HIT AND MISS

“Handover is a historic and institutionalised ritual that has remained part of nursing culture throughout the decades. Its roots lie deep in nursing tradition and nursing handover practice continues without questioning its purpose in contemporary times.” 1.

Handover is a constant in the working life of a nurse.

It is an essential component in the transferring of patient care from the departing nurse to the oncoming nurse.

Despite the ubiquity of handover, it is an area of nursing practice that is little reported about.

Handover by one definition is where the effective transfer of responsibility and accountability of patient care occurs.

The transfer of responsibility occurs either on a permanent or temporary basis.

The most common form of handover occurs at the shift change between nurses, either individually or in a group.

But handover can occur at anytime for any reason.

A ‘poor’ handover can have significant safety issues for the patient

Handover, without structure, can be lengthy, irrelevant and unprofessional and is usually done in private.

In a review of handover practices in the Journal of Clinical Nursing, clinical handover is described as “an area of poor performance. 2.

The review looked at the issues that occurs with a bedside handover.

But similar issues presented themselves no matter what the handover situation.

They were

1. The transfer of responsibility and accountability of care

2. Confidentiality

3. Bedside handover

4. Patient/carer involvement

5. Multidisciplinary approach

6. Structure and tools; and

7. Auditing clinical handover practices.

Most nurses felt that the transfer of responsibility and accountability occurred at the end of the shift.

And not at handover.

This lack of clarity about when the transfer occurs could lead to duplication or omissions with disastrous consequences for patient care during that time.

Naturally nurses are concerned about patient privacy and confidentiality when handing over in a public space that has other patients present.

This lead to sensitive information being exchanged in a private area but this has an impact on the patients or their carers no longer participating in decision making about their care.

The value of a bedside handover was that the patient had been sighted early in the shift by the incoming nurse, which gives a baseline to the condition of the patient.

There a number of methods that have been proposed to provide a standardised structure to handover.

A standardised structure to handover would reduce errors of omission.

And improve the quality of information transfer by reducing the reliance upon memory.

As well as maintaining a focus on the important aspects of patient care.

However there is not a one size fits all handover structure that meets all circumstances.

Each clinical area will have its own needs and these should be incorporated to ensure there is a consistent approach to handover.

Finally, there is no audit tool for the evaluation of clinical handover practices.

An audit tool would expose gaps in the handover process and where areas of improvement arebest addressed.

Until a tool emerges, the quality of handover between nurses will remain “hit and miss”.

To learn more about handover:

1. Kapurkar, Kavita S., et al. “To assess knowledge & knowledge of practice regarding standard operating protocol for implementing bedside handover in nursing among staff nurses at Krishna Hospital, Karad.” Journal of Evolution of Medical and Dental Sciences-JEMDS 5.103 (2016): 7566-7570.

2. Anderson, Judith, et al. “Nursing bedside clinical handover–an integrated review of issues and tools.” Journal of Clinical Nursing 24.5-6 (2015): 662-671.