Improving handover between doctorsand nurses on an elderly care ward

Background The Royal College of Physician guidelines (2011) identifiedhandover as a “high risk step” in patient care, especially in recenttimes within the NHS where shift patterns lead to more disjointedcare with a high reliance on effective handover by all staffmembers. Introduction At Cannock Chase hospital, Fairoak ward is an elderly carerehabilitation ward where there is a large multi-disciplinary team.While working on the ward as doctors we noticed that handoverbetween the MDT was poor. Anecdotal evidence from both doctorsand nurses felt that this was a high risk area in need of improvement. Aim to improve handover between doctors and nurses on this elderlycare ward. Method To measure the quality of current handover practice we did aquestionnaire. A total of 12 questionnaires were completed whichshowed that 92% of staff felt that handover on the ward was verypoor and 50% preferred both written and verbal handover. We measured the number of tasks verbally handed over betweendoctors and nurses over 3 days. On average 65% of the tasks werecompleted. We then made the below interventions and re-audited to see ifthere was any improvement. Interventions over 3 week period: 1. Post ward round “huddle” with nurse and doctor 2. On the board nurse allocation to which bay documented 3. Handover sheet on each notes trolley with “nurses jobs” and“doctors jobs” Results Questionnaire: Staff felt that there was an improvement in handover with 58%feeling that handover was still poor compared to 92%previously. The most useful intervention was the post ward round huddlethat had become well integrated into daily practice. The written handover sheet was good but poor utilisation bystaff made it less effective. Measuring task completion after interventions; Improvement from an average of 65% of tasks completed to79% completion Conclusion This project has made a positive change qualitatively and quantitatively to the ward handover practice. Staff satisfactionregarding handover has improved and the number of “handedover” tasks completed daily has significantly improved. Thewritten handover sheet had poor utilisation by staff but in4 months we are going to re-audit and trial the handover sheetagain to further improve service delivery. We hope thisimprovement will have a positive impact on patient care on thiselderly care ward.