How to Handover Effectively

There is nothing more irritating to the nurse taking over a new shift than the previous shift bumbling over patients, information and plans of care.  Not only is a poor hand over a monstrous waste of time but it sets up an irritation which may blight the oncoming shift for the several hours to come.

Every work place manages handover differently.  Some hand over all patients to all staff.  Some hand over particular nurses to particular patients and perhaps only the co-ordinator will know exactly what is going on.  If you are not the co-ordinator then you may answer the phone at your peril.  Some nurses hand over in the office and some at the bedside.  Some have co-ordinators who hand over to the whole team regardless of who looked after which patient.

Handover is probably one of the most regimented times of a nurses day.  It is often protected and nothing will be done over the half an hour of handover 2 or possibly 3 times a day.  Phones do not get answered and requests are delayed.  In my 30 years of nursing, handover has changed little despite the oncoming of SBAR and ABCDE.  These do of course have their place but rarely during handover time.

Handover sheets may be provided by the ward with a suitable amount of information but as an agency nurse, you may need to use a sheet of your own or a small notebook.  Many handover sheets have abbreviations that you have never heard of and phrases are used which you are not familiar with but the basics should always remain the same.  However, feel free to ask questions about abbreviations and make sure that you have a good understanding of the information given.  You will never remember all the abbreviations so jot them down so you can stop asking people.

Most places now hand over at the bedside but particularly private information may be handed over either in an office or in quiet tones in a quiet place to make sure Dame Caldicott isn’t listening.  Most staff are very good at maintaining privacy and a breach of this is not taken well by peers and management alike.

If you are handing over from a folder or a clip board make sure that relevant paperwork is in as much order as possible.  The paperwork that you use most frequently should be at the front such as the drug chart, NEWS chart, diabetic charts and the fluid chart.  Rounding sheets (if used) should be next.  Care plans and risk assessments can be added at the tail end of the folder.  Paperwork is declining due to the technological advances especially in larger hospitals where phones can be used to document NEWS and fluids as well as other information.  This poses problems if you are an agency nurse and not used to this way of using information.  Make sure that you know who is going to hand over your patients and if you need to, then add information from your day to your notebook or handover sheet.

When starting handover please be aware of the patient’s resuscitation status.  The form should be in date, in the notes and you should check it. Then start with the care plan.  I know it is at the back of the folder but it will have all the information regarding background that you will need to provide.  You need the patients name, age and reason for admission.  You will need any co-morbidities that are relevant.  All too many nurses are keen to mention the tonsillectomy at age 6 whilst missing out the coronary artery bypass graft done last year.  Medical issues take precedent over surgical ones.  Many medical issues do not go away.  Surgical ones are much more likely to.

Once you have finished with the co-morbidities, give a breakdown of what has happened with this admission.  One of the most important things to remember is how independent the patient is.  Do they need help with washing and dressing?  If they do, then that is a big impact on the next shift coming in.  Skin, bladder and bowels should also be commented on.  Consider any input from other disciplines e.g. physio or speech and language therapy.  Always handover about discharge even if it is going to be a long time coming.

Remember SOAP.

Subjective (what the patient says is going on),

Objective (what you think is going on),

Assessment (what is actually going on),

Plan (what are we gonna do about it).

Lots of patient who have been in hospital for a long time will have had a lot of issues.  To be honest, you are never going to remember them all but if you flick through the care plan, you will have a vague idea of what has happened and what plans were followed.  This especially happens if you have a patient with more than one diagnosis.  Make sure you hand over relatives information if a patient is for end of life care

When you have finished using the care plan you can flick to the front.  Go through the drug chart and make sure allergies are handed over.  Any unusual medication should also be mentioned.  Hand over the NEWS score, fluid balance, blood glucose et al.

Finally hand over the plan.  What is the next move?  What needs to be done on the following shift? What did you forget?  What did you do extra?  What did you find that made the life of the patient easier?  It should take around 5 minutes per patient.  Don’t waste time gossiping about a patient.  Handover is not the time.  Make sure that everyone has the opportunity to question you.

Example of a handover in a surgical ward

Mrs M is 89 years old.  She came in for a Left Total Hip Replacement on 10/07/2019 done by the surgeon Mr S.  Glue used to close wound. Surgery was done under spinal anaesthetic with sedation and a block.

She is allergic to Penicillin

Mrs M has a history of hypertension, atrial fibrilliation, congestive cardiac failure, arthritis to hips and back which prevents her from lying flat.  She has a hiatus hernia and suffers from constipation. She has a history of irritable bowel syndrome, glaucoma, depression, chronic kidney disease stage 3 and deafness.  She wears her hearing aid at all times.

Mrs M has been in bed since returning yesterday from theatre.  She had a urinary catheter inserted in theatre.  She has been able to lift herself off the bed and her skin remains intact.  Regular analgesia has been given overnight with good effect.  Some assistance will be required with washing and dressing today but Mrs M is normally independent.  She is now eating and drinking normally.  No leakage noted from surgical wound site.

Observations remain stable and all risk assessments have been done.  She had intravenous fluids overnight as her systolic dropped to around 87 on return to the ward and post morphine.  Fluid balance has been maintained and patient was in a positive balance of 400 at midnight.  Patient has been given anti-coagulant as prescribed.  Anti- hypertensive not given as patient has had low systolic overnight.

Plan is for check haemoglobin this morning.  Physio. is to mobilise the patient.  Continue with analgesia and anti-emetics as needed.  Surgeon may see today.  Patient should be able to go home following XRay and stairs assessment.   Daughter will take patient home and stay with her for 1 week following discharge.  Take home tablets to be written and outpatient appointment to be arranged.  Letter is still not written.  Doctor aware.

Now that you have handed over effectively, you can go home.  Good night.

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