Computerised Nursing Handover

1. Computerised Nursing Handover

2. Presentation Outline What is Handover? A look at Patient Safety Communication Introducing CHERRi CHERRi meshing with CRM  Where can CHERRi go�.

3. What is handover? �the transfer of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another person or professional group on a temporary or permanent basis� (National Patient Safety Agency: UK)

4. Presentation Outline What is Handover A look at Patient Safety Communication Introducing CHERRi CHERRi meshing with CRM  Where can CHERRi go�

5. Adverse Events

6. Patient Safety Measurements NSW Health � Patient Safety and Clinical Quality Program Victorian Health � Sentinel event program: Annual Report

7. Handover links to adverse events

8. Presentation Outline What is Handover A look at Patient Safety Communication Introducing CHERRi CHERRi meshing with CRM  Where can CHERRi go�

9. Communication

10. How does it go wrong?

11. Communication Barriers in Clinical Handover Lack of standandisation of clinical handover processes  Lack of training in effective clinical handover, communication and teamwork skills. Lack of time to prepare for handover. Lack of time to provide or receive a detailed handover. Limited policy development regarding clinical handover. Changing workplace practices leading to reduced continuity of care and increasing number of handovers.

12. Communication Example:  Occurring regularly in practice

13. Presentation Outline What is Handover A look at Patient Safety Communication Introducing CHERRi CHERRi meshing with CRM  Where can CHERRi go�

14. The need for something new� Always has a subjective aspect Differing skill and knowledge levels Abbreviations change over time Varying nurse roles and responsibilities Time consuming to produce and format The larger scope of handover It has been identified that increasing structure to handover reduces the presence of judgemental, stereotyping and emotional feelings of the current shift to be passed over. It will always be subjective but a structured handover provides decreased ability for this to occur. With the varied training that the nursing culture have received since forming the nursing arena is vulnerable for differing skill and knowledge levels within everyday practice. Depending on when nurses first trained or what is their preferred abbreviation it can be confusing to new or later training individuals to differentiate and therefore this places the content at risk for mis communication. The handover includes RNs, ENs, AINs, Casual and Agency staff, RN and TEN Students to name but a few. These varying roles will benefit from struture and consistancy for handover practices. A team leader is required to update the handover on the ward that CHERRi was implemented. It would take the team leader, with interruptions, the entire shift to read notes and update word document. This is time that could be better spent with structured datasets. A nursing handover is utilised by more than purely nurses. It is used often to inform Doctors, Allied Health, Patient Flow Managers and Consultants. It is therefore beneficial for the professionalism of nursing to consider the implication of having accurate, available information that can be used to advise groups on when needed.It has been identified that increasing structure to handover reduces the presence of judgemental, stereotyping and emotional feelings of the current shift to be passed over. It will always be subjective but a structured handover provides decreased ability for this to occur. With the varied training that the nursing culture have received since forming the nursing arena is vulnerable for differing skill and knowledge levels within everyday practice. Depending on when nurses first trained or what is their preferred abbreviation it can be confusing to new or later training individuals to differentiate and therefore this places the content at risk for mis communication. The handover includes RNs, ENs, AINs, Casual and Agency staff, RN and TEN Students to name but a few. These varying roles will benefit from struture and consistancy for handover practices. A team leader is required to update the handover on the ward that CHERRi was implemented. It would take the team leader, with interruptions, the entire shift to read notes and update word document. This is time that could be better spent with structured datasets. A nursing handover is utilised by more than purely nurses. It is used often to inform Doctors, Allied Health, Patient Flow Managers and Consultants. It is therefore beneficial for the professionalism of nursing to consider the implication of having accurate, available information that can be used to advise groups on when needed.

15. The CHERRi CCU Design Process

16. Design of Computerised handover User Interface Drop down boxes with pre-established abbreviations Minimal free typing space Ability to customise Categorised for viewing One screen update

17. So lets see it already�.

18. Effect and Feelings on CCU

19. What can Information Technology add? Improved communication Provide access to information Reducing unnecessary information Assist with calculations Allow monitoring of data Aid in decision support Can improve medication safety

20. CHERRi�s IT Advantage �Roughly 75% of all large Information Technology projects in health care fail�

21. What are the measurable outcomes with CHERRi Reduction of adverse events - Medication Errors - Falls - Manual Handling - Infection Rates Improved patient care Increased compliance with EDD Decreased Nursing Turnover Improved employee satisfaction Guided education needs Time of Team Leader Statistic module saves time and resource

22. Presentation Outline What is Handover A look at Patient Safety Communication Introducing CHERRi CHERRi meshing with CRM  Where can CHERRi go�.

23. Crew Resource Management (CRM) CRM developed by the Aviation industry in 1979 Emphasis human factors in high stress and high risk environments Developed by the airline industry to improve communication. - Extensive use of checklists - Identified command and control decisions - Decision making models There is no universal CRM training program CRM programs educate on the limitations of human performance.  Has identified potential to healthcare.

24. CRM Human error has caused or contributed to over 50% of aviation accidents. Root cause analyses by safety experts have found that errors frequently occur because flight crews fail to effectively manage the resources available to them (e.g., fail to verify information when uncertain about it, fail to plan for contingencies).

25. Four Principles of CRM Situational Awareness Communication Assertiveness Risk Situational Awareness� �is the realistic understanding of all factors which affect the safety and effectiveness of your crew and aircraft. Environment orientation (time, place and patients condition) Individual position in situation and personal capabilities (knowledge and skill level) Those around you in situation and their personal capabilities (knowledge and skill level) We can lose situation awareness from: Fatigue/Stress, Complacency, Decision Making, Inadequate error management, Hierarchy problems, poor communication Say what you mean, mean what you say. MAKE SURE IT IS UNDERSTOOD! Situational Awareness� �is the realistic understanding of all factors which affect the safety and effectiveness of your crew and aircraft. Environment orientation (time, place and patients condition) Individual position in situation and personal capabilities (knowledge and skill level) Those around you in situation and their personal capabilities (knowledge and skill level) We can lose situation awareness from: Fatigue/Stress, Complacency, Decision Making, Inadequate error management, Hierarchy problems, poor communication Say what you mean, mean what you say. MAKE SURE IT IS UNDERSTOOD!

26. CRM: Examples in Health Care Medical Emergency Teams: can have active simulation training which is consistent with CRM principles. Anesthesiology: 65-70% of safety problems (accidents or incidents) have been attributed at least in part to human error. VA Palo Alto Health Care System and  Stanford University, developed  Anesthesia Crisis Resource Management  (ACRM), modeled on CRM.

27. CHERRi and CRM CHERRi based on methodical steps and processes � acts as a checklist/template. CHERRi aims to reduce loss of important data in handover � acts as a tool to reduce human error. CHERRi acts to support team work � through real time updating and consistency. CHERRi offers a data collection tool � to identify training opportunities and potential safety risks.

28. Presentation Outline What is Handover A look at Patient Safety Communication Introducing CHERRi CHERRi acceptance  Where can CHERRi go�

29. Where to from here�. CCU Transferability Another hospital (CCU) Other interested hospitals? Ward Dataset Generation For other wards, e.g. Surgical, Medical, DEM etc Consensus conference, Collaboration Design Methodology Interested hospitals? CRM Meshing with CHERRi and possible future research to define this link.

30. CHERRi Future Currently CHERRi represents my BN (Honours) study at the University of Western Sydney. Plan to publish results in Thesis early 2008. Supervisors: Dr Yenna SalamonsonSenior Lecturer, University of Western SydneyClinical Nurse Specialist, ICU/HDU, Campbelltown Hospital, NSW Professor Patricia DavidsonProfessor of Cardiovascular and Chronic Care School of Nursing and Midwifery Curtin University of Technology, NSW Professor John DalyHead of School, Nursing, University of Western Sydney, NSW  Model for research and commercialisation (CHERRi Health Technology)