Bedside Handover: First Two and Three Months Post SCM

4.14.1.1 Solution Focused Sessions

Two themes emerged from the solution focused sessions with the emphasis on deterioration in patient management as shown in Table 4.23. The staff training theme emerged from comments in relation to requests for education on how to handover at the bedside, given the contrast from their traditional handover.

Table 4.23

Themes and Categories for Bedside Handover

Theme and Categories First 2/12 post SCM First 2/12 solutions 3/12 post SCM 3/12 post solutions Theme Staff training 1 Theme Deterioration in patient management Categories Decrease in patient information 25 9 1 4

Disruptive to patient care 15 3 1

Lack of patient confidentiality

1 2

The three categories for the deterioration in patient management theme captured staff concerns with bedside handover. Decrease in patient information caused the most concern as staff felt handover would be less comprehensive and they wouldn’t be able to respond to patient needs or queries from health colleagues for patients they had not received handover. The next major concern was related to disrupting patients’ rest period as afternoon handover coincided with this period and it was not possible to change the rest period time during the study period. In addition, concerns were raised regarding a loss of patient confidentiality by discussing sensitive issues within hearing of other patients.

4.14.1.1.1 Staff training solutions

Staff from all eight wards highlighted that many had not attended the education sessions prior to changing to bedside handover and more were required, along with further practice.

How do we improve handover?

This deficit was addressed by the facilitator, CNS/CNM and SDN providing ward based education using bedside handover scenarios followed by clinical demonstration. In addition, these staff subsequently supervised numerous handovers and provided constructive feedback. Further education was scheduled into each ward’s education planner during the trial period.

4.14.1.1.2 Decrease in Patient Information

Concerns were raised that staff were not using the agreed template and there were inconsistencies in the standard of handover among staff.

How can we improve the handover? What information do we need from handover?

This example is from a 30 beds orthopaedic and neurosurgery ward, where nurses were paired in teams of two, one of whom was an experienced nurse and both were collectively responsible for eight patients.

Staff first listed reasons why they were not using template, such as didn't allow for checking specific nursing care requirements had been met, or detailing nursing treatment plan. Problems identified in relation to inconsistencies in handover were determined to be in the type and detail of information provided by different staff.

Staff determined two strategies to address these questions. Firstly, to cease using the template previously used for ward handover and to develop their own using the headings of the patient care plan. Secondly, to develop a standard approach to

undertaking bedside handover. This included covering current treatment and effect, and using relevant charts such as medication and intravenous to indicate treatment and checking invasive lines. In addition, staff were encouraged to promote patient participation by asking if they wished to inform the nurses of any aspect of their management.

At subsequent meetings staff reported these strategies had assisted in the quality of the information provided and patient care improvements. They provided examples of improved care such as better planning with patients' intravenous fluid requirements and medication management as nurses ensured these had been ordered prior to handover and were able to demonstrate this with the intravenous fluids and chart checking component of handover. Nurses also reported helpful information was gained by asking patients information about their management such as information not yet passed on by the medical staff including surgery and discharge dates.

4.14.1.1.3 Disruptive to Care and Maintaining Patient

Confidentiality

How can the patients still get their rest with handover at 1300 and rest period at 1300-1400? How can we keep patient confidentiality with bedside handover?

Both questions were considered by staff to be interconnected. The following example is from a 30 bed orthopaedic and spinal ward. On this ward nurses were paired in teams of two consisting of one experienced nurse. Each nurse was primarily responsible for four patients but supported each other with manual handling, bed baths and complex care. Strategies were determined to investigate possibility of changing the time of patients’ rest period and to develop an information sheet for patients and their visitors. The CNS agreed to formally request extending the rest period by either 30 minutes or one hour to enable bedside handover and sufficient time for patients to rest without interruption. Two staff agreed to develop an information sheet informing patients and their visitors about bedside handover and the need for patient privacy during handover. Staff identified the solution from a patient centred perspective and the time change was discussed with patients and their visitors.

To maintain confidentiality staff agreed to discuss sensitive information outside the patient’s room and to point to the care plan and handover sheet for things they preferred not to verbalise in this context.

4.14.1.2 Staff Survey Bedside Handover Results

While the deterioration in patient management theme, identified by the content analysis, remained, in the solution focused sessions a new theme of improved management emerged at 3 and 12 months post SCM as shown in Table 4.24.

Table 4.24

Themes and Categories for Bedside Handover

Theme/Categories 3/12 post SCM 12/12 post SCM Theme

Improved patient management Categories

Improved patient care 1

Checking charts 1

Staff training 2

Theme

Deterioration in patient management Categories

Lack of patient confidentiality 7 5 Disruptive to patient care 6

Decrease in patient information 6 4

4.14.1.2.1 Improved Patient Management

The few improved management comments were related to acknowledging benefits of bedside handover but recognising the need for expertise among staff as illustrated by one nurse commenting: “bedside handovers provide better checking

mechanisms- but it doesn’t ensure accurate info [information] or relevant info [information] depending on calibre of staff.”

4.14.1.2.2 Deterioration in Patient Management

The same concerns raised in the solution focused sessions were reported in the staff survey. Issues relating to maintaining confidentiality remained with one nurse reporting: “there is no patient confidentiality with bedside handover” and disrupting the rest period with another nurse remarking: “bedside handover always impedes on

rest period and, no matter how quiet you are, 3-4 people walking and talking in room disturbs patients.” In addition, patient safety concerns from not knowing all patients’ details continued to be raised. As one nurse commented: “I miss detailed handover for

all the ward area. I feel it totally unsafe to not know all my ward patients.”

At the end of the three month study period one of the Rehabilitation and Orthopaedic wards elected to cease bedside handover and returned to ward handover, as they could not overcome concerns with maintaining confidentiality and found they were not able to promptly respond to patients requests for assistance or their relatives queries.