This survey was done using a questionnaire. The results of the survey reflected the findings of the audit. Seventy percent of the clinical staff that participated in the survey was not aware of the handover pro forma; hence they never completed it before the transfer of the patients. A similar number of surveyed staff commented that they had not received any formal training for the handover process. Although, 50% were aware of the guidelines and 70% were aware of the risks associated with the poor handover.
This audit was an eye opener for all of us. As a result of this audit and the survey, it was recommended that all staff should be provided with appropriate training for handover. Handover training should be included in the induction programme for junior doctors and physician associates. Since our trust will soon be digitalised, the e-handover process should be in place by then. The handover process should be regularly audited and monitored in line with the NICE recommendations. Communication should be improved between doctors and the nursing staff. We will repeat this audit after one year and monitor the progress in improving clinical handover practice in acute medicine.
1. Merten H, van Galen LS, Wagner C. Safe Handover: practical guidance. BMJ 2017; 359:j4328.
2. Communication (Clinical Handover) in Acute and Children’s Hospital Services. National Clinical Guideline No. 11 November 2015. ISSN 2009-6259.
3. Acute care toolkit 1: Handover-May 2011. Royal College of Physicians.
Dr Muhammad Shoaib Talib
Trust Grade Doctor in Acute Medicine
Dr Mohan Thomas
Consultant in Acute Medicine
Dr Shahid A. Kausar
Chair Clinical Governance, Clinical Audit and CME meeting for Medical Specialities
Russells Hall Hospital, Dudley
Competing interests: No competing interests