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Using quality improvement in practice; introducing labour ward handover
Abstract Number: S-65
Abstract Type: Other
In Good Medical Practice, the General Medical Council identified the importance of sharing relevant information at the point of handover when going off duty (1). When handover is unstructured, information can be missed leading to an increased risk of critical incidents (2). The use of a structure can increase the quality of obstetric anaesthetic handovers and thus enhance patient safety (3). Our labour ward handover was unstructured and independent of the multidisciplinary team (MDT) handover which potentially led to important patient information being missed. We used Quality Improvement in Practice (QIP) methodology to identify ways to introduce a structured handover.
The PDSA (Plan, Do, Study, Act) cycle was used to help structure the change. A driver diagram systematically looked at all aspects of the project. In phase 1 the form was designed, it included all patients that may need anaesthetic input (ante-, peri-, post-natal). The timing of the handover was studied using process mapping. This identified that anaesthetic handover occurred before the MDT handover and duplication of tasks was occurring. We acted on this by incorporating our anaesthetic handover into the MDT meeting. Phase 2 of PDSA saw implementation of our joint handover with the new structured sheet. The initial measurement of change was the number of completed handover forms and this was shown visually using a run chart.
Monitoring revealed that 44/62 (71%) forms were completed through December. There were only 4/31 days (12%) in which no forms were completed and these fell at weekends and on Christmas Day. Overall, the target of forms being filled in at both handovers occurred on 17/31 days (56%).
There was initial resistance to the structured handover sheet. It was felt that there would be duplication in the handovers. This was identified in phase 1 and after discussion with senior team members was solved by joining the MDT handover. This was welcomed. Our target was 90% of forms completed so we will continue the project to achieve this. Run charts are a good way to show variation in progress over time visually and will be put on posters for all clinicians to see. Further education is needed to improve the quality of information included about patients at handover. This QIP project identified when the form was less likely to be completed and will focus on these periods, which have been suggested as times of increased patient risk.
1. GMC Good medical practice 2013
2. Sabir N, Yentis SM, Holdcroft A. A national survey of obstetric anaesthetic handovers. Anaesthesia 2006;61:376-80
3. Bailes IDW, Dharmadasa A, Lucas DN. SAFE Handover: An audit of the efficacy of a structured handover tool. International Journal of Obstetric Anesthesia 2011;20:S11