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Monash Health

Resident Centered Handover
Monash Health
A.G. Eastwood Hostel, Cheltenham Vic.

Residential - Metropolitan, 30 - 79 beds

Award descriptors:
Health and wellbeing,Clinical care / medication management,Safety,Communication and engagement

About the program 
Bedside handover was introduced to enhance the communication between staff and residents at a time of shift change, to mitigate risk, to provide an opportunity for the resident to be included in their care. 

The project was undertaken in partnership with LaTrobe University and the Quality Program of Monash Health. We introduced resident centred handover as bedside handover was identified as best practice. We embarked on adapting the patient centred handover approach, utilised in the acute and sub acute setting, for use in residential care.  

A resident centred approach to handover was developed. The aim, to take the handover from the office to the resident’s room, enables staff to prioritise their work at commencement of their shift, complete a visual risk assessment and improve communication between staff and the resident. The outcome and feedback from this project confirms the positive outcomes that resident centred care has had on the clients.

Why we did it
Previous Monash Health audits identified the need to involve patients/residents in their care decisions, data was collated from local partnering with consumer audits. We also embarked on attempting to reduce our current falls rates and medication errors as a result of this project. We identified the need to improve the handover process to involve the resident in their care, enabling them to have a voice in their care planning, reduce risk and improve interactions between staff and the residents. 

We introduced resident centred handover as bedside handover was identified as best practice. A literature search identified articles relating to bedside handover in the acute and subacute setting but no published research or articles relating to the adaptation into the residential environment. We embarked on adapting the patient centred handover approach, utilised in the acute and sub acute setting, for use in residential care. We identified the need to take the handover from the office to the resident’s room with the aim to improve communication between staff and the resident and reduce clinical risk. The outcome and feedback from this project confirms the importance of involving residents in decisions about their care.

What we did 
Resident centred bedside handover was a qualitative research project. A literature search identified articles relating to bedside handover in the acute and subacute setting but no published research or articles relating to the adaptation into the residential environment. Ethics approval was sought both through the Monash Health Ethics Committee and the La Trobe University Ethics Committee. The number of residents in the low care facility was identified along with the numbers and skill mix of staff.  

Ten staff were interviewed prior and post implementation stage to identify their pre project knowledge of bedside handover. They were asked how they felt a resident centred bedside handover approach might affect communication between each other, between themselves and the resident and how this might affect clinical risk outcomes. 

Ten residents were interviewed pre and post implementation to identify their level of current interaction with staff at handover, if they wished to be involved in care planning discussions and if they were aware of what is currently discussed. 

Staff information sessions were held to provide an overview of bedside handover and provide them with the opportunity to discuss any concerns they might have. Role play was included in the sessions and coaching provided during the first two weeks of implementation. The implementation stage was over a six-week period, where regular visits by the quality team occurred to provide support and guidance. Each resident was visited, their room environment assessed for potential risk, discussion with the resident regarding the plan of care for the day and medication charts checked. The staff were able to identify the needs of the residents at commencement of the shift. The pre and post interview questions were reviewed, identifying a positive outcome for residents and staff.

Who worked with us (250 words):
The Facility Manager and care staff of the facility were integral to this project. The care staff included Registered Nurses, Enrolled Nurses and Patient Care Ateendants. Residents who were cognitively able to answer questions were involved in the interviews. The Deputy Director of Nursing, Quality & Innovation, residential and sub acute quality coordionators provided guidance and support throughout the project.

What we learned 
The same staff and residents were involved in both the pre and post interviews. The pre evaluation results for the staff interviews identified that 6 out of 10 staff were not aware of the bedside handover process and felt that it would not improve their handover. Six out of ten felt communication would not improve between each other and 7 out of 10 felt it would not improve between themselves and the residents. The staff expectations were to increase discussions with the residents, increase efficiency and information exchange. 

Post evaluation 8 staff were re-interviewed with 5 out of 8 identifying handover had improved between each other and 7 out of 8 felt there was improved communication between themselves and the resident. Seven out of eight felt their expectations were met. 

Resident question pre evaluation response: 10 out of 10 felt they were not involved in shift handover and 9 out of 10 did not know what was discussed about them. One out of ten felt that they wanted to be involved in decisions and 4 were undecided and 5 out of 10 were not aware of how their environment was assessed. 

In the post survey interviews, 8 residents were interviewed and identified that 7 out of 8 felt they were more involved in the handover process, all were aware what was discussed about them and all residents were able to provide examples of how their environment was assessed.  

In conclusion the residents felt included in the handover process, communication improved and there was an improved understanding of the residents’ needs. All residents are visually seen earlier in the shift and continuity of care had improved. Overall the resident handover was seen to be less time consuming and provided more opportunities for teaching and modelling of behaviours. The project continues to be monitored by the Facility Manager. The intention is to roll the resident centred handover to the remaining Monash Health residential facilities.

More information on this program: 
Ilona Waksman, , or phone (03) 9265 1002

 
Changed
Friday, 21 December 2018 - 6:57am