Implementation of a Structured Handover Tool in the Pharmacy Department
By Nicole Chan R.Ph., M.Sc in Clincal Pharmacy, Pharmacy
Background
The pharmacy department at the Hong Kong Sanatorium and Hospital consists of 2 main pharmacies and 10 satellite pharmacies, with over 120 staff working various shifts over a 24-hour period in different locations. The inpatient pharmacy alone process over 1100 prescriptions daily. Currently, no formal handover method exists in the pharmacy department. The transfer of information is mainly relayed through informal verbal communication, and are often times written down on disposable sticky notes. These current methods are prone to miscommunication errors and can ultimately impair patient safety.
Purpose and Problem Statement
The purpose of this project is to improve the handover process within the pharmacy department by creating a formal structured handover tool.
The problem statement is “Will the implementation of a structured handover tool promote pharmacist satisfaction during pharmacy handover?”
Implementation Plan
A handover binder is developed with the aim of presenting the transfer of information in a clear and well structured manner. The binder will consist of pages in chronological order. Each page is representative of one day, and is divided into 3 categories – a call to action category for items to be followed up, a for-your-information only category which does not require any action, and a category for outstanding items from previous days that have not yet been resolved. The pharmacist passing along the information must sign off, and the pharmacist acknowledging the transfer of information will sign off as well. This binder is to be utilized in addition to verbal handover. A pre-implementation survey will be conducted to assess pharmacist satisfaction prior to the handover binder usage, and a post-implementation survey will be conducted with the same questions 2 months after implementation.
Results
The pre-implementation survey identified 3 key areas of dissatisfaction – organization, accessibility, and comprehensiveness. No pharmacists agreed that the old handover practice was organized, while only 4% and 7% agreed that it was easily accessible and consisted of comprehensive information respectively. It was noted that 87% of pharmacists believed that information was likely to be lost or missed with old handover practice.
After the implementation of the handover binder, 61% of pharmacists agreed that the new system was organized. 58% agreed that it has become easily accessible, and 54% agreed that it consisted of comprehensive information. Only 4% of pharmacists now perceive that information is likely to be lost or missed.
With regards to the working experience of pharmacists, it is noteworthy to point out that junior pharmacists with less than 5 years of working experience (32% of total pharmacists) found the new handover binder to be the most helpful, they reported the most increase in satisfaction level.
Recommendations and Next Steps
A formally recognized handover tool improves communication between colleagues during times of shift change. It minimizes miscommunication errors, and thus improving patient safety. It maintains patient confidentiality, promotes teamwork, as well as serves as a tool to support junior staff.
The handover binder can be useful tool to implement in other pharmacy locations such as the satellite pharmacies. An electronic handover platform may be considered in the future as it can further improve accessibility issues, and can involve computer prompting functions for an incomplete handover or outstanding issues requiring attention.