Improving Medical Handover in the Tyrone and Fermanagh Psychiatric Inpatient Unit

Abstract

Aims

This project was undertaken in the Tyrone and Fermanagh Hospital, an inpatient Psychiatric Unit in Omagh, Northern Ireland. It was recognised that the previous method of medical handover via anonymised WhatsApp messages had several issues including patient data on personal phones, over-reliance on phone apps which have the potential to crash and short messages with limited details were included. The aim of our project was to improve patient safety by improving communication between medical staff members.

Methods

The previous method of medical handover was via text message on messaging platform WhatsApp. A message was sent the morning of handover, to the WhatsApp group.

We continued to use a digital platform, but used Microsoft word, and Western Trust email addresses to record and send the handover. At the start of this project, we allowed free space recording, resulting in variation in the handovers.

We agreed a minimum number of details to be included to ensure quality of handover, and audited the word documents, to assess the adherence to this.

This change, still does not require face to face handover. There have been pros and cons to the change, which will be discussed in this presentation.

We reviewed four months’ worth of handovers. They were reviewed for specific elements of essential handover criteria. The areas included Patient Name, H&C, detained or voluntary, admission or review, presenting complaint, patient's history, risks, physical issues, and handover to specific person.

It should be noted that the doctors involved were aware of the changes made, and standards being introduced, and therefore were aware that they would be auditing their own handovers. This might have created bias in the subsequent handovers.

We then analysed each month to see what percentage of handovers had been concordant with the standards. These data were then represented in graphs, as we will show.

Results

We identified areas which were performed well when completing handover. The areas which were consistently 100% included the date of handover and patient name or initials. Outstanding jobs were performed in 97.5% of handovers.

Areas for improvement identified when collecting results were the status of admission (i.e. voluntary or detained), the main patient risks and use of the document password.

100% of the shifts used the new digitalised format for handover using Microsoft word and trust email system.

Conclusion

We reviewed the results of the data, which highlighted areas for improvement

We hope to implement a standard performa for handovers, reducing the chance of key information being missed, thereby improving patient safety. We aim to collect data following this 2nd intervention in the next rotation and continue to examine handover processes using PDSA cycles.