Clinical Handover of Immediate Post-Operative Patients: a Literature Review
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Volume 31 Issue 2 Article 4 6-1-2018 Clinical handover of immediate post-operative patients: A literature review Samantha Clarke [email protected] Karen G. Clark-Burg [email protected] Elaine Pavlos [email protected] Follow this and additional works at: https://www.journal.acorn.org.au/jpn Part of the Health Services Administration Commons, Health Services Research Commons, Perioperative, Operating Room and Surgical Nursing Commons, and the Surgery Commons This work is licensed under a Creative Commons Attribution 4.0 License. Recommended Citation Clarke, Samantha; Clark-Burg, Karen G.; and Pavlos, Elaine (2018) "Clinical handover of immediate post- operative patients: A literature review," Journal of Perioperative Nursing: Vol. 31 : Iss. 2 , Article 4. Available at: https://doi.org/10.26550/2209-1092.1029 https://www.journal.acorn.org.au/jpn/vol31/iss2/4 This Article is brought to you for free and open access by Journal of Perioperative Nursing. It has been accepted for inclusion in Journal of Perioperative Nursing by an authorized editor of Journal of Perioperative Nursing. Peer-reviewed article Authors Samantha Clarke Clinical handover of immediate M App Sc, BN, RN The University of Notre Dame, Australia post-operative patients: Conflicts of interest: None to report. Associate Professor Karen Clark-Burg A literature review PhD, MBA (Executive), BN, Dip Bus, RN The University of Notre Dame, Australia Abstract Conflicts of interest: Manuscript reviewer for ACORN. The transfer of professional responsibility for some or all aspects of patient care, within and between professional groups on a Professor Elaine Pavlos MN, MBA, RM, GAICD. temporary or permanent basis, is termed clinical handover. The University of Notre Dame, Australia Communication during clinical handover is considered a Conflicts of interest: None to report. challenging patient safety problem. A key principle of transfer Corresponding author of professional responsibility for patient care is the minimum amount of information or content that must be contained and Samantha Clarke The University of Notre Dame, Australia transferred in any particular type of clinical handover. E: [email protected] Aim: The purpose of this literature review was to establish the scope of the literature about clinical handover from the operating room to Post Anaesthesia Care Unit (PACU) published in the last ten years and identify relevant key sources, theories, concepts and ideas. Method: The literature included in this review is divided into policy framework, practice, theoretical and primary research literature. Findings: This literature review demonstrates that either clinicians perceive clinical handover as informal, unstructured and inconsistent or transfer of information in handover as incomplete or unclearly expressed. Anaesthetists and PACU nurses differed in expectations of content and timing of information transfer. Conclusion: There is a need to develop training and educational strategies to improve clinical handover practice, particularly in a way that encourages collaboration. Keywords: clinical handover, post-operative, literature review, observational studies, interventional studies. Background Australian Commission on Safety and Quality in Health Care (ACSQHC) is The World Health Organization the lead technical agency for conduct (WHO)1 recognised communication and governance of the WHO ‘High 5s during patient care handover as project’ in Australia4. one of five challenging patient safety problems. This led to the Clinical handover has been defined launch of the ‘High 5s project’ in in National Safety and Quality Health standardising efforts for patient Service (NSQHS) Standards5 as ‘the safety1-3. The WHO4 stated in an transfer of professional responsibility interim report that ‘five standard and accountability for some or all operating procedures were drafted; aspects of care for a patient, or group however, due to resource constraints, of patients, to another person or only two were fully developed professional group on a temporary and implemented’ which were or permanent basis’(p.5). A standard namely ‘medication reconciliation’ key principle is the minimum amount and ‘correct site surgery’(p.9). The of information to be transferred Journal of Perioperative Nursing Volume 31 Number 2 Winter 2018 acorn.org.au 29 in any clinical handover that is qualitative and quantitative methods Inclusion and exclusion criteria inherently involved with the transfer will enable exploration of the whole Literature that met all three of the of responsibility. This is termed the story. Qualitative methods will enable following criteria was included in this ‘minimum data set’ and defined as an understanding of clinicians’ review: ‘the minimum set of information and needs, perceptions and behaviours, content that must be contained and in contrast to quantifying various • published in the last ten years transferred in a particular type of objective outcome measures related • relevant to the perioperative clinical handover’5. to clinical handover that is specific to setting this type of research inquiry. Clinical handover takes place at • incorporated the transition point many transition points between Methods of care from the operating room to professional interfaces within the the PACU. perioperative setting and in the This literature review of practice broader context of heath service standards, theoretical frameworks Literature that met all three of the delivery6. Transfer of patients and primary research literature following criteria was excluded from from the operating room to the published in the last ten years is this review: focused on clinical handover practice PACU involves inter-professional • transition point of care from the from the operating room to the PACU communication. At this transitional operating room directly to intensive of post-operative patients. Search point in care, when emerging from care unit or coronary care unit (not strategy for the literature, conducted anaesthesia, patients are clinically via the PACU) at high risk due to altered level of in March 2017, used key terms and consciousness and compromised combinations with Boolean operators • grey literature (unpublished airway7,8. and word truncations according to literature without peer review) database requirements to source • all information was available in the all possible keyword terms. Search Purpose published literature report for data terms included: post-operative, The purpose of this literature review extraction. recovery, Post Anaesthesia Care was to establish the scope of the Unit, handover, handoff, information There were 15 observational studies published literature available on transfer, communication, structured and 12 interventional (standardising) clinical handover from the operating communication, checklist, standards, studies included in this review. room to the PACU and identify education, training, safety, quality, The data that was extracted from relevant key sources, theories, quality improvement, adverse each primary research study was concepts, and ideas to understand events, omission and error. Search included into a table format with and ascertain the current knowledge terms were entered for each of the headings of lead investigator, base of this subject area. the following databases: Cochrane year of publication, country of A guiding research framework to Database of Systematic Reviews, origin, setting, sample size, research improve clinical handover practice Cumulative Index to Nursing & design, methods, aims, intervention proposed by Jeffcott and others9 Allied Health Literature, MEDLINE, (if included), instrumentation, identifies information transfer, EBSCO host research database, outcome measures, key findings and responsibility and accountability Ovid Technologies Incorporated, implications for practice. within systems as the three elements Joanna Briggs Institute and PubMed. of clinical handover. Measuring Additional studies and literature Results these elements together with were obtained from reference The literature included in this review policy, practice and evaluation will lists of retrieved papers. Other are divided into policy framework identify multi-dimensional gaps and information sources were hand literature (n = 3), practice literature underpin research to improve clinical searched and included: Policy and (n = 3), theoretical literature handover. Therefore, the elements of Practice Standards, WHO website (n = 2) and primary research information transfer, responsibility and their Institutional Repository for literature (n =27). and/or accountability within systems Information Sharing (IRIS) database. were posed a priori in structuring Policy framework literature and organising the research literature The ACSQHC developed the NSQHS 9 to date. Jeffcott et al. emphasised, Standard 6: Clinical handover5 with due to the complexities of handover, the intention of ensuring ‘timely, 30 Journal of Perioperative Nursing Volume 31 Number 2 Winter 2018 acorn.org.au relevant and structured clinical The Australian College of active participation and use of handover that supports safe patient Perioperative Nurses (ACORN) 14 opinion leaders15,16. care’(p.7). Key criteria were outlined in provides statements, criteria and three core or developmental areas rationale for both the anaesthetic Discussion to achieve this national clinical nurse and PACU nurse roles which Improving the measurement of handover standard and for purposes