2. Introduction
Bedside handover is a key initiative for patient safety
Sustaining this practice is a challenging process
Process of exchanging accurate patient information
and nurse responsibility
More organised nurse-patient conversation
4. Relevant Literature
Enhance team collaboration and nurse satisfaction
Increases patient interest and involvement
Allows shared decision making and care planning
Minimize medication error and identify near misses
Helps to build therapeutic relationship
5. NSQHS Standards
Communicating for
Safety Standard
Handover systems and
processes are used for
continuity of safe
patient care
Partnering with
Consumer Standard
Patient participation
enhance patient
experience and
progress
9. Leadership Style
and Capabilities
Reflecting upon my capabilities,
my communication skills still need
further improvement
Having effective communication
skills is essential for nursing
practice and leadership
10. Plans to Further Improve
Volunteering during
team discussions
Engaging in nursing
handovers
Communication
workshops
11. References
Australian Commission on Safety and Quality in Health Care. (2017). National safety and quality health service (NSQHS) standards.
https://www.safetyandquality.gov.au/sites/default/files/2019-04/National-Safety-and-Quality-Health-Service-Standards-second-
edition.pdf
Australian Commission on Safety and Quality in Health Care. (2019). National safety and quality health service (NSQHS) standards.
https://www.safetyandquality.gov.au/standards/nsqhs-standards/communicating-safety-standard/communication-clinical-
handover/action-608#key-tasks
Bressan, Mio, M., & Palese, A. (2020). Nursing handovers and patient safety: Findings from an umbrella review. Journal of Advanced
Nursing, 76(4), 927–938. https://doi.org/10.1111/jan.14288.
Dorvil, B. (2018). The secrets to successful nurse bedside shift report implementation and sustainability. Nursing management, 49(6),
20. https://journals.lww.com/nursingmanagement/Fulltext/2018/06000/The_secrets_to_successful_nurse_bedside_shift.7.aspx
Hada, J., Jack, L., & Coyer, F. (2019). Using a knowledge translation framework to identify barriers and supports to effective nursing
handover: A focus group study. Heliyon, 5(6), 1960–1960. https://doi.org/10.1016/j.heliyon.2019.e01960
Malfait, S., Eeckloo, K., Biesen, W. V., & Hecke, A. V. (2019). The effectiveness of bedside handovers: A multilevel, longitudinal study
of effects on nurses and patients. Journal of Advanced Nursing, 75(8), 1690–1701. https://doi.org/10.1111/jan.13954
12. Marmor, G. O., & Li, M. Y. (2017). Improving emergency department medical clinical handover: Barriers at the bedside. Emergency
Medicine Australasia, 29(3), 297–302. https://doi.org/10.1111/1742-6723.12768
McSherry, R., & Pearce, P. (2016). What are the effective ways to translate clinical leadership into health care quality
improvement?. Journal of Healthcare Leadership, 8, 11–17. https://doi.org/10.2147/JHL.S46170
Redley, B., & Waugh, R. (2018). Mixed methods evaluation of a quality improvement and audit tool for nurse-to-nurse bedside
clinical handover in ward settings. Applied Nursing Research, 40, 80–89. https://doi.org/10.1016/j.apnr.2017.12.013
Sharp, L., Dahlen, C., & Bergenmar, M. (2019). Observations of nursing staff compliance to a checklist for person‐centred handovers
– A quality improvement project. Scandinavian Journal of Caring Sciences, 33(4), 892–901. https://doi.org/10.1111/scs.12686
Slade, D., Murray, K. A., Pun, J. K. H., & Eggins, S. (2019). Nurses’ perceptions of mandatory bedside clinical handovers: An
Australian hospital study. Journal of Nursing Management, 27(1), 161–171. https://doi.org/10.1111/jonm.12661
Small, A., Gist, D., Souza, D., Dalton, J., Magny-Normilus, C., & David, D. (2016). Using Kotter's change model for implementing
bedside handoff: A quality improvement project. Journal of nursing care quality, 31(4), 304-309.
https://journals.lww.com/jncqjournal/Citation/2016/10000/Using_Kotter_s_Change_Model_for_Implementing.2.aspx
Thomson, H., Tourangeau, A., Jeffs, L., & Puts, M. (2018). Factors affecting quality of nurse shift handover in the emergency
department. Journal of Advanced Nursing, 74(4), 876–886. https://doi.org/10.1111/jan.13499
Tobiano, G., Bucknall, T., Sladdin, I., Whitty, J. A., & Chaboyer, W. (2018). Patient participation in nursing bedside handover: A
systematic mixed methods review. International Journal of Nursing Studies, 77, 243–258.
https://doi.org/10.1016/j.ijnurstu.2017.10.014
Wainwright, C., & Wright, K. M. (2016). Nursing clinical handover improvement practices among acute inpatients in a tertiary
hospital in Sydney: A best practice implementation project. JBI Evidence Synthesis, 14(10), 263-275.
https://journals.lww.com/jbisrir/Abstract/2016/10000/Nursing_clinical_handover_improvement_practices.19.aspx
Editor's Notes
Implementation of an effective patient-centred bedside handover is a key initiative to patient safety and a global priority as it provides an opportunity and time for nurses to observe their patients and interact with them directly in order to improve continuity of care (Sharp et al., 2019). It involves a primary process of accurate transfer of information, responsibility and accountability from one nurse to another which reduces patient harm (Sharp et al., 2019).
The major priority that needs improvement in the process includes effective communication between nurses and other clinicians and compliance of the staff towards performing structured handovers at the end of each shift (Slade et al., 2018). The adoption and sustainability of this initiative is a challenging and time-consuming process, where nurse leaders and other staff requires full organizational support to enhance patient safety culture (Slade et al., 2018).
Although bedside handover has been in practice from a long period of time, significant efforts are still being made by healthcare organisations to improve the quality of handovers as nursing handover remains highly variable in process and content (Hada et al., 2019) . The implementation of patient-centred bedside handover is an important part for improving patient safety in healthcare organisations, however, poor bedside handovers can result in delayed treatment, preventable readmissions, medication errors and incomplete information transfer (Marmor & Li, 2017).
The patient-centered handover needs continuous improvements and changes such as structure of the handovers and compliance of clinical staff to the handover checklists to improve the quality of bedside handovers (Redley & Waugh, 2018). Unreliable and variable handover processes can result in significant threats and can cause patient harm in hospitals (Redley & Waugh, 2018).
The fishbone or cause and effect diagram above shows the variety of causes that can lead to an ineffective bedside handover process and focusing to resolve these causes can improve the quality of handover (Thomson et al., 2018). As shown in the diagram, inadequate policies and procedures, lack of communication between staff, patient’s literacy level and miscommunication can lead to poor handover (Hada et al., 2019). Furthermore, lack of staff’s knowledge, training, and compliance to the process are factors that also contribute to failure of an effective handover (Wainwright & Wright, 2016). Studies suggest the nurse’s perception of patient’s confidentiality breach while performing bedside handovers is also a major concern that causes reluctance (Tobiano et al., 2018). Other barriers include inadequate handover tools (ISBAR: Introduction, Situation, Background, Assessment, Recommendation) or models to be followed, inconsistent evaluation, fatigued staff due to workload and distractions such as patients pressing nurse bells during handover (Thomson et al., 2018).
There is a plethora of literature that supports the significance of nurse-patient bedside handover as it does not only improve patient outcomes, but also enhances teamwork and respect between the nursing staff which increases staff productivity and job satisfaction (Dorvil, 2018). Studies suggest patients actively participating in handovers know more about their health status and treatment and hence are more satisfied with hospital service experiences (Wainwright & Wright, 2016).
Moreover, along with providing accurate patient information, bedside handover process has also been proved to increase patient safety by minimizing the risk of medication errors and provide nurses an opportunity to build good rapport with their patients (Bressan et al., 2020). As bedside handover allows the patients to participate, patients can specify their expectations and preferences to the nursing staff, which helps the nurses to provide more individualized care to each patient (Malfait et al., 2018).
The Standard 6 of National Safety and Quality Health Service Standard (NSQHS) emphasises on implementation of tools, policies and procedures for safe and effective clinical handover systems and processes that can be used by all the clinicians involved in patient care, and it also recognizes the importance of bedside handover (Australian Commission on Quality and Safety in Healthcare [ACQSHC], 2017). The use of safe and effective handover process and system improve the patient outcomes and safety (ACQSHC, 2017).
Bedside handovers also link with partnering with consumer standard by involving patients and carers in the planning and building effective partnerships (ACQSHC, 2017). Additionally, the involvement of patients and their families in the handovers has been proved to increase patient satisfaction, nurse-patient partnership and hence, better patient outcomes (Tobiano et al., 2018). Furthermore, there is strong evidence that nurse-patient bedside handovers significantly improve patient outcomes and patient experience in hospitals (Dorvil, 2018). Other advantages include improved documentation and discharge processes and hence improved transition of care (Tobiano et al., 2018).
The Australian Commission on Quality and Safety in Healthcare states that an adequately structured clinical handover is critical to safe patient care and involving patients and family is important to increase patient satisfaction (ACQSHC, 2019). The bedside handover also increases timeliness and accuracy of information to be exchanged between the staff (ACQSHC, 2019).
Moreover, the framework for conducting an effective clinical handover has been described by ACQSHC, which involves key principles to be used while handover. It includes nomination of a team leader for each handover process or when transferring care and involving the right participants such as multidisciplinary team and patients (ACQSHC, 2019). In addition, it is essential to arrange a format, specific place, time, and duration for an effective handover to occur in a healthcare setting to maintain consistency of the process (ACQSHC, 2019). Similarly, a handover should include a structured format with required content of information to be communicated in an organized manner while transfer of patient care (ACQSHC, 2019).
The first step in Kotter’s steps for leading change starts with ensuring that all the clinical staff understands the reasons and seriousness for implementing change in handover process, which is to improve patient safety and outcomes, communication, and quality of care delivered (Small et al., 2016). The second step includes involvement of enthusiastic, strong leaders such as hospital managers, nurse unit managers, nurse educators to motivate the other nursing staff to embrace the change by guiding and educating all staff about the process using adequate resources (Bressan et al., 2019). Involving clinical leaders is important to implement quality improvement and change in healthcare (McSherry and Pearce, 2016).
Furthermore, creating a vision of ensuring patient safety improvement and effective communication between nurses at bedside handover will direct the change and communicating that vision with all nursing staff via weekly education sessions and staff meetings will also help to educate and train the staff (Small et al., 2016). Training nurses to use equipment/tools such as electronic medical records, best practice handover videos or role playing will help to motivate the staff towards improvement (Hada et al., 2019).
The next step is to empower and enable the nursing staff to engage in daily bedside handovers, encourage patients and families to participate in conversations and ensure that staff communicate effectively (Small et al., 2016). To achieve this, nurse leaders can first start the handovers while staff observes, and then train the other nursing staff to lead a handover process using appropriate tools namely ISBAR (Small et al., 2016). Studies suggest that the nurses concerned about the breach of patient confidentiality while performing bedside handover can be trained by role playing and showing videos on practice guidelines, which can improve their confidence on how to deal with sensitive information (Tobiano et al., 2018).
Sustaining and supporting the change is an integral part of successful change implementation which is based on regular improvement while maintaining the focus on the vision (Small et al., 2016). In the chosen initiative, the best practice handover process can be sustained and can be further improved by conducting staff feedback sessions, audits and surveys to consolidate gains and produce necessary changes to the project (Tobiano et al., 2018).
Lastly, regulating or institutionalising the change involves producing an organisational culture where change becomes a significant part in the healthcare setting. Installing posters and providing cards for handover flowcharts and best practice written guidelines for the staff can ensure everyone in the hospital setting follow the mandatory steps for bedside handover process (Hada et al., 2019).
Clinical leadership includes a leader who can effectively communicate, influence and motivate others by acting as a role model (McSherry and Pearce, 2016). Being a nurse leader can be challenging and will require extremely good communication skills. I would like to educate and train myself to enhance my communication skills in order to become a good team worker and exchange my opinions or ideas with others where needed while practicing nursing.
Furthermore, while practicing nursing, I will have to communicate with my colleagues, patients and families on regular basis in order to ensure continuity of care and provide advocacy when required.
