Its been a busy day.
But the shift is almost over and you can hear a whole fresh set of nurses clattering into the unit.
The question is: are you prepared to handover to them?
Handover: A transfer of responsibility and accountability for patient care from one provider or team of providers to another.
Here are some checks to help you make the transition a good one for both of you. Im only going to touch on the actual handover techniques here. And I will not be discussing the pros and cons of different types of handover. I am going to give some you tips to prepare for the handover as the new shift approaches.
And this preparation should probably start at least 60min before the next shift.
The important caveat here is that excellent handovers are not always possible. Sometimes you will just not have time to prepare. Sometimes a whole lot of stuff just has not been done. Don’t beat yourself up. We all experience this.
During the handover you will need to ensure comprehension, acknowledgement and acceptance of responsibility for the patient.
Take time to prepare your information for handover.
Try to make the workload transition smooth for the oncoming nurse.
Keep the handover short and sharp.
Is all your documentation up to date?
Of particular importance is a contemporaneous record of your nursing care of each patient during the shift. It can be really helpful for the oncoming nurse to include a quick check-list of outstanding tasks at the end.
- Are the patients fluid balance charts up to date?
- Is the paperwork in order?
- Have you checked to see if there are any new orders that have been written since you last looked?
Take a few minutes to review the patients you are going to handover and parse all the information you will need to convey. Write down the important things, because it is easy to forget during the actual handover.
There are several tools to assist with handover such as: ISBAR (Identify, Situation, Background, Assessment and Recommendation)..
One tool I particularly like is SHARED (Situation, History, Assessment, Risk, Expectations, Documentation), although in reality I don’t strictly follow any one tool as my handover technique tends to vary between discrete clinical situations.
Other things to get your head around as you prepare for handover include:
- Clearly identify the patient.
- What is the immediate clinical situation of the patient
- What is the relevant background/history
- List the most important and recent observations
- Identify assessments and actions
- Identify timeframes and requirements for key nursing tasks.
Are the patients IV fluids about to run through? Is the patient laying in a wet bed? Is there an angry relative that is going to vent at the first nurse that comes near.
It takes time to transition into a new shift. Especially if there are new or unwell patients. We all want a few minutes to review the handover, check the documentation, and say a quick hello to each patient to see where they are at.
Those times that you hit the floor running, with IV bags that need changing and analgesia that needs giving and 2 patients asking for pans makes it really hard to get on top of things from the outset. You end up chasing your tail for the rest of the shift just trying to catch up.
Of course, sometimes despite your best efforts, this is what will happen anyway.
Interruptions. Is there anything you need to do to ensure that there will be no (or few) interruptions during your handover?
Confidentiality. Make sure you will be handing over in as confidential environment as is possible.
Tidy up: Do a quick sweep and make sure you have not left too much rubbish or clutter for the new shift. This can be really annoying.
Pt preparation: If your unit utilises bedside handover you will need to prepare the patient by explaining what is about to happen (if they have not experienced this before) and making sure they understand that they are an equal participant in the handover process.
Paperwork: You can improve the quality of handover by actually using the patients notes, medication sheet etc to reference and anchor items of information you are handing over. For example: when talking about the patients urine output you can confirm it by showing the fluid balance chart.
Likewise, if you are handing over a patient using patient controlled analgesia (PCA) you will need to check the infusion against the orders & observation sheets.
If you are going to do this, collect each patients paperwork and pre-arrange into an order that will align with the flow of your handover.
There is nothing worse than coming onto a shift where the nurse handing over exudes negativity and foreboding.
“Its been such a crap shift”
“Sorry but I think you are in for a smashing this evening”
“Mr Jones has been on that buzzer ALL shift! He says he is in 9/10 pain…and then I walk past 5 min later and he is asleep!”
You know. That sort of stuff.
It just tends to soil your own attitude from the outset… and negative comments can prejudice your own management of patients or situations.
So try to make the handover a welcoming, useful and positive experience for the oncoming nurse.
Hit and split:
Finally, try to keep the handover short and sharp. Again, the oncoming nurse doesn’t want to listen to long rambling backstories about the patients behaviours or funny anecdotes about the review by the orthopaedic registrar.
Present the information. Highlight red-flags. Make sure it was understood. Give opportunity for questions.