nDoes the Bedside Handover Improve the Patient Healthcare Outcomes?

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nInstitutions

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nProblem Statement

nRecently, a patient learned after discharge that the nurse was not aware of their admission to the hospital and that drug given in the preparation of the examination was not necessary (Baker, 2010, p.34). Similarly, the nurse failed to notice a sticker on the syringe stating that the drug needed to be diluted and no communication was made confirming the drug name and dose. On admission, another patient was given a drug to which he had a major reaction with and he was thought to be at the worse state of mental health (Baker, 2010, p.37). The incorrect assessment on admission delayed treatment and correction of the adverse effects. All these problems were brought about by the poor handover of information among nurses providing care in shifts (Baker, 2010, p.44).

nHand over practices remains an issue internationally in healthcare. Measures around clinical handover should be included to assist in improving the evidence around patient safety interventions (Farhan, 2012, p.67). In a hospital setting, nursing hand over have become an important form of communication between nurses caring for patients in one shift to the next. Information that transfers between nurses about patient care is becoming important in improving patient safety and quality care (Farhan, 2012, p.72). Clinical handover is the transfer of responsibility and accountability for patient care from one provider or team of providers to another. Ineffective handover can lead to wrong treatment, increased health care expenditure, increased hospital admission and delays in medical diagnosis (Farhan, 2012, p.75).

n There are various types of Nurse Handover; bedside, verbal, taped and nonverbal. Verbal is where within an office, the nurse responsible for a group of patients exchanges relevant documented information with the incoming nurse (Kumar, 2015, p.91). Taped is one way of information exchange where relevant information is collected and recorded in an audio tape so that the incoming shift may listen and provide the convenient care. A new shift starts in non-verbal handover as nursing staff are responsible for reading each other individuals plan to enable them plan and prioritize their workload (Kumar, 2015, p.96).

nAmong the four, the best standard has been set to be bedside handover as it contributes highly to patient centered care and provide the patient the opportunity to decision making. Bedside handover is an interactive process that enables an exchange of questions (Mansa, 2011, p.26). The patient is given a handover sheet and informed. Visitors are requested to leave other than the family. This way, the patient is ready to proceed with the handover, the relatives present will provide consent and privacy is secured (Mansa, 2011, p.29).

nThe next step that will follow is the introduction, whereby, the outgoing staff will greet the patient and introduces the incoming staff. Information will be exchanged including; clinical conditions, tests and procedures and discharge planning (Mansa, 2011, p.32). Any questions from the incoming staff are answered and the patient is involved in the conversation. If there is any question or comments and then be invited to clarify or confirm information (McMurray, 2011, p.38). All types of equipment are confirmed if they are functioning, tubes and lines are checked and bedside chart reviewed.

nTherefore, to ensure effective communication among nurses, bedside handover needs to be implemented (McMurray, 2011, p.42). It helps ensure that the patient brings up health issues not previously discussed, reduce anxiety of patients and relatives as well as improving the quality and continuity of care. It does so by ensuring clear and concise communication between healthcare professionals and ability to visually see the patients’ condition to prioritize care needs effectively (McMurray, 2011, p.47).

nLiterature review

nDuring handover, communication errors may lead to adverse effects of patient care. Many institutions want to redesign their handover process, there are specific factors limiting and facilitating handover; inadequate information, equipment malfunction, interruptions and inconsistent quality (Wei, 2012, p.44). Facilitators were face to face interactions, space for notes and checklist. Research on nursing handover mostly compares bedside, verbal, taped and nonverbal (Wei, 2012, p.47). Various studies have found that one important difference between bedside and other forms of handover is that, nurses receive report on only their assigned patients and not the other patient on the ward, the method facilitates more accurate information exchange, it provides patients with an opportunity to work in partnership with their patients (Wei, 2012, p.54).

nBesides, bedside handover does not extend the time taken for each patient. In fact, it saves oncoming nurses time because it is comprehensive and is aided by visualizing the patient (Wei, 2012, p.64). Verbal handovers were unreasonably lengthy and often including nonessential and irrelevant information instead of reliable information. Several investigations have also found that patients appreciated being acknowledged as partners in their care, as they viewed bedside handover as an opportunity to amend any inaccuracies in the information being communicated (Wei, 2012, p.69). Most patients have been found to appreciate the inclusive approach of handover as nurse–patient interaction.

nAdditionally, most explorations examining handover practices shows that bedside handover is variable, actual and error prone (Wei, 2012, p.73). During actual handover, environmental factors such as noise, crowding, and high workload on either side of staff involved, are potential threats to handover quality, as well as task factors such as interruptions and patient care activities (Wei, 2012, p.84). A survey of nurse experts was conducted to explore perceptions about workplace interventions in terms of feasibility and likelihood of positive impact on nurse outcomes such as job satisfaction and nurse retention.

nThe intervention that received the highest rating for likelihood of positive impact was bedside handover to improve communication at shift report and promote patient-centered care (Welsh, 2010, p.12). Emergency department nurses consider optimal handover to be specific for patients for whom they are caring, conducted at the bedside, structured and containing key elements; patient details, presenting problem, treatment, nursing observations, plan (Welsh, 2010, p.15). Quality improvement project implemented bedside handover in nursing, three wards in an Australian hospital changed from verbal reporting in an isolated room to bedside handover.

nPractice guidelines and a competency standard were developed. The change was received positively by both staff and patients (Welsh, 2010, p.22). Staff members reported that bedside handover improved safety, efficiency, teamwork, and the level of support from senior staff members. Some investigations have shown that handovers involving patients in the public spaces at the bedside facilitate a partnership model in medication communication (Welsh, 2010, p.27).

nNurses exercise discretion during bedside handovers by discussing sensitive information away from the bedside. Handovers across different wards during patient transfers cause communication breakdowns because information is not exchanged between bedside nurses (Welsh, 2010, p.33). A study in clinical practice between nurses and neuro doctors in India, three hundred and eighty-two each of nurses and doctors revealed varying adherence for time, place and documentation (Welsh, 2010, p.42). Doctors fared better only in process elements and bedside handovers; however, only nurses had a statistically significant fall in levels over weekends and in night shifts. Staff interaction and patient communication were positively correlated (Welsh, 2010, p.51). Bedside handover is easily implemented to the satisfaction of patients and staff in general.

nFurthermore, various explorations have revealed that nurse educators identified safe patient care, patient centered care and patient nurse satisfaction as benefits of bedside report. Barriers identified include lack of confidentiality and the time-consuming nature of the method (Welsh, 2010, p.77). All of the nurse educators felt that inclusion of students in bedside report is feasible. There was improved patient safety, improved patient involvement and decreased end of shift overtime.

nGaps in Literature

nThe components that entail effective bedside handover present a major gap in the study. Patient safety research needs to include measures around bedside handover to assist in improving the evidence around patient safety interventions (Klee, 2012, p.47). The whole process may include a combination of tools, checklists, electronic and computerized system that avoid the use of memory (Klee, 2012, p.52). While all this were implemented, confidentiality of patient information should be maintained. Another gap is that incident reporting may not include issues of handover content that cause adverse effects (Klee, 2012, p.57).

nSystems and strategies need to be developed to ensure best practice arising from this handover. Knowledge of staff on this method of handover should be studied to ensure that all personnel are well trained and have up to date knowledge pertaining this (Klee, 2012, p.61). Once the components are better understood, it needs to be disseminated to health professional education and reflected in communication systems within healthcare organizations. Staffing levels at the time of handover needs to be studied to consider patient care needs and threats to security in the clinical area (Klee, 2012, p.65).

nAim of the Study

nThe aim of the study is to identify the factors that should be employed to make bedside handover more effective in improving patient healthcare outcomes.

nResearch Question

n How should bedside handover be made more effective in improving patient healthcare outcomes?

nSignificance of the Proposed Research

nThe proposed research will be of great importance since new methods will be identified for better implementation of bedside handover to improve healthcare delivery. As nurses continue to give less importance on handing over their assessment and recommendation to the incumbent, there is an emphasis in the need for training (Chaboyer, 2010, p.23). Since, better interaction showed the direct relation with patient communication, promoting for better methods in bedside handover, is likely to result in overall improvement (Chaboyer, 2010, p.25).

nIt may also be problematic in the specialist palliative care setting due to the patient fatigue and need to share sensitive and confidential information. Thus these factors may help solve such problems (Chaboyer, 2010, p.29). Methods in which ward nursing can be structured and design systems that can best meet the particular needs of the patient can be formulated. For instance, training and dissemination of knowledge among health care providers and students will greatly improve healthcare when it is practiced (Chaboyer, 2010, p.43). As health care evolves, information technology will widely be integrated into every department as well as handing over.

nThese will ensure proper communication between the nurses in shifts, confidentiality and storage of information. Given that there is no best practice around clinical handover, innovations projects that develop systems and strategies will be greatly needed (Doran, 2014, p.7). The rating of effective communication skills may be a priority in employing staff in order to achieve optimal results. Presence of specific information around critical and emergency procedures will be of great value to the nurses (Doran, 2014, p.17).

nConclusion

nThere exists a wide agreement that patient bedside handover is a key process to improve patient safety (Doran, 2014, p.23). New techniques and designs should be implemented in handover to ensure improved health delivery and care. The evidence base for effective handover is still evolving and many studies in handover in many clinical setting are difficult to interpret.

nReferences

nBaker, S. J. (2010). Bedside Shift Report Improves Patient Safety and Nurse Accountability. Journal of Emergency Nursing , 36 (4), 355-358.

nChaboyer, W. A. (2010). Bedside nursing handover: A case study. Article in International Journal of Nursing Pratice , January.

nDoran, D. C. (2014). Nurses’ Expert Opinions of Workplace Interventions for a Healthy Working Environment: A Delphi Survey. Nursing Leadership , 27 (3), 40-50.

nFarhan, M. B. (2012). A qualitative study to develop a new tool for handover in the emergency department. Energency Medicine: The ABC of handover , 29 (12), 641.

nKlee, C. L. (2012). Using Continuous Process Improvement Methodology to Standardize Nursing Handoff Communication. Journal of Pediatric Nursing , 27 (2), 168-173.

nKumar, P. J. (2015). Who is More Hands on with Hand-offs? A Comparative Study of Clinical Handovers among Doctors and Nurses. nternational Journal of Research Foundation of Hospital & Healthcare Administration , 1 (3), 33-40.

nMansa, T. S. (2011). Effective handover communication: An overview of research and improvement efforts. Best Practice & Research Clinical Anaesthesiology , 181-191.

nMcMurray, A. C. (2011). Patients’ perspectives of bedside nursing handover. The Australian Journal of Nursing Practice , 18 (1), 19-26.

nMcMurray, A. W. (2009, July 3). Implementing Bedside Handover: Strategies for Change Management. Journal of Clinical Nursing , 1-20.

nWei, L. E. (2012 , August). Medication communication between nurses and patients during nursing handovers on medical wards: a critical ethnographic study. Medication communication between nurses and patients during nursing handovers on medical wards: a critical ethnographic study , 941-52.

nWelsh, C. A. (2010). Barriers and facilitators to nursing handoffs: Recommendations for redesign. Nursing Outlook , 58 (3), 148-154.