Moving with the Times: The New Handover - a Change of Practice
2001
It is often discussed that information technology (IT) is fast becoming an important part of health care, that an information revolution is occurring and the only thing getting cheaper is quality clinical information. The introduction and implementation of information systems is an immense change process on its own which requires enormous human and financial resources commitment. Therefore, apart from generating information to assist in decision making, considerations should be given to other possible avenues of utilising the system, such as to improve work practice, to obtain optimal benefits for the investment made. Blacktown-Mt Druitt Health is committed to the implementation of the Excelcare patient care information system. It was recognised that Information Technology is a potent mechanism to allow the organisation to improve its business, either clinical or management processes. The relationship of Information Technology to change may occur at different levels - initiation, facilitation, support or Information Technology may cause change to occur unexpectedly. To make the most of the potential of Information Technology System, the author of this article being the senior nurse manager in clinical informatics, responsible for the implementation and management of the Excelcare system, implemented various change processes and quality projects, one of which was the pilot of the new strategy: a new nursing handover process. The aims of the pilot project are to improve standard of information generated by the Excelcare system on plans of care delivery for patients; to improve standard of nursing documentation and to improve the effectiveness and efficiency of the nursing handover. The nursing handover has been described as ritualistic, inefficient, ineffective and time consuming; a forum where nurses, through group consensus, reach agreed patient stereotypes. It also occupies an important position in the cultural life of nursing, for socialisation and indoctrination of new nurses; debriefing; team building and the development of group cohesion. However, with the amount of time it occupies, the nature and content of the communication and the accuracy of information exchanged, there is great potential for the process to be investigated, analysed and new strategies developed to improve its effectiveness and efficiency. Problems also exist if nurses based care delivery only on the verbal transmission of information during the handover period without verification on the accuracy and completeness from documentation. This may put the nurses and patients at great risk of making mistakes. Furthermore, appropriate, accurate and timely documentation in patient health records plays a vital role in ensuring accuracy in information sharing between health professionals of various disciplines and maintaining a complete and legal patient health record. Failing to comply with the above may lead to potentially disastrous consequences. In Blacktown Mt-Druitt Health, the new nursing handover project was piloted to replace the traditional verbal nursing handover methodology. This article presents the background, rationale, implementation strategies, change management process and results of the pilot handover project, and share the methodology, success, problem/issues, and sometimes frustration experienced throughout the process.
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