A Human Factors based analysis of a clinical Handover system in acute care setting

Transcription

1 A Human Factors based analysis of a clinical Handover system in acute care setting Dr Srikanth Mada Consultant Endocrinologist

2 Human Factors In health - 1: 10 patients suffer from preventable harm (DOH, 2000) 70% of harm -Poor or break down in communication( NPSA, 2012). Enhancing clinical performance through an understanding of the effects teamwork, tasks, equipment, workspace, culture, organization, on human behavior(catchpole, 2013) Any thing that affects a clinician performance (Norris, 2012) Ergonomics is a scientific discipline concerned with the understanding of humans and other elements of a system (Chfg.org) Health care is a high risk industry The study of all the factors that make it easier to do the work in the right way. Study of the interrelationship between humans the tools and equipment they use in work place and the environment in which they work. 98,000 deaths/yr -USA & 850,000 adverse events in UK hospitals/ year ( DOH, Kohn, 1998). Ineffective handover of care at shift change is a significant risk to patients care ( Roughton, 2009).

3 Benefits of integrating Human Factors. Design of work environment and medical devices Design of healthcare systems Build safer clinical systems Enhance team work Measure Non-Technical skills Investigate incident situation.

4 Handover : safety critical task. High Risk: leading to preventable adverse events Gaps in the continuity of care ( Cook,2000) Not enough time set for handover Increased incidents (JCNPSA, 2009) Poor strategies set to fail (Hoffman, 2007) No designated time (Tokodem, 2008) No formal requirement to attend (McCann, 2007) No standardised methodology (Vidyarthi,2006) Hanover key Priority ( RCP 02)

5 Clinical handover Situational Awareness Effective communication Gathering Info Interpreting info Anticipation Working memory Giving info clearly & concisely Standardise Listening skills Identify and address barriers of communication. Hand over of patients care Team working Skills Leadership Skills Supporting Conflict resolution Exchange info Co-ordinating A A n t i c i p a t o r y C H a n d o v e r Use authority Maintaining standards Plan & priorities Manage work load and resources (LawrenceRH,2008) B P r e p a r a t o r y D P o s t h a n d o v e r

6 Hand over

7 Junior doctor at work Individual Uncertainty Individual experience led Loss of SA Poor standard handover Stress and Fatigue Poor job satisfaction Increased incidents

8 RCP Acute care toolkit-handover. Policy & Culture Documentation, discussion, seminar & champions. Training & Standardize Induction, I-P education Tailor to local unit A&E, AMU, back of the house etc) Multiprofessional Avoid silo workings Time and Environment Leadership Presence of senior staff.

9 SHELL Model ( Hawkins,1975) S Hardware H Hardware. IT technology Computers Devices etc. E Software. Governance frame works Policy Structured Induction SOP Software L Human Factors in Handover Environment L Environment Organisation Wards, Specialty Man power Equipment Service users. Team/ Group. Team dynamics Inter-professional skills Hierarchy Different training methods Priorities Liveware (Team) Liveware (individual) Liveware Individual experience Training Previous exposure Personal skills etc.

10 Traditional Vrs Human Factors based Paper based Stake holders, Standardized Duplication, not standard No Audit trail Gov issues, poor satisfaction Handover Trainee Champion IG standard, Audit trail IT custom build

11 Patient Screen: The patient screen is separated into four areas: Patient/ Bed information Handover Observations Task Management

12 Handover Handover should be updated when a patient s condition changes, when modifications to treatment or discharge plans occur, or during board/ward rounds. To add to the handover click into any of the white boxes with the grey arrows. Input your information and press on handover (in top left corner of screen) to save the information. This will be date and time stamped with your name and will automatically update across all devices and the web platform.

13 Accessing Charts Charts can be accessed by clicking the chart button in the observation page. If the device is held portrait it will display the grid view, if turned landscape it will show the trends. Portrait Landscape

14 Once a patient has been seen they need to be removed from the list. In the individual patient screen, under the section added to lists, swipe the list you wish to remove to the left. A delete button will then appear; once the delete button is pressed the patient will be removed from the list. Patients should be removed in a timely manner, ideally after the patient has been seen. However, please can you ensure all previous day jobs are removed at the morning handover.

15 Handover evaluation : Series 1 n= 15 (July 2016) Previous Handover rating: 2.5/5 New IT based handover rating : 4/5. Has nerve center improved quality of handover : 65%(yes). Has nerve center improved efficiency of handover 100%.

16 Handover evaluation : Series 2 n= 15(Jan 2017) Experience of IT based handover rating : 3.9/5. Ease of use: 4.5/5 Rate nerve center based quality of handover : 80%(4/5). Percentage of weekend hand over via Nerve center: 100%. Has nerve center improved efficiency of handover 100%. Incomplete input by the user!.

17 Summary Human factors principles integration enhances patients safety Health Organisations do need to think proactively working closely with Human factor experts. Integration of Human factors do enhance safe hand over during shift change overs. Need measures to increase awareness of Human factors.

18 Acknowledgement 01 Health Education North East and NELA CDDFT Education Department 02 Teesside University Gillain Janes, John Franklin, Dave Murray 03 Glocal Academy and Brighton Medical School Dr Krishnakanth 04 Trainee Champion / Project lead Dr Taylor / Paul Latimer

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