care delivery - handover

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The safe transfer of care is a vital component of the quality of care and safe practice (Pothier, Monteiro, Nooktlar et al, 2005). Handovers have been identified as ‘error hotspots’. All handovers may be error prone including those between individuals from the same or different professional groups, between departments and between sectors of care (Bruce Bayley, et al, 2005). When the process of handover is inadequately undertaken risks to the patient are increased and may subsequently lead to harm (BMA, 2005; Joint Commission, 2007). Patients are no longer cared for by just nurses and doctors; multiple healthcare professionals now contribute to the care of patients which increases the need for robust mechanisms for handover of care (RCN, 2008). BMA (2004) state Continuity of care now means team responsibility for care as well as individual responsibility. Information regarding patients must be transferred from shift to shift to provide continuity and consistent patient care (Hoban, 2003). Handovers occur on all wards and have been described as a religious rite (Scovell, 2010). Currie (2002) identified one common feature of all handovers: the quality of the handover effects the provision of nursing care in the subsequent shift. Scovell (2010) argues that quality is important but there are unanswered questions about whether this involves the content or the structure of the handover and if there are any variables during the handover process that affect quality. Best practice will be explored by reviewing literature regarding nursing handovers. There are three themes that have emerged; patient safety, patient confidentiality and patient participation for continuity of care. These themes will be explored to enable professional and managerial development in this area of care. The new found knowledge will be used in future and disseminated to colleagues and patients to ensure safe and effective nursing practice.

Patient Safety
The NMC (2008) urges nurses to work within a team to monitor the quality of care delivered and maintain the safety of the patient within their care. The Code (2008) states that all nurses ‘must work with others to protect and promote health and wellbeing of patients in a nurses care’. Seddon (2007, cited by Wallis, 2010) suggests that bedside handover can promote patient safety due to the ability to observe equipment, medications and intravenous lines whilst discussing the patient. the information that should be shared on handover should consist of the patients health condition, any relevant changes, medications, ongoing treatment, tests, examinations and any possible complications that may arise (WHO, 2007). Personal experiences have shown vital information being incorrect or missed on handovers putting patients safety at risk. An ineffective handover can contribute to patients falling through gaps in the system. Failures relating to patient safety include medication errors and patient deaths as found by Friesen et al (2008). Friesen et al (2008) states that 66% of medications errors occur during handover to other healthcare teams due to ineffective communication. Ineffective communication in healthcare settings is recognised by the NHS Institute for Innovation and Improvement (2013) as being the most common cause of organisational and clinical errors. McMurray (2009) discovered nurses that worked different shifts, for example, short shifts, found they were not receiving as much information due to not arriving on shift at the same time as other nurses. They often receive rushed handovers and are misinformed of patient care; therefore putting patients at risk. Kassean and Jagoo (2005) found that office based handovers consist of one way communication from the previous nurse in charge. This method was found to lack individual important information, patient care planning and whether actions had been documented throughout the shift as the notes could not be accessed during handover. Without the patients...
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