1. Joanne Lomax | BACCN Conference September 2018 | Bournemouth
Improving Critical Care Handovers - a reflection on my checklist creation
Joanne Lomax | BACCN Conference September | Bournemouth
Introduction
Research reported on in July 2018 found that many clinicians rely on their memory during patient handover which has led to participants reporting feeling less confident that they had received all essential information (Nursing Times, 2018). Bhabra et al (2007) comments that note taking is shown to be an effective method of handover.
The design of the handover sheet embed these principles and helps provide a structured approach to handover note taking. This has helped colleagues in ICU to be more assured in handover and ensure tasks and process are recorded to be shared at handover, aiding efficiency and with the aim to support patient safety.
Development of the Handover checklist
Over a period of time I began to recognise the basic structure of the handover from nurse-nurse on my unit. I also noted how my colleagues would document the patient’s care at the end of the shift and use this as a baseline for the handover to the following shift. Aslanidis, et al. (2014) identified that the structure of the intensive care handover should emphasise a system-based approach focusing on each system in turn, such as the respiratory system and the central nervous system.
The Conwy and Denbighshire NHS Trust (2007) also recommended that as well as a structured approach the handover should follow the 5 P’s rule:
P1: Patient’s name, diagnosis, doctor and past
relevant history
P2: Patient’s date/reason for admission
P3: Present restrictions (i.e. fluids only etc.)
P4: Plan of care
P5: Progression
The NMC Code of Conduct (2015) outlines that as registered nurses we need to make sure that any treatment or care for which we are responsible is delivered without undue delay and that we manage time effectively to ensure the quality of care delivered is putting the needs of those receiving care first. I also included a time line so that I could document my jobs and ensure they were completed according to the time I needed them done.
With all this mind, I designed the handover/checklist. Initially it’s intention was for my own use, however as more colleagues saw me working with it, it was suggested it was rolled out across the unit.
Discussion & results
Staff were invited to respond to a survey to evaluate the effectiveness of the handover/checklist.
Of 37 respondents, 25 use the task list and of these 25, 88% thought the list had a positive impact (12% thought the impact was neutral). 100% (n=25) would recommend to new colleagues on ICU and 83% to other wards and units. Of the 22 who thought the list had a positive impact, 91% thought it improved handover and 73% thought it improved time management. The introduction of the structured handover model has ensured that handover between nursing staff is properly documented and that tasks are completed in good time. There has been no recommendation for change to act on; however following on from the results of the study the handover has now been introduced to other critical care areas in the trust.
Key points
The handover task list has been quickly adopted by staff – without any mandate
Staff agree the checklist has benefits to handover and time management
Other wards are also adopting, demonstrating its flexibility & value
Anecdotally new nurses have found the checklist provides a quality structure and level of detail expected in handovers