Key principles

The Acute Care Taskforce engaged a wide group of stakeholders across the state and with national bodies to develop the key principles that must be standard to all scenarios of clinical handover.

"Flexible Standardisation" means that the key principles of clinical handover must be standard, but that the processes and relationships by which they are realised can be adapted to fit local needs. See the Tools and Templates page for the Implementation Toolkit and other support resources.

Clinical handover is more than just what information is handed over, but also how, where, when, by whom and utilising different media or tools.

Standard key principles:

Leadership
Valuing handover
Handover participants
Handover time
Handover place
Handover process

1. Leadership

Nominate a leader at each clinical handover.

The larger the handover process (i.e. more handover participants) the more important the role of the leader becomes to manage clinical handover.
The leader for handover must have a comprehensive understanding of the handover process and their role as the leader.
The leader ensures that all participants attend and are heard.
Immediate escalation of deteriorating patients for action must be undertaken by the leader.

2. Valuing handover

Set the expectation that clinical handover is valued and an essential part of daily work. Ensure staff are available to attend the handover of all patients relevant to them.

Review your clinical staff rosters to ensure they support handover.
Innovative solutions may be required to reinforce the importance of
attendance at clinical handover.

3. Handover participants

Identify and orient handover participants. Involve them in regular review of the clinical handover process. Wherever possible, patients and carers should be recognised and included as handover participants.

Identify the staff that must be present for clinical handover to occur.
In Multidisciplinary teams, handover should be structured to allow staff to be present for patients relevant to them and then released.

4. Handover time

Set an agreed time, duration and frequency for clinical handover to occur. It is highly recommended that, where possible strategies are defined to reinforce punctuality.

Clinical handover is not just at shift change, but every time a change of accountability and responsibility occurs – e.g. consider when a patient is transported from the ward to a test (refer to Matrix of clinical situations and handover options pdf - 44 KB).
Timeliness of handover is imperative to ensure a sustainable and effective process.

5. Handover place

Set a specific location for clinical handover to occur. Preferably, clinical handover occurs face to face and in the patient’s presence, where appropriate (bedside handover).

Taped handover is a practice that is considered inappropriate. (Special Commission of Inquiry into Acute Care Services in NSW Public Hospitals - Page 533) "In my view, this process is manifestly inadequate and ought be discontinued."
If handover cannot happen face to face, then other options should be considered to ensure effective and safe clinical handover (refer to Clinical handover matrix pdf - 47KB)
Make sure that the handover place is as free from distractions as possible – e.g. pager noise, telephones and general ward noise.

6. Handover process

Define the clinical handover process:

Standardised Protocol

Generate process maps, scripts and cues for how clinical handover occurs each and every time. Your standard protocol should:

Clearly identify the patient, you and your role
State the immediate clinical situation of the patient
List the most important and recent observations
Provide relevant background/history to the patient's clinical situation
Identify assessments and actions that need to occur
Identify timeframes and requirements for transition of care
Promote the use of the patient record to cross-check information
Ensure documentation of all important findings or changes of condition
Ensure comprehension, acknowledgement and acceptance of responsibility for the patient by the clinician receiving handover.

Deteriorating Patients

Where the condition of a patient is deteriorating, escalate the management of these patients as soon as a deterioration in condition is detected.

Other Critical Information

Prioritise alerts of other important information (e.g. outstanding actions, planned patient moves, Occupational Health and Safety risks or staffing pressures).