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HNN320 Leadership and Clinical Governance OZ Assignments
Communication is an essential part of health and social care organization and ineffective communication along with errors can bring terrible outcomes for the patient as well as the organization. It is the very important part for patient safety to have effective communication or poor clinical handover of the patient may result in delayed diagnosis and treatment, incorrect treatment and medication and missed tests (Wilson, 2011). Thus, this is the major responsibility of nurses to accurately and timely communicate essential patient-related information to other carers and clinicians. This assignment is aimed at depicting the role of nurses in improving the quality of services delivered to users in health and social care organizations by identifying an effective communication strategy in the services. a strategy would be highlighted to have better and safe clinical handover and improve patient safety The strategy would be related to the National standards along with explaining the way of implementing this strategy in the ward.
Body Of The Assignment
Clinical handover can be explained as the temporary or permanent transfer of professional responsibility and accountability of a patient or group of patients to another carer or clinician (ACSQHC, 2012). It may be required at the time of shift change, shifting from a ward to another, at the time of patient discharge or while transferring a patient to another facility. It is daily practised in healthcare settings in several ways and it is the responsibility of carers or nurses to have safe and effective clinical handover or it may have serious negative consequences for the patients (Wong, et al. 2008). In order to ensure safety and protection of service users and delivering them with high quality care services, nurses must make sure that while giving a handover, they have communicated details of transfer well with the patient and carer, have given essential information about the patient arrival to the receiving clinician and department, have carefully assessed patient's identification details and have completed documentation like progress notes, handover forms, etc.
Communication in healthcare settings and Handovers can be carried out in various ways right from face to face bedside handover to telephonic conversations, communication through mails, etc. Face to face communication is the most effective and recommended method as it includes good interaction and information clarification (Thomas, et al. 2013). However, this handover must not be limited to verbal handover since it carries the high risk of missing out essential information and relies on memory rather handover must be supported with a document with complete and updated information of the patient. One of the retrospective ways of clinical handover also included audiotaped information transfer that allows focused communication but it also carried the limitation of no opportunity to clarify. Thus, one of the best ways of clinical handover is found to be bedside face to face handover with accurate and documented information. Further, it must always be ensured that the receiver has completely understood the information and all important information including adverse event information is being properly documented. For assisting clinicians and nurses to carry out an appropriate clinical handover process, a number of handover tools have been recommended that not only allows information to be transferred in a structured and comprehensive manner but also make sure that concise, relevant and focused information is being transferred. Thus, the handovers can be standardized using tools like ISBAR, ISoBAR, etc. ISBAR is an acronym that stands for Identify, Situation, Observations, Background, Agree on a plan and Read back and is used to appropriately design the handover document without missing essential patient related information. These clinical handover tools, if used appropriately, can prove to be really beneficial. However, the issue is that most of the nurses are not adopting recommended procedures and endangering patient safety (Iedema, et al. 2009).
Although a number of clinical handover tools have been recommended for nurses and clinicians and they are well aware of the high risk of poor handover on patient safety, still as per a survey conducted in Australia, it is found that any formal or set procedure for handover is not being adopted in hospital settings (ACSQHC, 2010). Another survey revealed that in nearly 15% of cases, essential information is not being accurately transferred leading to adverse events. Moreover, it was found that in only 6% of cases, a written handover is being received and in the UK 83% believed that the handover was poor (ACSQHC, 2010). Further, studies and data reveal that handover is the major cause of patient harm leading to malpractice and adverse events and can be easily prevented through the adoption of appropriate procedures. Therefore, a focused change management framework has been developed for supporting the implementation of standard clinical handover process in healthcare settings called OSSIE. OSSIE is the acronym that stands for Organizational leadership, Simple Solution development, Stakeholder engagement, Implementation and Evaluation and maintenance and this framework is a guide to have better clinical handover programs not only in acute care hospital setting rather alls in primary care, multidisciplinary and community handovers (ACSQHC, 2010). Thus this framework may provide direction for standardized clinical handover and would ensure patient safety.
The Australian Commission on Safety and Quality in Healthcare has suggested certain standards of healthcare practice that needs to be followed by staff to ensure healthcare service users are provided with high quality safe and secure services (ACSQHC, 2010). National standard 6 recommends that all clinical leaders and managers use a documented system to have structured and effective clinical handover in healthcare organizations to transfer timely and relevant patient-related information and ensure patient safety. This standard is also in accordance with standard 1 of delivering safe and quality healthcare service to clients (ACSQHC, 2012). As per this standard, an organizational system must be developed and implemented to have a structured clinical handover where a documented policy exists along with agreed tools and guides. There must be structured processes in the organization to make sure that the clinical handover are documented along with regular monitoring and evaluation processes to assess the same. This monitoring and evaluation must be done in collaboration with patients, carers and clinicians. Local procedures and clinical handover must be regularly reviewed and on the basis of identified issues, quality improvement activities must be undertaken. Further, the national standard suggests that there must be a proper reporting, investigation and change management organization-wide system so as to appropriately address clinical handover incidents (Eggins & Slade, 2012). In addition, the National Standard 6 suggests that a mechanism must be developed and implemented in the healthcare organization to actively involve patients and their families as well in the clinical handover process (ACSQHC, 2012).
The OSSIE guide is developed in accordance with this above-mentioned standard and all the essential components of the standard are being incorporated in the guide. This guide to improve clinical handover process in the organization, first of all, emphasize on the organizational leader. The guide suggests that in order to establish a structured clinical handover process to enhance patient safety, the handover improvement process must be prioritized, all the motivators of change and existing barriers to change must be identified and understood, local practices must be carefully assessed even from the perspective of staff, staff must be well lead so that they understand the requirement of change and must be empowered to bring the required change in the organization. In this phase, views need to be obtained from maximum possible participants regarding the handover process and handover improvement must be promoted (Kerr, et al. 2011). The process of organizational leadership also includes certain observations of current practice in the organization where the current type of handover would be observed, the time and situations when handover is carried out would be noted along with the role of patients and carers. It would also be observed that who is leading and attending the current handover process, the way patient care continuity is being assured while handover, handover is being documented or not and how effective and efficient is current handover process. Finally, it would be seen whether the current handover system follows a standard format and are any tools being used in the preparation and transfer process.
The second phase is simple solution whose objective is to make sure that a patient and practice centred standard handover process is being adopted in the organization that actively involve clinicians in designing process, contents and information tools (ACSQHC, 2010). This phase basically involves considering varying inputs of participants for designing the process and producing a standard format. It has to be ensured that an appropriate handover is being prepared which is well organized, provide environmental awareness and effectively transfer responsibility and accountability of patient care using recommended tools like ISBAR, SHARED, etc.
Another major part of OSSIE guide and implementing clinical handover improvement process is stakeholder engagement (ACSQHC, 2010). The main objective of this phase to assist stakeholders in understanding the objectives of the clinical handover improvement project and identify their individual roles and responsibilities. They must be encouraged and empowered to participate and commit. This phase involves identification of stakeholders, make initial contact with them, engage them by explaining project details, involving and engaging them and finally maintaining their engagement to have required output from them (Eggins & Slade, 2012).
The next major phase is implementation and it would need the engagement of staff, developing support materials like memory triggers, information tools and education. In this phase, a project plan is being developed, the staff is being trained and educated, handover solution is being revised, the new handover process is spread, a continual learning strategy is established along with development if innovative activities for ensuring successful implementation of the plan. Staff education and training is an essential part of this phase and would require the understanding of content like ensuring patient safety, preventing medical errors, the understanding significance of appropriate clinical handover, understanding the standardized process for handover, techniques of communication improvement and explaining them about local implementation plan. Once the plan is developed and the staff is trained, the new and improved clinical process is ready to be implemented in the organization (Webster, et al. 2008).
This would be followed by the final process of evaluation and maintenance. In this phase, an evaluation framework would be developed and tools would be used for evaluating the impact of the new handover process. Additionally, strategies would be developed for spreading results of the evaluation process and to ensure continuous improvement (ACSQHC, 2010). This phase involves evaluation of consistency and completeness of the steps of the new process, the level of staff participation, the effectiveness of the process and time of completion of the new process. All these are indicators of the success of the project. The evaluation may be done by direct observations, participant’s interviews, retrospective and prospective audit of documentation, incident reports, etc. However, one thing has to be considered that the project is never complete or over, it keeps going on and must be maintained for continuous clinical handover improvement. It is essential that the standardized solution is being maintained and updated and the process becomes a part of organization’s policies.
It can be said that using OSSIE guide as the reference, major positive changes can be brought in an organization and clinical handover process can be improved. The patient can expect better, safe and secure services where they would be handover in the most appropriate manner and the chances of miscommunication or medical errors would be minimum (Thompson, et al. 2011). As breakdown in information transfer in healthcare organization has been found as one of the major cause of adverse events, OSSIE guide would direct and help clinicians and nurses to have improved clinical handover programs in the organization which would be in accordance with the standard recommended process. Although a number of resources would be required including staff participation, staff training, time, money, etc but the benefits of using this guide is way above the resources and efforts (ACSQHC, 2010). The organization would have a standardized handover where all participants would be aware of the significance of handover along with information which is needed to be communicated to others. A form would be designed and available for staff that would have been agreed by the clinical unit to ensure the safe and efficient handover of the patients.
It can be concluded from this piece of work that one of the major requirement to ensure patient safety in the healthcare organization is effective communication between staff and a good clinical handover process. Clinical handover is the transfer of relevant patient-related information to clinicians, nurses or carers while shift change or transfer of the patient from one unit to another. It has been found that a poor clinical handover with incomplete patient-related information can bring serious negative consequences on patient's health outcomes. It can lead to wrong treatment, missed tests, repeated tests, administration of wrong information, etc and thus carries a high risk. Thus to ensure patient safety and avail them of high-quality services, nurses need to understand the significance of clinical handover. There are several recommended framework to handover patients like ISBAR, SMART, etc but the reports and research suggest that the number of people and organizations actually adopting the standard process is very limited.
To improve the existing clinical handover process in an organization and make it standardized, an OSSIE guide has been presented from the workplace- based research that involves a user-centred approach and iterative feedback. There are five major phases of this guide that helps in development and implementation of handover improvement project. Thus through an investment of time, resources and energy in the right direction, a positive change can be brought in the organization and patient safety be improved.
ACSQHC (2010) OSSIE Guide to Clinical Handover Improvement. Sydney: Australian Commission for Safety and Quality in Health Care. Available from: http://www. safetyandquality.gov.au/internet/safety/publishing.nsf/ content/PriorityProgram-05# [last accessed on 5 December 2017)
ACSQHC (2012) Standar 6 Clincial Handover. Safety And Quality Improvement Guide. Available from https://www.safetyandquality.gov.au/wp-content/uploads/2012/10/Standard6_Oct_2012_WEB.pdf [last accessed on 5 December 2017)
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