Why bedside handover

What are the benefits and challenges of ' bedside ' nursing handovers? In acute hospital settings nursing Objective: The objective of this systematic review was to synthesize the best available evidence. Published by NHS resolution, 25 September This case story is based on real events and NHS Resolution is sharing the experience of those involved to help prevent a similar occurrence happening to patients, families and staff.

Although this Read Summary. The team attend the patient's bedside to review the current situation, notes, charts and Scheduling Structured information from shift handovers should be available. Results of investigations should Background An accurate handover of clinical information is of great importance to continuity and safety of care. If clinically relevant The literature review compares bedside handovers with other methods such as, verbal, written and taped and what settings they used, for example a nursing station.

In the report produced by Australian Council on Safety and Quality in Health Care it recommends clinical handovers to have evidence-based guidelines to guide an effective handover.

In a study carried out by McMurray, Chaboyer, Wallis, and Fetherston, , one nurse commented on how communication and interacting with the patient had increased since bringing clinical handovers to the bedside.

Bringing in clinical handovers to the bedside promotes patient safety, builds employee teamwork, accountability and ownership and it responds to a number of National Patient Safety Goals set by the Joint Commission Baker, Research has shown this can be avoided if the communication process gives clear and precise information and instructions, following a Standardised Operating Protocol SOP Australian Commission on Safety and Quality in Healthcare, In a study by Chaboyer, McMurray and Wallis it mentions nurses face challenges at the bedside on handover with not knowing what they should entail, how to involve the patient and family members and what not to discuss.

By having a mnemonic helps to organize and plan the report of the patients care plan and improve patient safety by including critical information and reducing adverse events Australian Commission on Safety and Quality in Healthcare, Not one method of shift-to-shift handover has been proven to be more superior than the other but the general census is bedside handover is more personal and informative for the patient and their families Street et al. The REED model record, evidence, enquire, discuss is a framework used in a study by Tucker and Fox in shift-to-shift handovers and has been proven to improve efficiency of communication by involving the patient, and more importantly reduce errors of misinformation by correct documentation and promoting patient safety.

This was also identified in another study carried out Maxson, Derby, Wrobleski and Foss , where nurses promoted patient safety by engaging with them at the bedside and involving their patients into the discussions of their care plans which was welcomed by the patients. In another study carried out by Tobiano, Marshall, Bucknall, and Chaboyer, , patient participation was not always welcomed with some of the nurses and Patients found it difficult to engage with nurses when they sensed they were too busy to talk or not get eye contact and this put a barrier between nurse and patient as communication was very weak between both parties.

Handover is vital for patient safety and any inaccuracies can lead to adverse events as demonstrated in the Sentinel Event Program annual reports Street et al. This may interrupt the process for treatment, and further delays in treatment are apparent causing prolonged hospital stays and increasing hospital financial costs.

The World Health Organization mentions patient safety can be improved by checking procedures, learning from errors, engaging with patients and families and communicating effectively with other healthcare team members. Reporting errors at the time can be analysed and help identify the main contributing factors. By following these simple steps costs can be saved because of minimizing the harm caused to patients The World Health Organization, In a study carried out by Bradley and Mott the results suggested that bedside handovers were preferred by patients compared to taking place behind closed doors.

Patients felt included in the discussions relating to their care when the nurses handed over at the bedside and they were able to visualise their nurse. The benefits of bedside handovers include promoting patient safety by visualising the patient, checking their call bell is within reach, oxygen is working correctly and checking medication charts Athanasakis, , intravenous sites, infusion rates and any other assessments required.

In addition it enables receiving feedback from patients regarding their care plan and contributing to the discussion if anything was either not passed by the off going nurse or something misinterpreted Athanasakis, This allows for correct care planning, reducing any anxiety from the patient and for the patient and nurse to work as a partnership Athanasakis, In turn all of these, along with being guided using a Standardised Operating Protocol SOP have contributed to reducing adverse events and a shorter stay in hospital which also contributes to reducing hospital expenditure Athanasakis, Not one method is seen more superior to the other; however bedside handovers seem to be more favoured amongst the findings.

The literature review also expresses the need for accurate communication as studies have reported miscommunication can have unwanted adverse events on the patients that can easily have been prevented by relaying accurate information through good communication. According to Nelson and Massey, , bedside handover allows for the patients and their families to build a rapport and interact with the nurses.

It also allows for visualisation of their oncoming nurse, to help the patient feel reassured and this can lead to the patient feeling empowered over their condition. In the findings of the literature identified by Nelson and Massey, , it states that between verbal, taped recorded, written, telephonic and bedside handovers one has not been proven to be more superior to the others.

Tucker and Fox , highlighted how bedside handovers improved efficiency of communication by involving the patient, reducing errors such as being able to check medication charts and patient safety.

A key element to safety and quality of patient care is communication during handover Chaboyer et al. Patient safety is acknowledged by being able to visualise the patient at the bedside, giving an holistic view and the environment surrounding the patient, for example checking oxygen is set at the right level, IV lines are running correctly Athanasakis, Tape-recorded handovers could hold information that is out of date, have no immediate contact with the patient and errors were high due to not getting clarity from patient Tucker and Fox, In a study carried out by Radtke, taped and centralised reports were explored and confirmed neither had an impact on patient satisfaction and these handover methods were not held at the bedside but in a nurses station or another private room.

The study also highlighted the benefits of patients on bedside handovers by allowing the patient to be actively involved, being allowed to questions and receive reassurance by the nurse of their ongoing care, which keeps the patient informed, reduces anxiety and has lower-risk.

A disadvantage of bedside handover was the concern of breaking confidentiality at the bedside. Providing a structured framework enables a guide for nurses to follow to improve bedside handovers Australian Commission on Safety and Quality in Healthcare.

Bedside reporting is seen to improve communication between patient, nurses and families and build on a therapeutic relationship, which is an essential ingredient for good communication which delivers positive results by reducing errors in shift-to-shift handovers at the bedside Radtke, Once nurses had got over the initial change of shift-to-shift handovers to the bedside the feedback was very positive and they could see an improvement in prioritising their work, feeling more confident with their patients in their care planning, greatly improving communication by allowing the patient to be involved in the bedside handover and increasing patient safety by visualising their patients straight away and alerting the nurses to any immediate attention, for example, checking of oxygen and intravenous lines IV lines Radtke, From the survey carried out by Radtke, it revealed an increase in patient satisfaction in nursing communication from 75 per cent to Shift to shift handovers are vital in patient care and much evidence suggests that ineffective handovers can cause harm to patient safety with irrelevant or incomplete data relayed Dean, Communication has to be effective to produce a good handover and document accurately.

Medical history of a patient is critical and if not documented and verbally passed on to the incoming nurse it can put the patient in danger Dean, A report published by the National Patient Safety Agency in showed communication error was a significant factor in contributing to deterioration of patients who subsequently died Dean, For patients, effects on patient activation, individualized care and quality of care were measured.

Design: This is a longitudinal, controlled, multicentred study on 13 nursing wards in five hospitals. Methods: A questionnaire for patients and nurses at baseline May-June , 3 July-August and 9 months December January after implementation was completed by patients and nurses.

Per protocol analysis was used in combination with linear mixed models analysis. Results: With exception for work interruptions and patient participation for nurses, no overall effects could be found for both patients and nurses.