Handover - PowerPoint Presentation

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Handover

Davy GreenSlide2

Chinese Whispers

Davy GreenSlide3

What’s the point?Provide seamless careEnsure in-hospital team have all the factsTransfer important/relevant informationBuilding professional relationshipsSlide4

What’s the point?PreparationSpaceTeamEquipmentAdvanced help/imagingSlide5

What’s the point?“Handover of care is one of the most perilous procedures in medicine, and when carried out improperly can be a major contributory factor to subsequent error and harm to patients.” Professor Sir John Lilleyman, Medical Director, National Patient Safety Agency, UKSlide6

What’s the problem?“Healthcare professionals sometimes try to give verbal handovers at the same time as the team taking over the patient’s care are setting up vital life support and monitoring equipment. Unless both teams are able to concentrate on the handover of a sick patient, valuable information will be lost.” Junior Doctors Committee, British Medical AssociationSlide7

What’s the problem?Information lossNot handed overNot understoodVarianceED talking not listeningSpace issuesStaffing issuesSlide8

What’s the problem?Not just NI ED’s!Information Loss In Emergency Medical Services Handover
Of Trauma PatientsAlix J. E. Carter, Prehospital Emergency Care

2009;13:280–285 4.9 Data points handed over per patient

Only 72.9% of these receivedSlide9

What’s the problem?Not just NI ED’s!Maintaining Eye Contact: How To Communicate At Handover Erin Dean. 

EN1910Mar2012 06-07

Variance in handovers93% of time ED asked questions – 1/3 already had provided the answers

Recommended 20 second hands off timeSlide10

What’s the problem?Not just NI ED’s!Review article: Improving the hospital clinical handover between paramedics and emergency department staff in the deteriorating patient, Sarah Dawson,
 Emergency Medicine Australasia (2013) 25, 393–405

Paramedics - Confident and succinct

ED staff - actively listening

Structure was neededRepeated handovers leads to information being lost?displaying the prehospital observations on a computer screenSlide11
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NICE Trauma Guidelines 2015Record pre-alert information using a structured system and include all of the following: age and sex of the injured person time

of incident mechanism of injury injuries

suspected signs, including vital signs and Glasgow Coma Scale

treatment so far estimated time of arrival at emergency department requirements (such as bloods, specialist services, on-call staff, trauma team or tiered response by trained staff) the ambulance call sign, name of the person taking the call and time of call. Slide13

A senior nurse or trauma team leader should receive the pre-alert information and determine the level of trauma team response. The trauma team leader should be easily identifiable to receive the handover and the trauma team ready to receive the information. The pre-hospital documentation, including the recorded pre-alert information, should be quickly available to the trauma team and placed in the patient’s hospital notes. NICE Trauma Guidelines 2015Slide14

NIAS PRF Guidance2.10 - At handover, the clinician must provide a structured verbal handover with the accompanying PRF. A format such as ATMIST will facilitate this but staff should also include any other pertinent information e.g. patient medications, use of anti- coagulants, allergies, known conditions etc. Slide15
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What’s the solution?StandardiseProformasMulti-disciplinary buy-inTeam workingSlide19

What’s the solution?Active listeningEye contactTeam leader receiving handoverMove patient – 30 second ‘hands-off’ Don’t interrupt!Slide20
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The PlanUse ATMIST Take 30 seconds hands off for proper handoverCPRHaemorrhage controlCompromised airway

Massive transfusion requiredSlide23

The Plan