Ballarat Health Service (BHS) were approaching accreditation during 2014 and were looking for a way to improve their nursing handover process to ensure they complied with the National Safety and Quality Health Service (NSQHS) Standard 6 – Clinical Handover. BHS had a variety of different handover methods which were dependant on which ward you worked on. Processes were very manual and inconsistent and mostly involved printing patient lists from the PAS and handwriting notes on them. Notes were then disposed of, with no record retained of what was discussed during handover.
Core Medical Solutions (CMS) worked with BHS to help create a nursing handover process in BOSSnet. BHS created their own customised dynamic eForm, which included all the information they needed to collect for their nursing handover. This eForm is located on the Nursing Précis, and when selected, the form is prepopulated with the patient’s details. The BOSSnet Précis is a snap-in that is designed to display a clinically appropriate, context relevant summary of the patient’s current state, summarising key data for the user, to assist in rapid decision making and action. BHS have a nursing Précis which is specifically designed to meet the needs of the nursing staff. Having the Nursing handover eForm on the nursing Précis allows nurses to quickly retrieve the eForm for the appropriate patients and complete. Because it is a dynamic eForm, it also retains the information from the previous handover on that patient, so the nurse only needs to update information that may have changed (e.g. if that patient had a fall).
CMS then built functionality to allow BHS to create their own customised task list for nursing staff to enable the information in the handover notes to be exported to a list. The list was built using a standard ISBAR format (Identification, Situation, Background, Assessment, and Request) which is the framework BHS have chosen to adopt to comply with the National Standard 6 – Clinical Handover. This list is printed, and used as the discussion point for handover.
BHS also created a dynamic eForm for mental health handover in addition to the general nursing handover, as mental health required different information to be identified and discussed.
The implementation of the nursing handover note at BHS received praise from the Surveyors in their accreditation report:
“The surveyors attended many clinical handovers and the adherence to the guidelines and processes was exemplary”
“Surveys of staff and patients indicate high satisfaction with clinical handover…”
Other benefits and positive outcomes from the implementation include:
The clinical engagement from the nursing staff has been a huge positive and BHS are extremely pleased with the way nursing staff have embraced the change in how they do their daily handovers. The new handover process has resulted in better communication between clinical staff, and therefore better outcome for patients.
"We now have all of our nurses documenting handover in BOSSnet on a daily basis, meeting and exceeding our accreditation requirements!"Kate Nolan