Have you ever found handover difficult or received a handover that you found to be seriously lacking?
Progressively more hospitals are moving to a ‘bedside’ or ‘chart’ handover, where nurses handover to the oncoming shift at the end of the patient’s bed, often going through the chart at the same time to help identify issues (“has that medication been given?”) and clarifying any questions about things like fluid orders.
“We’ve started the antibiotics…” was a recent opening line I received on a patient handover, I had to interrupt with “err.. what has he come in with?” to gain some context on the presentation.
Here’s a simple handover layout that will become second nature when you practice it a lot:
- Patient Details
- Presenting Complaint
- Significant history
- Patient Details – this is a brief intro to the patient and can also include introducing yourself or the oncoming nurse to the patient. An example would be, “This is Jacob, a 65 year old man who presented by ambulance at 4pm today…”
- Presenting Complaint – Any relevant details about the presentation should be conveyed, keep in mind this does not need to go on and on and on about details that can be read in the chart. It should be clear, succinct, and allow for any questions from the oncoming nurse. “Today around 10am Jacob’s breathing became worse than normal, he became laboured and distressed at home and his wife called the ambulance.”
- Significant history – this should be relatively brief, but can be very helpful, particularly if it gives context to the current presentation. An example would be, “Jacob has a history of emphysema for the last 15 years, he is under treatment by the respiratory team and is on home oxygen 24hrs a day….”
- Treatment – what treatment has already been given, and what are we doing now? This is a brief rundown on where we are up to with the patient – are we treating with antibiotics? Waiting on chest xray? Waiting for blood results? Any important details should be noted here also, like allergies, family dynamics or phobias.
- Plan – where are we heading in our treatment for this patient, and do any tasks need to be handed on to the next nurse?
Generally speaking, the idea is to give a short burst of concise information about the patient so that the oncoming nurse can takeover care, ensuring there is transmission of the most important information with minimal impact on patient care.
Following an ordered sequence like the one above ensures the handover takes as minimal time as possible, while conveying the most important information to the oncoming nurse.
If it helps, you could learn one of the common mnemonics to assist in sequential delivery of information, such as:
S: Situation – chief complaint, current status
B: Background – previous history
A: Assessment –result of assessment, vital signs and symptoms
R: Recommendation – suggested and anticipated changes, critical monitoring
I: Identify the patient and staff
S: Situation and status
O: Observations, MET calls etc.
R: Risk management