1.

Was ISBAR used to structure communication in between staff-to-staff endorsement for coverage
(ei, when handing over to cover break time)
2. Was ISBAR used to structure communication during patient case presentation?

Introduction/ Identification

3. Identity of person providing handover evident

4. Identity of individual(s), team receiving the handover
5. Identity of patient

Situation

6. Location of patient mentioned

7. Brief summary of patients current status (ei. state the immediate clinical situation of the
patient)
8. State most important and recent observations (ex Isolation status: reason for isolation, updated
culture)
9. Was a problem identified?

Background

10. Concise summary of reason for admission

11. Provide relevant background/ history to the patients clinical situation
12. State baseline observations (current admission for vital signs)

Assessment

13. Evidence of patient assessment (ei. what is his clinical assessment of the patient at present?)
14. Identify assessments and actions that need to occur

Recommendation

15. Were recommendations made?

Observation during Shift Handover

16. Primary nurse conducts clinical handover on individual patients using verbal face-to-face
17. Primary nurse uses ISBAR as core communication script and tools to document Clinical
Handover
18. Primary nurse promotes the use of the patient record to cross-check information
19. Primary nurse receiving handover has comprehension, acknowledgment and acceptance of
responsibility for the patient
20. Performed visual checking of the patient and their environment by the person handing over
and the person taking over care.
21. Primary Nurse participate in medical-led clinical handovers (e.g. medical team handover)
 22. Primary Nurse routinely document in the relevant nursing notes the fact that a clinical
handover was conducted.

Plan, Do, Study, Act.

Outputs of improvement processes may include:

ability to demonstrate a measure of improvement, such as clinical handover incident reports, percentage of
handovers carried out according to the policy and workforce satisfaction with clinical handover before and after
implementation of improvement plan
agendas, meeting minutes and/or reports from relevant clinical handover and quality improvement meetings
which show relevant actions or action plans to address identi ed issues
attendance records and/or results of competency-based training demonstrating knowledge and skills required for
effective performance in clinical handover situation. This training will correlate to appropriate localised policies,
procedures and/or processes speci c to the local environment
using available clinical and administrative data and information from patient feedback to implement and evaluate
changes in clinical handover processes.

Principles of Handover

Nursing Observational handovers by clinical area and number of patient handovers observed
 23. Was ISBAR used to structure communication in between staff-to-staff endorsement for coverage
(ei, when handing over to cover break time)
24. Was ISBAR used to structure communication during patient case presentation?

Introduction/ Identification

25. Identity of person providing handover evident

26. Identity of individual(s), team receiving the handover
27. Identity of patient

Situation

28. Location of patient mentioned

29. Brief summary of patients current status (ei. state the immediate clinical situation of the
patient)
30. State most important and recent observations (ex Isolation status: reason for isolation, updated
culture)
31. Was a problem identified?

Background

32. Concise summary of reason for admission

33. Provide relevant background/ history to the patients clinical situation
34. State baseline observations (current admission for vital signs)

Assessment

35. Evidence of patient assessment (ei. what is his clinical assessment of the patient at present?)
36. Identify assessments and actions that need to occur

Recommendation

37. Were recommendations made?

Observation during Shift Handover

38. Primary nurse conducts clinical handover on individual patients using verbal face-to-face
39. Primary nurse uses ISBAR as core communication script and tools to document Clinical
Handover
40. Primary nurse promotes the use of the patient record to cross-check information
41. Primary nurse receiving handover has comprehension, acknowledgment and acceptance of
responsibility for the patient
42. Performed visual checking of the patient and their environment by the person handing over
and the person taking over care.
43. Primary Nurse participate in medical-led clinical handovers (e.g. medical team handover)
44. Primary Nurse routinely document in the relevant nursing notes the fact that a clinical
handover was conducted.

Nurseing

1. As part of their induction, all new nursing staff receive instruction in clinical handover
2. Clinical handover is designated as a scheduled clinical activity for nursing staff, i.e. there is protected time for the activity at
each duty shift change
3. All nursing staff are recommended to use a standardised clinical handover tool when conducting clinical handover
4. Nursing staff conduct clinical handover in a private area (e.g. ward of ce) of the clinical department to which they are
assigned
5. Nursing staff conduct clinical handover on individual patients using verbal face-to-face communication
6. When conducting clinical handover, nursing staff routinely (i.e. in their daily practice) use a standardised clinical handover
tool
7. Nursing staff participate in medical-led clinical handovers (e.g. medical team handover)
8. Nursing staff routinely document in the relevant nursing notes the fact that a clinical handover was conducted

45.
 3

ISBAR
Communication (Clinical Handover) Tool SAMPLE Shift Clinical Handover
Identify:
I Identify
Lead clinical handover person Individuals/Team receiving clinical handover Patient(s)
Situation:
S Situation
Location of patient(s) Brief summary of current status Is there a problem?
Background:

Concise summary of reason for admission

Summary of treatment to date
Baseline observations (current admission)
2

B Background

Vital Signs: BP, Pulse, Resps, SpO , Temp, AVPU. NEWS/PEWS/IMEWS (include previous
NEWS/PEWS/IMEWS if appropriate)
Assessment:
A Assessment
 What is your clinical assessment of the patient at present?
3

Recommendation:
R
Specify your recommendations
Read-Back: Recipients to con rm clinical handover information Risk: Include the safety pause to
identify possible risks

Recommendation Read-
Back Risk

able 3.22 Supporting tools

Tools supporting handover Number used

Electronic medical record (on screen) 0
Electronic medical record (print out) 0
Mnemonic tool 0
Pre-printed handover sheet 2
Nursing care plans 2
Nursing/Medical Notes 2
Whiteboard (not electronic) 4
Random paper 3
Notebook 1
Combination of all the above 3
TOTAL
Estimated Cost over 5
Recommendation number and description Additional Costs and Timing of Costs
years
 3

Printing costs 4,086 per annum

3. Clinical handover should be conducted using the ISBAR

communication tool
4. Availability of readily accessible patient information in 20,430
electronic format
21. Clinical handover should be conducted face-to-face 6,139
3

ISBAR in electronic format 6,139 year 1

only

22. ISBAR communication tool should be used for patients

who are critically ill and/or deteriorating.
6. Implement interdisciplinary shift clinical handovers
7. All patients must be handed over at shift clinical handover Medical Duty Shift Handover 54,664,590
273,322,950
17. Protected time should be designated for interdepartmental per annum
clinical handovers
13. Provide staff with mandatory education and training to Train the trainer cost 75,388 year 1 only 75,388 1,578,184
support Staff Training: Initial phase 1,578,184 year
14. Incorporate human factors training into all clinical handover 1 only Continuing education
training materials 449,290 per annum 2,246,450
education.
TOTAL ESTIMATED COSTS over 5 years
 and accountability for care

understanding of handover as the of cial transfer of care responsibility.

regular audit in clinical handover periods to ensure that compliance to the policy is appropriate.

Schedule of Guideline Development Group meetings

Communication (Clinical Handover) Guideline Development Group Schedule of Meetings 2015

GDG meeting will be Wednesday afternoons on the third oor of Kings Inns House. Dates and times as follows:
Date Time
21/01/2015 14.00-15.00
04/03/2015 14.00-15.00
01/04/2015 14.00-15.00 postponed
06/05/2015 14.00-15.00
03/06/2015 14.00-15.00
01/07/2015 14.00-15.00
05/08/2015 14.00-15.00
12/08/2015 11.00-16.00
19/08/2015 11.00-16.00
26/08/2015 11.00-16.00
02/09/2015 14.00-15.00
23/09/2015 14.00-15.00 cancelled
28/09/2015 14.00-15.00 extra meeting prior to HSE sign off 30th Sept.
07/10/2015 14.00-15.00 cancelled
21/10/2015 14.00-15.00

Barriers and facilitators and SWOT analysis

National Clinical Guideline for Communication (Clinical Handover) in Acute and Childrens Hospital Services
SWOT, Barriers & Enablers
Standardisation & minimisation of variables reduces risk for patients
Standardised communication practice for all healthcare staff will ensure:

- Effective transfer of patients from one care facility to another and to and from a different level of care
Strengths
- Minimal training requirements for staff transferring from one healthcare setting to another resulting in ease
of movement of staff throughout the system

Empowering for staff

Existing practices local preferences
Resistance to change
Lack of interdisciplinary handover practice silo culture
Weaknesses
Lack of sign off for handover by an appropriate clinician
No national policy
Challenge to implementing policy and monitoring adherence
Develop national policy
Implement across all healthcare settings
Opportunities
Develop system for audit of clinical handover
Address national agenda HSE, DoH, HIQA
 eLearning programme
Interdisciplinary learning
Include education in undergraduate/post graduate education programmes
Build on existing undergraduate/post graduate / continuing professional

development programmes

Patient participation
Make communication a priority in patient safety
Inform the design of an electronic tool
HIQA Reviews

Needs full support from high level HSE Existing tools

Resistance to change from staff
Lack of compliance
Threats
Lack of clarity re: responsibility for implementation, monitoring and sustainability lack of audit and quality
improvement initiatives
Resistance to change
Lack of effective leadership
Lack of corporate and clinical governance arrangements Lack of clearly identi ed roles and responsibilities
Lack of resources

- location where the handover takes place

Barriers
- rostered handover time
Lack of education and training
Lack of IT support for evaluation and audit
Lack of standardised IT systems in general
Breadth of remit across all acute hospitals both clinical and diagnostic

Committed staff at senior level and in the clinical areas

Effective leadership
Effective governance arrangements to include clear accountability and authority Clearly identi ed roles and
responsibilities
Multi-disciplinary team working
Enablers
IT support
Dissemination of information
Robust patient safety culture
Build on existing education and training for staff
HIQA as a regulator

| A National Clinical Guideline

Identify yourself the site/unit you are calling from

Identify the patient by name and the reason for your report
Situation
Describe your concern

Give the patient's reason for admission

Explain signicant medical history
You then inform the consultant of the patient's background: admitting diagnosis, date of admission, prior
Background procedures, current medications, allergies, pertinent laboratory results and other relevant diagnostic
results. For this, you need to have collected information from the patient's chart, ow sheets and progress
notes

Vital signs
Assessment
Contraction pattern
 Clinical impressions, concerns

Explain what you need be speci c about request and time frame
Make suggestions
Recommendation
Clarify expectations

Patients MRN, Name and DOB

Name and title/role of staff handing over
Identify
Operation and date (e.g. Vag hyste + A/P repair)

Reason for admission (e.g. Hyperemesis @12 weeks)

Diagnosis if known (e.g. Active stage of labour)
Situation
Mode of delivery and date (e.g. LSCS for CTG changes)

Background Relevant previous history (e.g. Elective LSCS for breech, allergic to penicillin, any social issues of note)
Latest clinical assessment, clinical and investigations (e.g. VE: 4 cm ROT -1 at7.30, Urine output, Labs, Hb
Assessment
,B/P, pulse, temperature and respirations, pain score, patient anxiety)
Actions required after handover (e.g. Call surgeon for urgent consult specify level of urgency with
timeframe; Dr Jones to discuss situation with patient and partner at 10:00am)
Recommendation Risks (e.g. eclampsia)
Assign individual responsibility for conducting any task

regularly review and assess unit handover practices, provide feedback, and engage staff in appropriate quality improvement
strategies.

46. Strategies for evaluating the effectiveness of clinical handover processes are required such as clinical, observational, and
retrospective audits using established standards and tools, and subjective assessments provided by clinical staff.
 3

Note: The ISBAR communication (clinical handover) tool should be documented in the patient notes and audited as part of a
documentation audit and as a step in a quality improvement process.

Was the handover face to face, telephone supported by follow up documentation etc? Please specify______________

Was the handover documented? Yes No

Date: _____/_____/______ Ward:___________________________________

Did the documentation contain the following as part of the ISBAR communication (handover) tool for the transfer?

Identi cation

Identity of person providing handover evident Identity of individual(s), team receiving the handover Identity of patient

Situation
Location of patient
Brief summary of patients current status Was a problem identi ed?

Background

Concise summary of reason for inter-departmental Clinical handover

Summary of treatment to date
All baseline observations (current admission

BP; Pulse; Resps; SpO ; Temp; AVPU

NEWS/PEWS/IMEWS (Previous NEWS/PEWS/IMEWS if appropriate)

Assessment

Evidence of patient assessment

Recommendation

Were recommendations made re: care of patient?

Read-back

Is there evidence of read-back to con rm clinical handover information?

Risk

Was the safety pause included in the handover? Were any risks identi ed?

Is there evidence of acceptance of responsibility and accountability for patient care ?

Yes No Yes No Yes No

Yes No Yes No Yes No

Yes No Yes No Yes No

Yes No Yes No Yes No

Yes No

Yes No Yes No

Yes No

Observational studies may also be carried out to audit communication in relation to communication (handover).

Did the documentation contain the following as part of the ISBAR communication (handover) tool for the transfer?

Identi cation

Identity of person providing handover evident

Identity of individual(s), team receiving the handover I

dentity of patient

Situation

Location of patient
Brief summary of patients current status

Was a problem identi ed?

Background

Concise summary of reason for inter-departmental

Clinical handover

Summary of treatment to date

All baseline observations (current admission
 2

BP; Pulse; Resps; SpO ; Temp; AVPU

Assessment

Evidence of patient assessment

Recommendation

Were recommendations made re: care of patient?

Read-back

Is there evidence of read-back to con rm clinical handover information?

Risk

Was the safety pause included in the handover?

Were any risks identi ed?

Is there evidence of acceptance of responsibility and accountability for patient care ?

Observational studies may also be carried out to audit communication in relation to communication (handover).
 3

ISBAR
Communication (Clinical Handover) Tool SAMPLE Shift Clinical Handover
Identify:
I Identify
Lead clinical handover person Individuals/Team receiving clinical handover Patient(s)
Situation:
S Situation
Location of patient(s) Brief summary of current status Is there a problem?
Background:

Concise summary of reason for admission

Summary of treatment to date
Baseline observations (current admission)
2

B Background

Vital Signs: BP, Pulse, Resps, SpO , Temp, AVPU. NEWS/PEWS/IMEWS (include previous
NEWS/PEWS/IMEWS if appropriate)
Assessment:
A Assessment
 What is your clinical assessment of the patient at present?
3

Recommendation:
R
Specify your recommendations
Read-Back: Recipients to con rm clinical handover information Risk: Include the safety pause to
identify possible risks

Recommendation Read-
Back Risk