De-coding your handover!

So I am going to presume you found my blog or even this blog post because you are a student nurse or another type of medical student! If not I'm hoping you can take something from this post that may be useful in some ways to your career or job.

Being a second year nursing student I have started noticing first years saying 'how did you get so much from handover?!'. Now for anyone not in the healthcare setting, handover is similar to a team talk you may get in retail or even a briefing you may get (these examples depend completely on which type of job you work as!), it is a small period (often 5-15 minutes) in which nurses from the shift before will hand over the patients they have been caring for all night/day including any changes. As much as it banes me to say this student nurses are kind of expected to sit there and catch what they can and write it down (this part becomes especially important as you advance through your training). 

Most handovers will in some form rotate around SBAR, for anyone yet to meet this lovely acronym it stands for Situation, Background, Actions and Recommendations. It is used in practically every bit of communication between healthcare workers as the structure prevents any vital information being missed.  

A 'normal' (I say 'normal' as such as no handover is normal, each person differs it slightly to suit them) handover will usually begin with patients split into teams or bays and will often start with 'Bed 12 - Robert Deval* - 64 - then Dr's name' (*as you can probably guess this is just a false patient who doesn't exist and in line with NMC regulations name has been changed so that it doesn't reflect any patient's past or present). This allows you to break up your hand over, I would recommend finding out which patients you will be caring for that shift and writing their names down pre-handover and sectioning them off (I highlight each name to break it up but some people draw a line in a different coloured pen before the next new name, it's what you prefer), you may even find that certain placements may have designated sheet. I have found some placements have designated SBAR sheets and some may sheets that have little boxes for you to write your handover as well. If you are really creative you could even make your own and could get lucky and the ward may even introduce it to their staff!

Tip 1 ~ Try and write down as many bits/acronyms of information you can. It may be that you don't fully understand in handover or how it relates to something else but that is what having a mentor during placement is for and of course that is often what google helps with! More often that not google with a little bit of smarts you will get the right acronym which you can then ask your mentor or another nurse and check that it actually is what it says it is!


So of course for you lovely ladies and gentlemen I have made an example of how I write a handover, it may work for you it may not but you can want you want from it or completely disregard it! I prefer to write my handover on a sheet of A4 as there's such a fast turn over of patients on my last placement that practically every single shift I have a different patient I didn't have the day before!

Tip 2 ~ If you don't understand certain acronyms or you can never remember the typical acronyms, just make your own! Instead of T2D then the medication they are on, do D in a circle then next to it you can put the medication. 

Tip 3 ~ A lot of this stems from doing your research before you start placement! If you've done your research, you can become Sherlock and work out well my ward does X so Y must mean this. Again you can then go confirm this with your mentor or even ask them to go through hand over with you again, they will often 'dumb' things down so you understand it clearly or more often than not they will actually fully say the acronym which you can then note down for next time!

Tip 4 ~ Try SBAR (Situation, Background, Action, Recommendations), you will learn more about this in university and whilst on placement but it equates in everything you do while being a nurse! You use SBAR when handing over to doctors and in emergency cases for example 'Hi Dr X, our 53 yr old patient Mr Adams* currently has a MEWS score of 9 due to resps of 30, sats of 80% and temp of 38.7. - SITUATION. He's been in for the past week for heart failure management with a history of COPD, IBS and type 2 diabetes (its worthy to note that some people will include observations here instead of in the situation)  -BACKGROUND. We've started him on salbutamol nebulisers on 15l oxygen and got him sat bolt upright - ACTION. Is there anything you want us to do till you get here? - Recommendations. 

Now depending on how you work will depend on how you set out your handover! I have seen many different nurses set theirs out in different ways. If you wanted to make a word document version, I would strongly suggest completing one shift so you get a rough idea of how many patients you will be taking handover for (I think the most I've had is 8 ish) so you know roughly how much information you are going to need room for, it my also help you figure out how you want your handover. One thing I will say is that if you find the way that works for you...use it no matter how silly it is!

So this is one way you can write your handover and I will admit that for pretty much all of first year my handover looked exactly like this, especially when the people handing over seem to talk extremely fast! I start on the left part of the page with a history of why they have come into hospital e.g. went into hospital X with angina like-symptoms with no relief from GTN spray. Transferred to us on 30/9 for angios +/-. Once I had all that information down I would then put what jobs needed completing that shift below it. On the right side I would have any past medical history.

Now this is the way I've started to write my handovers after my latest placement like before I start of with the bed number, patient name, age and doctor, all of which is highlighted. Underneath this I write the relevant history of why this patient has come into hospital, including important things that have been completed. After that I draw a line (lines help to seperate up all the different sections and makes it easier to look at in a glance when you are trying to work out what you still have to get done and also for when you are writing/typing up your nurses notes), under that line is any relevant medical history for the patient such as chronic conditions like diabetes and things like social sections of the patients life like whether they live alone or with someone, if they have a positive family who can help the patient once he/she has been discharged. 

Then seperated on the far right I have two other sections, at the top is a smaller section which I generally use to writing patient MEWS score (helps with completing nursing notes, no more flicking back and forth between different areas of the notes) or I will also write anything like whether the patient has pu'd or had their bowels opened (with amount or type of bowel movement). I find this section becomes really useful if you have patients going for surgery that have to have specific things completed and be ready for a certain time, I will put it all in this section which surrounded in red pen or highlighter it kinda draws your eye! Really you could put anything you wanted in that! Underneath that I put things that need to be completed for the patient for that shift such as bloods completing, IV antibiotics, sputum sample etc etc.

And remember it's your handover, if you can't understand it how are you suppose to tell the next nurse on shift about it?! 
Danielle Levy

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