The breakdown in the transfer of information during clinical handover is one of the most important contributing factors in serious adverse events and a major preventable cause of patient harm.
In Australia, nursing handover practice in mental health settings has largely adopted Australia National Safety and Quality Health Service Standard 6 which outlines 3 categories: governance and leadership for effective clinical handover, clinical handover processes, and patient and carer involvement in clinical handover. At present, there is no clear guideline or published research paper on standardised items for the content of mental health nursing handover. This study aims to develop a minimum data set to address this gap.
The study was undertaken in 2015 and 2016 at two approved NSW Health study sites involving three data collection methods: handover observations (n=233), staff focus groups (n=36), and consumer interviews (n=8). The data collected from the handover observations were quantitatively collected and analysed. The data collected from the staff focus groups and consumer interviews were digitally recorded, transcribed and analysed. All data were triangulated to determine the final data set items.
The final data set includes the following items: patient introduction; clinical status (includes relevant clinical history, diagnosis and mental state); summary of key nursing interventions (e.g. PRN medications); risk level and management strategies; social interactions; consumer/carer requests; changes to treatment plan (includes follow up post investigation or reviews); and care instruction (includes legal, leave and observation level).
At present, the data set has been successfully introduced to the study sites. The researchers aim to determine any improvement in practice by evaluating the utility of the data set during nursing handover practice in 2017. It is expected that the data set items will be utilised in nursing handover practice and aligned with Introduction Situation Background Assessment Recommendation (ISBAR) clinical handover structure.
The study outcome has a direct impact across the following fields: guiding content standard and consistency in mental health nursing handover, acting as a quality tool for continuous practice improvement, and supporting the translation of research evidence in policy making. It has been written up for publication and the authors are currently responding to journal reviewers’ comments.
Clara Luo (Xiaoou), Clinical Nurse Consultant, Mental Health Drug & Alcohol – Northen Sydney Local Health District