Issues with communication during transfers of care and patient handover feature in the Clinical Risk Unit’s analysis of incidents on NIMS, the National Incident Management System, and in claims management.

Why is good communication so important during transfers of care and handovers?

Good communication is integral to how we deliver high quality and safe patient care. The State Claims Agency knows that when communication is done well, it can lead to improved teamwork, enhanced patient safety, and better outcomes for patients and service users.

Transfers of care and clinical handovers represent critical moments in the patient care pathway. All health and social care practitioners involved in a patient’s care are responsible for ensuring all relevant information, including the patient’s condition and treatment plan are handed over effectively and documented in a timely manner.

Watch now: Enhance patient and service user safety

Watch now if you would like to learn how you and your team can work together to make a real impact on the quality of transfers of care/handover in the health and social care sector.

What can the State Claims Agency see in its incident and claims analysis?

Handover incidents feature in the Clinical Risk Unit’s analysis of incidents and claims on NIMS. Issues that have been identified include:

• Inadequate handover within and between teams and services when transferring care
• A failure to recognise a deteriorating patient
• A failure to act on abnormal findings/results and to escalate as appropriate

Patients who experience poor handover are at risk of suboptimal treatment, inadequate assessment and monitoring, medication errors, clinical care requirements, including their will and preferences, not being met, and the incorrect person identification leading to the wrong interventions for both patients.

Learning from these incidents and claims will help health and social care practitioners improve patient safety and minimise the risk of these issues featuring in claims.

How can health and social services enhance safety during transfers of care and handover?

Handover should be standardised and uninterrupted to aid clear communication and delivery of information. At a minimum, it should include patient identification, clinical history, treatment/ interventions undertaken or planned, medication prescribed and administered, and any special requirements.

Drawing on the State Claims Agency’s unique perspective, the above video, featuring Clinical Risk Advisors Wayne Meehan and Irene Maguire Byrne, explores learning from incidents and claims. It also sets out practical advice on how health and social care practitioners can optimise communication with their colleagues, in line with expected legal, professional, and regulatory standards.

Queries

If you are employed by a State authority in the health and social care sector, on behalf of which the State Claims Agency manages claims, and have any queries, please get in touch with us.