Junior Medical Staff Handover Process

Standard Operating Procedure for the

Junior Medical Staff Handover Process

CATEGORY: / Procedure
CLASSIFICATION: / Governance / Clinical
PURPOSE / To describe the operational procedure for junior medical staff handover
Controlled Document Number: / 899
Version Number: / 1FinalDraft
Controlled Document Sponsor: / Executive Chief Operating Officer
Controlled Document Lead: / Deputy Director of Strategic Operations
Approved By: / Executive Chief Operating Officer
Executive Chief Nurse
Executive Medical Director
On: / March 2015
Review Date: / December 2017
Distribution:

Essential Reading for:

Information for:

/ All Trust staff / departments involved in the juniormedical staff handover process
All staff

SOP for Junior Medical Staff Handover ProcessPage 1 of 12

Issued: TBC

Document Control Number: 899Version No: 1

Contents

Page
1.0 / Aim / 3
2.0 / Junior medical staff handover process to be followed / 3
3.0 / Roles and Responsibilities / 4
4.0 / Process for Clinical Decision Unit (CDU) / 5
5.0 / Process for Critical Care Unit (CCU) / 6
6.0 / Emergency theatres / 6
7.0 / References/Bibliography / 7
Appendix 1 / Situation, Background, Assessment and Recommendation (SBAR) Tool / 8
Appendix 2 / Quick reference Guide for Junior Medical Staff / 11

Standard Operating Procedure for Junior Medical Staff Handover

1.0Aim

1.1The aim of this Standard Operating Procedure (SOP) is to provide information for all members of staff involved in the junior medical staff handover process. This should facilitate improved communication, better coordination and continuity of care therefore contributing towards good patient care.

1.2The aim of any handover process is to achieve the efficient transfer of high quality clinical information at times of transition of responsibility for patients.A common set of principles should apply and the Trust encourages the use of the Situation, Background, Assessment and Recommendation (SBAR) Tool for increased communication within the team. More information on SBAR is provided in Appendix 1.

1.3This SOP details the process which must be followed by all staff within the Trust involved in the junior medical staff handover process.

2.0Junior medical staff handover process to be followed

2.1Tier 1 Handover

2.1.1Tier 1 handover for each individual specialty will take place locally in the agreed location, preferably in the ward area and at the agreedtime.This will be between two junior doctors, the one departing and the one arriving on duty. The bleep will be handed over at this meeting.

2.1.2Handover data must be input into the Prescribing and Information Communication System (PICS) by the junior doctor handing over at specialty level. The handover module in PICS will have the functionality to include a mechanism to highlight the acutely ill and deteriorating patients. PICS includesa requirement to record details of acutely ill or deteriorating patients, any significant workload pressures and any unusual issues/ tasks that need to be brought to the attention of the Clinical Site Management Team.

2.1.3Appendix 2 provides a Quick Reference Guide to the standards for completing a patient handover.

2.1.4One junior doctor from each Specialty must then attend Tier 2 handover (See section 2.2).

2.2Tier 2 Handover

2.2.1Tier 2 handover will take place at 21.30 hrs. Thefloor based Clinical Site Manager will meet the junior medical staff in the agreed areas and will both receive and give information on:

Location of any acutely unwell or deteriorating patients
Unusual workload pressures
Site overview to include any medical staffing issues
Any escalation or mitigation plans

2.2.2 Tier 2 handovers will take place in the following locations:

Group One

ENT, Maxillofacial, General Surgery, Urology, Renal Surgery, Renal Medicine

Location: Ward 303

Site Manager Bleep Number 2236

Group Two

Haematology, Oncology, General Medicine, Neurology, Cardiology

Location: Ward 515

Site Manager Bleep Number 1433

Group Three

Liver Medicine, Liver Surgery, Vascular, Cardiac Surgery,

Location: Ward 727

Site Manager Bleep Number 2831

Group Four

Burns & Plastics, Trauma & Orthopaedics, neurosurgery

Location: Ward 410

Site Manager Bleep Number 2400

Group 5

Old Hospital

Location: Wellcome Office

Site Manager Bleep 1067

2.3Following the Tier 2 handover, at 22.00hrs the Clinical Site Management Team will meet in the Operations Centre for the bed meeting. At this stage they will have a comprehensive view about what is happening across the Trust in terms of capacity, staffing and workload issues.

2.4The handover process will be clearly documented in PICS allowing all doctors and the Clinical Site Management Team to see the total picture across the Trust in all specialities.

2.5The escalation process for any key issues identified will be agreed at this time and communicated back to the junior doctors by their floor basedClinical SiteManager.

2.6The Clinical Site Management Team will know which specialities have a resident or non resident for escalation and support.Any issues around staff not responding appropriately must be escalated by the Clinical Site Management Team to the On-Call Manager and ultimately the Executive Director on call.

3.0Roles and Responsibilities

3.1The junior doctor departing musthand over the bleep and give both a verbal and written handover (using the PICS system) to the junior doctor arriving (Tier 1 handover).

3.2The junior doctors on night duty must meet with the floor based Clinical Site Manager to ensure they give information and receive information onwhat is going on across the Trust as a whole (Tier 2 handover).

3.3The floor based Clinical Site Manager will attend the agreed ward areas to share and receive information from the junior doctors on night duty.

3.4The Clinical Site Management Team will keep a record of all acutely ill or deteriorating patients across the Trust and monitor them throughout the 24 hour period. At the end of each shift, there will be a verbal handover between to outgoing and oncoming staff as well as adding each of these patients to the Hospital @ Night System.

3.5The consultant must ensure the junior doctors are well supported in regards to the escalation process and know who to contact should the need arise.

3.6Switchboard will ensure the rotas are sent to the Operations Centre so the Clinical Site Management Team know the names and bleep numbers of those staff on duty.

3.7The Clinical Site Management Team will, via switchboard, alert the junior doctors on night duty if the Trust is under pressure and they will be requested to attend the Operations Centre for further instructions or task redeployment.

4.0 Process for Clinical Decision Unit (CDU)

4.1Tier 1 Handover

4.1.1This will take place in the CDU handover room at 21.00hrs and be managed by the Clinical Site Management Team(bleep number 1433) and led by the incoming SPR. In addition the representatives will be; the outgoing SPR, incoming and outgoing FY1, the incoming and outgoing RMO and lead nurse, as required.

4.1.2SBAR principles to be adopted and will include;

Number of patients waiting to be seen in CDU, clinic and Emergency Department;
Patients who are medically unstable not seen and just referred from resuscitation;
Patients who are medically unstable and seen;
Overview of the inpatients on CDU, the patients who have already had a post take review;
Outstanding jobs;
Staffing update, medical and nursing (expected or unplanned absence);
Handover of bleeps.

4.1.3The Clinical Site Management Team will take information to the Tier 2 handover at 21.30hrs with the knowledge of what is happening at the front door.

4.1.4.All general medical night teams will meet again at 03.00hrs in the CDU handover room. This will include the Clinical Site ManagementTeam.

5.0 Process for Critical Care Unit (CCU)

5.1Tier 1 Handover

5.1.1This will take place in the four areas (A, B, C and D) at 20.00hrs. This will be between the junior doctors departing and the junior doctors arriving. The bleeps will be handed over at these meetings. Currently there is an excel spreadsheet in use that is standardised across the unit.

5.1.2The Clinical Site Management Team will make contact with the SPR Team Leader in CCU(bleep number 1259) at 22.00hrs to identify any potential problems and create a line of communication.

6.0Emergency Theatres

6.1The handover of emergency surgical cases between Anaesthetic junior doctors takes place at 08:00hrs and 20:00hrs.

6.2The handover meeting at 08.00hrs takes place in Theatre office 18, extension 12860, known as “the bunker meeting”.

6.3The junior doctorsfinishing the night shift will hand over all the cases booked, the bleeps and the completed anaesthetic sheets of those patients who have been pre-assessed, to the arriving junior doctors. The arrivingjunior doctors are also made aware of the cases that have been booked but not pre-assessed by an Anaesthetist.

6.4When there are cases in theatre at 08:00hrs undergoing emergency surgery, an arriving junior doctorof suitable experience and seniority relieves the night junior doctorlooking after the emergency and does not attend the bunker meeting. This junior doctoris later briefed by the other junior doctors who do attend the bunker meeting about the other emergencies booked, pre-assessments pending and surgical priorities.

6.5The 20:00hrs handover takes place in the bunker and is attended by the outgoing and incoming junior doctors if possible. Typically at this time of the night there will be emergency cases in theatres.In this case, the outgoing junior doctorswill be relieved in theatre by incoming junior doctors of suitable experience and training. The handover of bleeps, completed anaesthetic sheets of those patients who have been pre-assessed and any outstanding pre-assessments will take place in theatres after handing over the clinical case which is being operated on.

7.0References/ Bibliography

British Medical AssociationSafe Handover; Safe Patients

[Accessed 6.1.15]

NHS Institute for Innovation and Improvement (2008)Situation, Background, Assessment, Recommendation (SBAR)

[Accessed 6.1.15]

Royal College of Physicians (2011)Acute Care Toolkit 1 handover

[Accessed 6.1.15]

Royal College of Surgeons (2007) Safe Handover

[Accessed 6.1.15]

Appendix 1: Situation, Background, Assessment and Recommendation (SBAR) Tool

What is SBAR and how can it help me?

SBAR is an easy to remember mechanism that you can use to frame conversations, especially critical ones, requiring a clinician's immediate attention and action. It enables you to clarify what information should be communicated between members of the team, and how. It can also help you to develop teamwork and foster a culture of patient safety.

The tool consists of standardised prompt questions within four sections, to ensure that staff are sharing concise and focused information. It allows staff to communicate assertively and effectively, reducing the need for repetition.
The tool helps staff anticipate the information needed by colleagues and encourages assessment skills. Using SBAR prompts staff to formulate information with the right level of detail.

When does it work best?

The NHS is often criticised for poor communication, however, there are few tools around that actively focus on how to improve communication, in particular verbal communication.
The tool can be used to shape communication at any stage of the patient's journey, from the content of a GP's referral letter, consultant to consultant referrals through to communicating discharge back to a GP.
When staff use the tool in a clinical setting, they make a recommendation which ensures that the reason for the communication is clear. This is particularly important in situations where staff may be uncomfortable about making a recommendation i.e. those who are inexperienced or who need to communicate up the hierarchy. The use of SBAR prevents the hit and miss process of ‘hinting and hoping'.

How to use it

A detailed description of the steps involved:
S Situation:

Identify yourself the site/unit you are calling from
Identify the patient by name and the reason for your report
Describe your concern

Firstly, describe the specific situation about which you are calling, including the patient's name, consultant, patient location, code status, and vital signs. An example of a script would be:

"This is Lou, a registered nurse on Nightingale Ward. The reason I'm calling is that Mrs Taylor in room 225 has become suddenly short of breath, her oxygen saturation has dropped to 88 per centon room air, her respiration rate is 24 per minute, her heart rate is 110 and her blood pressure is 85/50. We have placed her on 6 litres of oxygen and her saturation is 93 per cent, her work of breathing is increased, she is anxious, her breath sounds are clear throughout and her respiratory rate remains greater than 20. She has a full code status."

B Background:

Give the patient's reason for admission
Explain significant medical history
You then detail patient's background: admitting diagnosis, date of admission, prior procedures, current medications, allergies, pertinent laboratory results and other relevant diagnostic results. For this, you need to have collected information from the patient's chart, flow sheets and progress notes. For example:

"Mrs. Smith is a 69-year-old woman who was admittedten days ago, following a MVC, with a T 5 burst fracture and a T 6 ASIA B SCI. She had T 3-T 7 instrumentation and fusionnine days ago, her only complication was a right haemothorax for which a chest tube was put in place. The tube was removedfive days ago and her CXR has shown significant improvement. She has been mobilising with physio and has been progressing well. Her haemoglobin is 100 gm/L; otherwise her blood work is within normal limits. She has been on Enoxaparin for DVT prophylaxis and Oxycodone for pain management."

A Assessment:

Vital signs
Contraction pattern
Clinical impressions, concerns

You need to think critically when communicating your assessment of the situation. This means that you have considered what might be the underlying reason for your patient's condition. Not only have you reviewed your findings from your assessment, you have also consolidated these with other objective indicators, such as laboratory results.

If you do not have an assessment, you may say:
"I think she may have had a pulmonary embolus.'"
"I'm not sure what the problem is, but I am worried."

R Recommendation:

Explain what you need - be specific about request and time frame
Make suggestions
Clarify expectations

Finally, what is your recommendation? That is, what would you like to happen by the end of the conversation?.
"Would you like me get a stat CXR? and ABGs? Start an IV?"
"Should I begin organising a spiral CT?"
Taken from: NHS Institute for Innovation and Improvement (2008)

Appendix 2: Quick reference Guide for Junior Medical Staff

Junior Medical Staff Handover

Quick Reference Guide

The aim of the handover process is to achieve the efficient transfer of high quality clinical informationat times of transition of responsibility for patients.

Process to be followed

Tier 1 Handover

This is the local handover between the departing and arriving Junior doctor within each speciality

Aim is to provide a structured electronic handover using the principles of the SBAR Tool (situation, background, assessment and recommendation for increased communication within the team)

The handover data will be reviewed and updated in PICS during this process

The bleep will be handed over at this point with agreement of the nominated speciality representative who will attend Tier 2 handover at 21.30hrs

Tier 2 Handover

A second handover which is designed to exchange and collate information on a site basis will take place at 21.30hrs. Please note that ITU / Theatres / ED are exempt from the Tier 2 Handover)

The nominated speciality representative from the Tier 1 process will be required to attend this handover which will be split into 5 speciality sub groups who will meet in a designated location. The handover will be chaired by a member of the Clinical Site Management Team and its aim is to bring together specialities to share information across 4 principal areas:

1)List and location of any acutely unwell or deteriorating patients as identified from the Tier 1 handover and PICS

2)Unusual workload pressures

3)Site overview to include any medical staffing issues and overall Trust activity volume

4)Establish any escalation or mitigation plans

Tier 2 Specialty Groups

Group One

ENT, Maxillofacial, General Surgery, Urology, Renal Surgery, Renal Medicine

Location: Ward 303

Site Manager Bleep Number 1433

Group Two

Haematology, Oncology, General Medicine, Neurology, Cardiology

Location: Ward 515

Site Manager Bleep Number 2831

Group Three

Liver Medicine, Liver Surgery, Vascular, Cardiac Surgery,

Location: Ward 727

Site Manager Bleep Number 2831

Group Four

Burns & Plastics, Trauma & Orthopaedics, neurosurgery

Location: Ward 410

Site Manager Bleep Number 2400

Group 5

Old Hospital

Location: Wellcome Office

Site Manager Bleep 1067

What is e-Handover in PICS

Name, location of patient and consultant in charge.

A short summary box including what has happened to the patient with key points about their care.

A task list with the ability to list and sign off tasks.

Flags to show up infection control, DNAR, SEWS, dependency and classifications, and OLOS.

The summary box is a brief, restricted summary and must briefly reflect what has happened to the patient and key points about their care. It should reflect what was previously written on the handover sheets – it can be modified and deleted when appropriate.

It must be up-dated continuously – as you would the paper sheet

What e Handover isn’t

It is not clinical noting – this remains paper based and within a patients’ notes. Day to day, noting must be maintained within the paper record.

At the moment there is no ability to look back at old e-Handover notes. The first version of the tool will be used for an ‘in the moment’.

It cannot be printed – PICS is the source of the “single truth” for patient information

Pilot Wards 303, 728, 622, 623

Feedback encouraged to

SOP for Junior Medical Staff Handover ProcessPage 1 of 12

Issued: TBC

Document Control Number: 899Version No: 1