Handover Davy Green

Chinese Whispers Davy Green

What’s the point? Provide seamless care Ensure in-hospital team have all the facts Transfer important/relevant information Building professional relationships

What’s the point? Preparation Space Team Equipment Advanced help/imaging

What’s the point? “Handover of care is one of the most perilous procedures in medicine, and when carried out improperly can be a major contributory factor to subsequent error and harm to patients.” Professor Sir John Lilleyman, Medical Director, National Patient Safety Agency, UK

What’s the problem? “Healthcare professionals sometimes try to give verbal handovers at the same time as the team taking over the patient’s care are setting up vital life support and monitoring equipment. Unless both teams are able to concentrate on the handover of a sick patient, valuable information will be lost.” Junior Doctors Committee, British Medical Association

What’s the problem? Information loss Variance ED talking not listening Not handed over Not understood Variance ED talking not listening Space issues Staffing issues

What’s the problem? Not just NI ED’s! Information Loss In Emergency Medical Services Handover
Of Trauma Patients Alix J. E. Carter, Prehospital Emergency Care 2009;13:280–285 4.9 Data points handed over per patient Only 72.9% of these received

What’s the problem? Not just NI ED’s! Maintaining Eye Contact: How To Communicate At Handover Erin Dean. EN1910Mar2012 06-07 Variance in handovers 93% of time ED asked questions – 1/3 already had provided the answers Recommended 20 second hands off time

What’s the problem? Not just NI ED’s! Review article: Improving the hospital clinical handover between paramedics and emergency department staff in the deteriorating patient, Sarah Dawson,
 Emergency Medicine Australasia (2013) 25, 393–405 Paramedics - Confident and succinct ED staff - actively listening Structure was needed Repeated handovers leads to information being lost ?displaying the prehospital observations on a computer screen

NICE Trauma Guidelines 2015 Record pre-alert information using a structured system and include all of the following: age and sex of the injured person time of incident mechanism of injury injuries suspected signs, including vital signs and Glasgow Coma Scale treatment so far estimated time of arrival at emergency department requirements (such as bloods, specialist services, on-call staff, trauma team or tiered response by trained staff) the ambulance call sign, name of the person taking the call and time of call.

NICE Trauma Guidelines 2015 A senior nurse or trauma team leader should receive the pre-alert information and determine the level of trauma team response. The trauma team leader should be easily identifiable to receive the handover and the trauma team ready to receive the information. The pre-hospital documentation, including the recorded pre-alert information, should be quickly available to the trauma team and placed in the patient’s hospital notes.

NIAS PRF Guidance 2.10 - At handover, the clinician must provide a structured verbal handover with the accompanying PRF. A format such as ATMIST will facilitate this but staff should also include any other pertinent information e.g. patient medications, use of anti- coagulants, allergies, known conditions etc.

What’s the solution? Standardise Proformas Multi-disciplinary buy-in Team working

What’s the solution? Active listening Eye contact Team leader receiving handover Move patient – 30 second ‘hands-off’ Don’t interrupt!

Take 30 seconds hands off for proper handover The Plan Use ATMIST Take 30 seconds hands off for proper handover CPR Haemorrhage control Compromised airway Massive transfusion required

The Plan