Bedside Handovers Communication Proven To Be Most Effective In Practice

Written by Clare Lawrence

  Introduction

Bedside handovers has shown that communication between patient, nurses and families is more effective at the bedside compared to verbal, written and taped elsewhere.  Patients feel more involved are in an equal partnership with the nurse and they feel empowered by being able to contribute to their care plan.  This can have a significant impact on communication by reducing errors with the patient input.  Holding shift-to-shift handovers in a nurse’s station or away from the bedside takes away the patient input, the chance to be able to correct nurses if information lead to unwanted adverse events.

 

A standardised report reduces time spent at the bedside as the report guides the nurse to give factual information, avoids the use of subjective data and prevents the nurse from being confused or muddled with what needs to be handed over.  Bedside handovers allow training for students and gives the opportunity to educate the patients about their care. 

 

Overall from the research evidence has shown that bedside handovers can reduce errors in documentation, increase communication between nurses and patients’, increase patient safety and reduce adverse events.  Although there is ongoing research into how shift-to-shift handovers are undertaken, bedside handovers are viewed as working towards best practice.

  Literature Review

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 (2005) it recommends clinical handovers to have evidence-based guidelines to guide an effective handover.  Miscommunication between clinicians from worldwide literature has been linked to an increase in adverse patient outcomes and effective communication is apparent when patients and families are involved (Lu, Kerr, & McKinlay, 2014).  In a study carried out by McMurray, Chaboyer, Wallis, and Fetherston, (2010), 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, 2010).

In recent years communication and engagement were reported to be the two most common complaints (Waters & Whyte, 2012).  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, 2010).

 

To improve clinical handover it has been suggested for a framework to be implemented as a guide for healthcare workers to transfer patient’s current healthcare status in a shift-to-shift handover (Australian Commission on Safety and Quality in Healthcare, 2010).  In a study by Chaboyer, McMurray and Wallis (2010) 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, 2010).  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., 2011). 

 

The REED model (record, evidence, enquire, discuss) is a framework used in a study by Tucker and Fox (2014) 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.  Nurses are seen to be accountable and responsible for patients in their care and the REED model for bedside handover encouraged focusing on patient’s assessment, identifying any gaps in care and potentially increasing patient safety (Tucker & Fox, 2014).  This was also identified in another study carried out Maxson, Derby, Wrobleski and Foss (2012), 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, (2015), 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.  Patients can be harmed due to poor communication, lack of engaging with the patient, and not communicating effectively with the other health care professionals involved in the patient’s care (World Health Organisation, 2009).

 

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., 2011).  Deficiencies included poor communication, medication errors, not identifying correct patient, and falls risks (Health Quality & Safety Commission New Zealand, 2012).

 

To be able to give a thorough handover effective communication is vital and research has shown without the use of a clear model, vital information is not passed on in a timely manner, for example, if a patient needed to fast and this was not documented and/or passed on verbally.  This may interrupt the process for treatment, and further delays in treatment are apparent causing prolonged hospital stays and increasing hospital financial costs.  The National Patient Safety goals of the Joint Commission reported 80 per cent of sentinel events was the root cause of poor communication where critical information was not passed on through communication and so recommended organizations to have a standardised reporting system to avoid such errors (Chung, Davis, Moughrabi, & Gawlinski, 2011). 

 

The World Health Organization (2009) 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, 2009).

In a study carried out by Bradley and Mott (2013) 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.  Nurses in this study by Bradley and Mott (2013), preferred the new handover style, (which incorporated a three stage model of change, developed by Lewin (1947)) as one commented by saying ‘It cuts out the rubbish’ and focuses on giving factual information and works towards a patient-centred approach, which has been found to give positive health outcomes (Bradley and Mott, 2013). By engaging with the patient this also develops the therapeutic relationship between nurse and patient, involving trust, which has professional boundaries in place (Crisp & Taylor, 2013). 

 

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, 2013), intravenous sites, infusion rates and any other assessments required.  It also allows for nurses to introduce themselves when getting the handover from the off going nurse (Nelson & Massey, 2010). 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, 2013).  This allows for correct care planning, reducing any anxiety from the patient and for the patient and nurse to work as a partnership (Athanasakis, 2013).  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, 2013).

 

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.

  Comparisons

According to Nelson and Massey, (2010), 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, (2010), it states that between verbal, taped recorded, written, telephonic and bedside handovers one has not been proven to be more superior to the others.  However, bedside handover does seem increasingly more popular with patients and is possibly emerging as best practice (Nelson & Massey, 2010).

 

Tucker and Fox (2014), 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., 2009).  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, 2013). 

 

It was reported that verbal office based handovers are inclined to be time consuming, with the use of subjective data, often including irrelevant information and not sticking to facts based on patient documentation (Chaboyer, McMurray, & Wallis, 2010), which can cause some nurses to disengage (Tucker and Fox, 2014).  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, 2014).  In a study carried out by Radtke, (2013) 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.  This exchange does not involve the patient and/or their families, which mean any miscommunication, would not be clarified by patient and/or family and can lead to reporting errors, which in turn can lead to adverse events (Radtke, 2013). 

  Rationale

According to a study carried out by Laws and Amato (2010), research confirmed the benefits of bedside handovers by nurses being able to visualise the patient straight away and to compare and acknowledge any errors that maybe in the previous report that does not match the patients’ current status.  It also allows for the nurse to prioritise the work load for that shift (Laws & Amato, 2010).  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.  However to overcome this Starr, (2014) recommends “private and sensitive material should not be disclosed at the bedside.” (Starr, 2014, p. 21).  To overcome this study suggests discussing confidential information at the nurses’ station prior to going to the bedside (Caruso, 2007).  Providing a structured framework enables a guide for nurses to follow to improve bedside handovers (Australian Commission on Safety and Quality in Healthcare. (2010).

 

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, 2013).  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, 2013).  Patients also gave positive feedback on the bedside handover saying, “wondered why they don’t do this at other places” (Radtke,2013, p.24).  From the survey carried out by Radtke, (2013) it revealed an increase in patient satisfaction in nursing communication from 75 per cent to 87.6 per cent. 

  Recommendations

One recommendation to put forward is a need to have a structured framework when doing a bedside handover, which has been proven to reduce adverse events, improve communication and improve documentation (Gregory, Tan, Tilrico, Edwardson, & Gamm, 2014).  By having a structured framework allows fewer mistakes to be made and more communication within the healthcare team, families and patients (Gregory, Tan, Tilrico, Edwardson, & Gamm, 2014).  A structured framework can include a mnemonic that is easy to follow and to be used in conjunction with a printed report of the patients’ details like name, age, diagnosis and length of stay so far in hospital (Australian Commission on Safety and Quality in Healthcare, 2010).

 

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, 2012).  Staggers and Jennings (2009), reported on a hospital where no standardised operating protocol was in place for shift-to-shift handovers causing disarray and concluded a SOP was crucial to improve communication and documentation of patients care plans (Staggers & Jennings (2009).  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, 2012).

 

A report published by the National Patient Safety Agency in 2007 showed communication error was a significant factor in contributing to deterioration of patients who subsequently died (Dean, 2012).  From this it is evident that training needs to be reinforced on handovers to prevent this from happening through miscommunication (Dean, 2012).  According to Chaboyer, McMurray, and Wallis, (2010), bedside handovers gives the opportunity for students to see how visualizing the patient and interacting can lead to a partnership. (Chaboyer, McMurray, & Wallis, 2010).  The only teaching that students may get on handovers is when they are on placement (Dean, 2012).  There is agreement that nursing education programs should include teaching regarding shift-to-shift handovers (Waters and Whyte, 2012; Dean, 2012).

  References

Athanasakis, E. (2013). Synthesizing knowledge about nursing shift handovers: overview and reflections from evidence-based literature. International Journal of Caring Sciences, 6(3), 300-312.

 

Australian Council for Safety and Quality in Health Care. National Clinical Handover Initiative (Australia). (2005). Clinical handover and patient safety: Literature review report. Darlinghurst, Australia: Australian Council.

 

Australian Commission on Safety and Quality in Healthcare. (2010). Ossie guide to clinical handover improvement. Retrieved from communications/clinical-handover/ossie-guide/

 

Baker, S. J. (2010). Bedside shift report improves patient safety and nurse accountability. Journal of Emergency Nursing, 36(4), 355-358. doi:10.1016/j.jen.2010.03.009

 

Bradley, S., & Mott, S. (2013). Adopting a patient-centered approach: an investigation into the introduction of bedside handover to three rural hospitals. Journal of Clinical Nursing, 23(13-14), 1927-1936. doi:10.1111/jocn.12403

 

Chaboyer, W., McMurray, A., Johnson, J., Hardy, L., Wallis, M., & (Sylvia) Chu, F. Y. (2009). Bedside handover: Quality improvement strategy to transform care at the bedside. Journal of Nursing Care Quality, 24(2), 136-142. doi:10.1097/01.ncq.0000347450.90676.d9

 

Chaboyer, W., McMurray, A., & Wallis, M. (2010). Bedside nursing handover: A case study. International Journal of Nursing Practice, 16(1), 27-34. doi:10.1111/j.1440-172x.2009.01809.x

 

Chung, K., Davis, I., Moughrabi, S., & Gawlinski, A. (2011). Use of an evidence-based shift report tool to improve nurses' communication. Evidence-Based Practice MedsurgNursing, 20(5), 255-268.

 

Crisp, J., & Taylor, C. (2013). Potter & Perry's fundamentals of nursing (4th ed.). Chatswood, Australia: Mosby.

 

Dean, E. (2012). Smoother, faster...many nurses are working hard to improve the effectiveness of staff handovers. Nursing Standard, 26(52), 16-19.

 

Gregory, S., Tan, D., Tilrico, M., Edwardson, N., & Gamm, L. (2014). Bedside shift reports: What does the evidence say? JONA: The Journal of Nursing Administration, 44(10), 541-545. doi:10.1097/nna.0000000000000115

 

Health Quality & Safety Commission New Zealand. (2012). Making our hospitals safer: Serious and sentinel events reported by District Health Boards in 2010/11. Wellington, N.Z: Health Quality & Safety Commission.

 

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Maxson, P. M., Derby, K. M., Wrobleski, D. M., & Ross, D. M. (2012). Bedside nurse-to-nurse handoff promotes patient safety. Medsurg Nursing, 21(3), 140-44. Retrieved from ncbi.nlm.nih.gov

 

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Starr, L. (2014). ANMI Legal. Bedside handovers and confidentiality - can they co-exist?, 22(1), 21.

 

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