Student Transforming Care
Creating a Standard Operating Procedure for Handover
Helen Price, University of South Wales
Context and Problem
Context:
Patient status at a glance (PSAG) is one of the foundation modules
within the Transforming Care programme. Patient safety boards are
recommended as a tool to support effective communication.
These safety boards, know as PSAG have been piloted in acute
services within Anuerin Bevan University Health Board. Three
specific wards have been involved in the development of the board
using the IHI model for improvement. The standard created is
currently being spread to other wards. The final format for the board,
reflect the information required for efficient patient flow, safe and
timely care delivery, actions and interventions.
Handover one of the specialist modules within the programme is
currently undertaken in isolation and without consultation of the
PSAG board. This improvement project refers to the delivery of
effective handovers using PSAG as a communication tool
Assessment of the Problem:
The National Patient Safety Agency (NSPA, 2007) suggests that
effective and efficient handover is paramount in improving clinical
practice, with emphasis on patient safety.
Absence of a reliable handover to transmit the right information may
affect many aspects of care delivery such as:
Improved patient outcomes
Avoidable errors
Reduction in repetition
Increasing safety
Improvement in patient satisfaction
Personal experience as a student and a Healthcare support worker
has demonstrated a common theme; staffs view the handover as just
a method of transferring responsibility of care shift to shift.
There appears to be a lack of understanding in regard to the potential
for serious error or harm if information is not transmitted appropriately.
Strategy for Change
Aim: To reduce the length of handover by standardising the
quality of information transmitted by establishing a Standard
Operating Procedure aligned to a communication tool (PSAG
Board).
Intervention:
Establish a team to drive the project forward.
Identify leads for specific work streams.
Train staff in new skills (Bronze IQT)
Agree time spans for each aspect of the project
Identify what methods will be used to evidence changes
Demonstrate that changes are leading to improvements
Create feedback reporting mechanisms
The changes proposed will be implemented by an identified
project team over a 3 month period. The IHI Model for
Improvement will be used to support success. All wards will be
included in the pilot.
The Patient Perspective
Patients and their families have the right to expect the best
possible care and treatment. They should be confident that should
their condition deteriorate they will receive prompt and effective
treatment facilitated through clear communication.
Taking time to communicate effectively is directly related to patient
safety and avoidance of harm.
Effects of Changes
Measurement of Improvement:
Improvements will be measured using quantitative and qualitative
data.
Time handover to establish baseline information
Continue timing throughout project to identify interventions
Use SPC charts to generate statistical information
Repeat Activity Follow to measure improvement in handover
time
Observe a handover process to audit information transmitted
Collate data and use SPC to generate bar charts
Engage staff through questionnaires to ask what they feel
should be included in handover
Set Standard Operating Procedure from information obtained
Proposed Effects of Change:
All staff will be engaged in delivering a safe, efficient, effective
and timely handover
Time spent looking for information will be reduced maximising
time for direct patient care
The quality of handover will be consistent across all wards
Introducing a SOP ensures effective communication for delivery
of safe and reliable person-centred care
The Outcome
Lessons Learnt:
The focus of the project is not just on measuring time; a
reduction of handover time may facilitate a poor quality
handover. This may create risk as staffs strive to complete in the
time allotted and miss vital information. The project aims to
demonstrate how creating a SOP for the quality of information
delivered can impact on efficiency and save time by being
effective. An initial increase in handover time may occur through
the introduction of SOP, therefore recommendations are made
that measurement will need to be maintained for the duration of
the project to reflect how and when staff integrate the SOP into
daily routine it becomes a key part of practice.
Conclusion:
The project has enormous potential in supporting the provision of
safe and timely quality patient care. I would recommend the
project be taken forward.
Helen Price 11216468@students.southwales.ac.uk