Context Our hospital serves a surrounding population of over two hundred and fifty thousand people and caters to about three thousand deliveries a year. There is one postnatal ward with nineteen beds for mothers and their babies. It is usually staffed by three midwives, two healthcare assistants and one paediatric SHO during working hours.
Problem Communication between the obstetric, midwifery and paediatric staff regarding any babies on the postnatal ward was casual and ad hoc with no set verbal or written handover between daytime and out of hours staff. This appeared to lead to delays in treatment of certain babies, for instance antibiotic administration, screening for sepsis and serum bilirubin measurements.
Assessment of problem and analysis of its causes A multidisciplinary survey of those involved in obstetric and neonatal care was undertaken to identify the cause of these problems and to garner suggestions for improvement.
Intervention A more formalised handover system was developed. Information was passed between the daytime paediatric SHO to the on call team using a printed handover sheet passed from the daytime paediatric SHO to the on call team. The sheet contains a list of babies needing specific paediatric input and includes aide memoires of NICE guidelines concerning early onset neonatal sepsis and neonatal jaundice. At change of shifts patients are discussed with the written sheet as a reminder.
Study design This study was carried out as a clinical practice improvement project.
Strategy for change The printed handover sheet was introduced on a Monday morning for a trial of four weeks. It was used at each morning, early evening and night-time handover. Its introduction followed discussion with the paediatric medical staff and the midwifery team via the ward sister.
Measurement of improvement The staff of both departments were surveyed a month later to feed back any changes brought about through the new handover system. The results were very encouraging with 100% respondents reporting an improvement in communication of postnatal duties.
Effects of changes There was a improvement in both the speed at which babies were reviewed and management plans instigated. The number of bleeps to the postnatal SHO decreased. No problems were encountered throughout the period of quality improvement. The midwifery staff are now considering introducing a similar system for their daily handover.
Lessons learnt Importance of asking for feedback from all staff involved on the ward to obtain opinions on the need for change was the best way to do this. It has ensured any improvement introduced has been user friendly and staff are enthusiastic with regards to the change.
If the authors were to repeat this quality improvement project, it would be useful to assess the implication of poor handover on infant care. For example missed/ late blood samples or delayed discharge.
Message for others The message conveyed by this project is that every ward should have an effective handover and that with using simple measures dramatic differences can be made. This project identified a lack of effective handover on a postnatal ward which led to delayed or missed patient care. Using a handover tool designed following staff feedback, handover between staff members improved significantly and this positively impacted on patient care.
Effective handover helps ensure patients receive appropriate and timely care. Potentially serious results are not forgotten about or missed when staff finish duty. It is essential as clinicians to ensure patients receive the best care and effective handover is an integral part of this.
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