Handover may be defined as “the exchange between health professionals of information about a patient accompanying either a transfer of control over, or of responsibility for, the patient” (Cohen & Hilligoss, 2010, p. 494). It is an important forum for communicating patient information. Communication breakdowns during handover may have adverse effects on patient safety and quality of healthcare (Department of Health, 2012). Existing research on handovers involving nurses has largely focussed on information provision during shift-to-shift nursing handovers in specific hospital settings (e.g., medical wards). Research to date does not adequately convey the detail and complexity of handover communication. Handovers take place multiple times during a nurse’s working shift, and is an important communication forum for conveying information pertaining to a patient’s medications (e.g., at-home medications, medication treatment, goals and outcomes of medication treatment, and discharge medications). Liu, Manias, and Gerdtz (2012) and Manias, Aitken, and Dunning (2005) have explored medication communication during nurse-to-nurse handovers in individual settings. However, there is a lack of research on communication about medications during handovers involving nurses (in which health professionals other than nurses may give or receive handover) in a variety of specialty hospital settings. We seek to address this gap in research by examining how medications information is communicated during handovers involving nurses in a variety of speciality hospital settings.
This exploratory qualitative study draws on over 200 hours of audio-recorded participant observation of health care professionals in hospital specialty settings. The study was conducted at a metropolitan Australian public hospital in cardiothoracic care, intensive care, emergency care, and oncology care settings. Communication interactions involving nurses performing handovers to, or receiving handovers from, ambulance officers, doctors or other nurses, were observed. Handover types included health care professionals’ communication for the purposes of shift changeover, moving patients between or within a ward, receiving or sending patients via ambulance services, and leaving or returning to the patient area for tea breaks or other purposes. All audio recorded handovers were de-identified and transcribed verbatim. A comprehensive thematic analysis was performed by three researchers.
Factors shaping medication communication during all types of handover included: whether an intravenous infusion was being administered and the type of infusion, medication tasks to be attended to, anticipated time away from the bedside, a receiving nurse’s knowledge of the patient, and potential risk to the patient. Outgoing nurses who left the bedside temporarily, such as for a tea break, infrequently received a handover of information upon return to the patient area. There was a lack of medication communication involving patients and any present family members during handovers, despite these handover interactions often taking place at the bedside. Little time was devoted to conveying medication information. Information conveyed focused on medications prescribed during a patient’s hospital stay. Patient medications taken prior to hospitalisation were seldom mentioned, except in ambulance officer-nurse interactions. Medication names were not always mentioned during handover, with generic medication referents used instead (e.g. antibiotics). Often the names of medications were abbreviated and units of medication doses omitted. In regard to shift-to-shift handovers, the structure of communication varied according to the setting in which it was conducted. In cardiothoracic care and intensive care nurses were observed to use a body systems approach to order their communication, which facilitated the sharing of medication information. In emergency care and oncology care, patient documentation was used to structure communication. Medication communication did not arise consistently with this approach. In all settings, medication administration records were often reviewed at the end of handover interactions.
Effective communication between health care professionals during handover enhances patient safety and quality of care. Currently little time is allocated to the communication and discussion of medication information. Greater emphasis on medications during handover, and the involvement of patients and family members, could improve the content, accuracy, timeliness and completeness of medication communication. This may reduce the risk of medication incidents.
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