Hands Off Clinical Handover Project

Transcription

1 Poster Session HRT11420 Innovation Awards November 2014 Melbourne Hands Off Clinical Handover Project Presenter: Jillian Waring, Donna Robertson, Margaret Murphy, Jennifer Fitzsimons & Kate Hackett Westmead

2 THE PITCH Issues: It was identified there was no standardised handover process between the Emergency Department (ED) and the High Dependency Units (HDU) This was ultimately affecting patient care and patient outcomes. There was a growing need to comply and align practice with the National Safety and Quality Standard 6: Clinical Handover Opportunity: Use the ISBAR tool to standardise practice Modify existing trauma/ Resuscitation handover practices to suit inpatient handover Improve communication between transfer of care from ED to HDU and improve patient care and outcomes

3 PRESENTERS SUMMARY Key problem No standardised handover process between ED and HDU Approximately reported incidents (IIMs) or near misses per month related to clinical handover and transfer of patients from the ED to HDU areas Aim of Innovation To standardise the handover process using the ISBAR tool across ED and HDU areas What we did Modified existing Trauma/ Resuscitation practices into inpatient transfers and handovers Hands Off handover ensuring information is presented to accepting unit in a control focused environment. Allowing an opportunity for dialogue and questions to be asked an answered Outcomes Incidents and near misses have reduced since implementation (June 2014) Communication and trust between the clinical areas has improved

4 KEY PROBLEM No handover process between ED and the HDU areas Approximately IIMs incidents or near misses per month related to clinical handover and transfer of patients from ED to the HDU areas Need to align with NSW Health Safe Clinical Handover Key Principles Person transferring patient wasn t the primary clinician Poor relationships between ED and the HDU units

5 AIM OF THIS INNOVATION To engage ED and High Dependency clinicians in assessment of and reflection on real-time issues with clinical handover; To design an ED-High Dependency handover standard that aligns with the NSW Health Safe Clinical Handover key principles; To integrate this ED-High Dependency handover standard into practice; To evaluate how clinicians use of the designed standard adheres to the NSW Health Safe Clinical Handover key principles; To evaluate the practical impact of the designed standard on clinical safety

6 BASELINE DATA Responses N/A 29.89% (26) Staff not available 33.33% (29) Staff distraction 37.93% (33) Multiple interruptions 32.18% (28) Not primary care nurse: Asked to do transfer 43.68% (38) Excessive questioning by the receiving nurse 27.59% (24) JMO in HDU unaware of patients condition 12.64% (11) Unstable vital signs but PACE criteria not altered 27.59% (24) Takes too long 8.05% (7) Ward nurse unaware patient is for admission to their unit 34.48% (30) Receiving nurse stating patient is too unstable for 18.39% (16) transfer Total Respondents: 87 STAFF SURVEY RESULTS What issues have you encountered as the ED nurse giving handover? (More than one option may be chosen) Following handover, do you have sufficient information for continuity of patient care during your shift? Responses Yes 18.39% (16) Sometimes 48.28% (42) Rarely 13.79% (12) Never 0% (0) N/A 19.54% (17) Total 87

7 KEY CHANGES IMPLEMENTED

8 KEY CHANGES IMPLEMENTED SAGO Chart Emergency staff must complete pages 5 and 6 prior to transfer to the unit/ ward

9 OUTCOMES SO FAR IIMS (incident) data - overall reduction in incidents with the Hands Off clinical handover reporting

10 LESSONS LEARNT There is no such thing as a transfer nurse! All stakeholders were not involved in the initiation of the project e.g. porter/orderly services Clear processes improve patient safety Following the process correctly is time consuming in regards to documentation but has lead to improved patient outcomes and staff relationships

11 FOR MORE INFORMATION: Jillian Waring (02) Jennifer Fitzsimons (02)