Introduction

This guideline should be read in conjunction with the Clinical Handover procedure. The purpose of this guideline is to provide nurses across the campus with a structured approach for the safe communication of clinical handover. 
Structured clinical handovers are effective in decreasing communication errors within healthcare and are linked to improved patient safety and quality of care. Clinical handover is particularly important during transitions of care when there is an increased risk of communication errors impacting patient care. 
The involvement of patients and their families/carers in the paediatric setting during handover is an important tool to maintain communication and promote family cantered care. Effective communication of patients and their families/caregivers during care transitions has also been shown to enhance patient outcomes, reduce adverse events during care, and lower the rate of hospital readmissions (Australian Commission on Safety and Quality in Health Care, Communication at Clinical handover).

Aim

To provide a framework for nursing clinical handover at the RCH. 

Definition of terms

Bedside handover individual patient handover that occurs at the patient’s bedside and includes patients and parents/ carers

Clinical Handover: Transfer of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another person / family / legal guardian or professional group on a temporary or permanent basis 

Group handover may be facilitated as a large group with all nurses commencing the shift and/or within smaller groups of nurses working together in a pod  

ISBAR: acronym that stands for Identification – Situation – Background – Assessment – Recommendation/Response.  See  Clinical Handover Procedure for more information.

OILS: acronym that standardises checking IV orders, infusions, lines and securement. See  Policies and Procedures : Standardised checking procedure for infusion pump programming at the RCH  

Management Responsibilities  

The Nurse Unit Manager’s (NUM) has responsibility for compliance with the clinical handover.

The operational leadership of handover and allocation of nurses to patients is usually the role of the Associate Unit Manager (AUM).  

The NUM and/or AUM has the responsibility to ensure that the following principles are applied:  

• Nurses have a clear understanding that patient care, as required, continues while handover is occurring. 
• The Electronic Medical Record (EMR) is available for nurses. 
• The venue, starting times and duration of the handover are set. 
• Nurses have a clear understanding of the structure and expectations of handover. 
• Disruptions are minimised. 
• All relevant nurses, including student nurses attend handover. 
• ISBAR is the format used to structure communication.  
• Audits of the handover process are completed as required.                   

Group Handover (inpatient, ward based) 

• Occurs every day at the time of the shift change-over or start of shift 
  
• Group handovers are led by the AUM in charge of the shift to enable team awareness for the group of patients in the clinical area.
  
• Timing and structure of group handover is determined by the time available, needs of the ward and clinical demands   of the shift (e.g. large group with all nurses commencing their shift or in smaller groups of nurses working in a pod) 
  
• ISBAR format utilised as appropriate (EMR handover report function may be useful) 
  
• At the conclusion of group handover, any important messages pertaining to the ward or hospital are discussed e.g. staffing, potential issues relevant to running of the unit 
  
• Group handover is completed allowing adequate time for individual patient handover before nurses finish the previous shift
  
• Handover for nurses working in the community allows adequate time to review all documented handover, see below for more information.  

Individual Patient Handover (inpatient, ward based) 

• Individual patient handover occurs between the nurse that holds responsibility for care and the nurse who will be assuming responsibility for the care of the patient. The ISBAR format should be used more information can be found on the  Clinical Handover Procedure.
• Individual patient handover should include bedside handover as appropriate.
• Parental/carer and/or patient (where appropriate) involvement in bedside handover is encouraged where possible, to support the engagement of parent/carer and/or patient in care planning and to allow the necessary patient checks such as the OILS checks.

Parent/carer and/or patient involvement in handover

Parents/Carers’ and patients’ preferences to be involved in handover may change throughout admission. Nurses are to regularly discuss with parent/carer and/or patient how they would like to be involved in handover. For example, would they like to be woken up for handover? 

Some children and young people may find handover distressing. Nurses are to work with families to identify the best option to suit them for handover. Nurses can invite parents/carers the opportunity to participate in handover outside of the room.

Considerations for conducting some elements of handover away from the bedside include:

• A parent/carer and/or patient requesting handover not to be conducted in the room. 
  
• Staff require a computer for EMR access, not available in patient’s room.
  
• Handover includes sensitive clinical or social information that is not appropriate to be discussed at the bedside.

Individual patient handover should also include the following, as appropriate:

• Positive patient identification – confirming name, date of birth and Medical Record Number (MRN)
  
• Identification of clinical alerts (e.g. FYI flags, allergies, infection control precautions)  
  
• Patient assessments and care plan as clinically relevant.
  
• Completion of OILS check (orders, infusions, lines and securement) as per standardised checking procedure for infusion pump programming at the RCH
  
• More information can be found on the  Clinical Handover Procedure

The accepting of responsibility upon completion of handover is documented in EMR. 

A brief clinical handover should also occur when the nurse with responsibility for the patient is leaving the clinical area or will be unavailable to provide clinical care for a short period of time, for example when having a break, collecting a patient from another ward etc.

• ISBAR format is utilised to structure handover focusing on ISR – identification of the patient, current situation (including medications and/or infusions that may be running) and any risks or recommendations for interval where the nurse with responsibility for the patient is unavailable.    

Transfer of patient within the hospital (for procedure, treatment or to another ward) 

• All patients transferred to from one clinical area to another clinical area require individual patient handover.
  
• This is documented in the EMR. This includes details of the transfer time indicating a transfer of professional responsibility and accountability. 
  
• ISBAR format is utilised. 
  
• Positive Patient identification process occurs to confirm full name, date of birth and Medical Record Number (MRN) to the EMR as per the  RCH Patient Identification Procedure.
  
• Clinical alerts are identified (e.g. FYI flags, allergies, infection risk alerts , MET modifications).   
  
• If IV fluids or medications running complete OILS check as per  Standardised checking procedure for infusion pump programming at the RCH.

A patient can be transported by CARPs, parents/ carers if the patient is assessed as: 

• Stable, observations within normal limits, no altered MET criteria
• Predictable
• Having no IV fluids or blood product transfusions running 
• Requiring clinical observations 4 hourly or less frequently 

Handover can be conducted over the phone to the receiving nurse, AUM, appropriate health practitioner who will then assume responsibility and accountability for the patient  

• A patient must be escorted by the nurse if the patient is assessed as: 
  • Unstable 
  • Have IV fluids or blood transfusions running 
  • Requiring clinical observations more frequently than 4 hourly (ie, hourly observations)  

Transfer of inpatients to pre-op hold 

• Handover occurs between the nurse that holds responsibility for care and the pre-op hold  nurse who will be assuming responsibility for the care of the patient. 
• For Rosella/Butterfly inpatients being transferred to & from theatre, clinical handover is required from the bedside nurse to the anesthetist.
• For acutely unwell inpatients consider the need for the bedside nurse to handover to the anesthetist. 

Ambulatory Care

Transfer of Ambulatory Care patient to another clinical area/inpatients to Ambulatory Care 

• The nurse transferring care contacts the relevant nurse in charge of the receiving clinical area to ensure patient is expected and handover is given. 
• Relevant local administrator (Desk Staff, Ward Clerk) to be notified of transfer or admission by the AUM/CNC. 
• Patients transferring/discharging to Ambulatory teams require a referral, via EMR, which is submitted during transfer/discharge planning.                    

Electronic Handover (Ambulatory Services Only) 

Nurses who work autonomously, providing care in the community do not perform shift to shift handovers. Electronic handovers replace bedside handovers in this instance as follows: 

• All nurses working in Ambulatory services, including students, commencing a shift start by reviewing Electronic handovers. 
• These staff members access each patient’s handover within the patient chart in EMR.  
• Staff review the handover, orders or plan of care every day at the time of shift commencement. 
• Review of electronic handovers takes place in a designated area. 
• ISBAR format is applied to Handover/Plan of Care in EMR for structure/clear communication. 
• Handover is respected with minimal disruptions.  
• It is the responsibility of the nurse to clarify any information from the handover with the AUM/CNC on the shift. 
• It is the responsibility of the nurse to update the handover/Plan of Care for every patient on their shift for the next visit. Any changes to therapy and care enacted in consultation with the MDT must also be verbally handed over to the AUM/CNC and included in patient progress note.  

Group Handovers/Communication in Ambulatory Care 

• Important messages pertaining to the team or hospital (e.g. staffing, potential issues relevant to running of the unit) are relayed: 
  • During group handover in the Complex Care Hub
  • Individually, to the nurses on shift when onsite and/or via email as needed in the Wallaby Ward 

Patient Discharge 

• See:  Policies and Procedures : Discharge Summary Completion and Management (rch.org.au)
• On discharge home patients are provided with written discharge advice about the patient’s hospital stay  
• An After Visit Summary (AVS) can be printed for the parents/ carers, along with any attendance certificates, which has a minimum data set including:  
  • name of consultant 
  • diagnosis 
  • medication plan  
  • follow up information  
  • phone number to contact if more information required  
  • The clinician documents in the EMR that the discharge advice has been given to the parents/ carers and the time of discharge.  

Companion documents 

• Patient and Family Centered Care (procedure) 
• Patient Identification Procedure (policy)
  
• Governance (policy) 
• Consumer Focused Care (policy) 
• Clinical Handover (procedure) 
• Discharge Summary Completion and Management (policy)
  
• Supervision and movement of inpatients across RCH and access to inpatient areas Procedure Transmission based precautions (procedure) 
• Multi resistant organisms (procedure) 
• Standardised checking procedure for infusion pump programming at the RCH (policy)

Links

Australian Commission on Safety and Quality in Health care; Communicating for Safety Standard.   https://www.safetyandquality.gov.au/standards/nsqhs-standards/communicating-safety-standard (accessed 20/01/2023) 

Evidence table

Evidence table for Nursing Clinical Handover Nursing Guideline can be found here. 

Please remember to read the  disclaimer . 

The revision of this nursing guideline was coordinated by Stacey Richards, CNC, Nursing Research, and approved by the Nursing Clinical Effectiveness Committee. Updated October 2023.