Friday, 3 October 2014

The Handover Issue

For the 25 years I've been staying on and off at Her Majesty's Pleasure, Healthcare Branch, I learnt almost immediately never to ask for painkillers within 15 minutes of handover. At least. 30 minutes is better.

Handover is the term for when one shift goes home and the next take over. In this hospital handover starts at 7.45 am and 7.45 pm. This means I always make sure my painkillers and anti-sickness medicines are PRN, meaning I ask for them when I need them, they are not brought automatically at certain times of the day.

This means I have to ask for painkillers well before 7.30 (am or pm) should they happen to fall due around that time.

It's very hard to explain to someone who isn't in pain how totally unlikely it is that you should "forget" this crucial detail. When it feels like someone is holding a red hot poker deep in your solar plexus, you tend to make a note of the exact minute you asked and make totally sure you don't ask at a time you are likely to be left with that poker indefinitely.

But after all these years, I just can't understand why we still do it that way. 

How can we possibly guarantee that 62 patients will be able to suspend the various issues that brought them in here for 45 minutes or so twice a day? Why on earth do all 7 or 8 trained staff nurses, charge nurses and sisters take handover all at once?

Would it not be immensely sensible to ensure that handovers are either staggered, or that we ensure that 2 trained nurses sit out and remain available on the ward while everyone else is unavailable?

I mean, surely in 25 years this has occurred to somebody? Most painkillers are what are known as "controlled drugs" and are locked away. Only two trained nurses can administer them to avoid mistakes or abuse.

If any other business had to close for 45 minutes, twice a day, loss of profit alone would ensure pretty damn quickly that cover was arranged. Surely avoiding human suffering is at least as important as a balance sheet?


  1. So good to know I'm not the only one who's been annoyed by this. You have put it so well. X

  2. never be in transition to last stage of labour at handover :(

  3. That's really stupid of them, my local hospital (not a big one my any means) does hand over at 8pm & 8am but at least two nurses on the ward do twilights so starting at 8am (I think though it could be 9/10am) and finish at 10pm. Usually it's one of the head nurses and a sister who do this, it also means they can get the other nurses up to speed and do a proper handover to the person in charge for the next shift.

    If my hospital which only serves 250,000 people in my town can get it right why can't your well funded teaching/centre of excellence do it?

  4. I've also heard of patients in psychiatric units being promised leave or some other "privilege" by staff on one shift, or even their so-called responsible clinician, but because the detail got forgotten during handover, they didn't get it. This includes people with learning disabilities.

  5. This is one of my real bug bears too. It wouldn't be so bad if it had any point whatsoever. I cannot count the times I have asked nurses things (both in my career as a physiotherapist, or as the daughter of a patient), only to hear 'I don't know, I've only just come on'. I almost fell over in shock once when a nurse replied, 'I've only just come on, hold on, let me check my handover notes...'

  6. My mum died at handover. You have to wonder if she was getting the care she really needed in her last minutes.

  7. Most wards I've ever worked on practise team nursing so that the oncoming shift receive handover sequentially from each team of nurses leaving the nurses in the other teams still on the ward. to deal with things such as requests for analgesia.

  8. Keep your own meds with you, I did that my second time in this summer and will from now on, they slept with me and stayed with me 24/7.

  9. handover is crucial for patient safety on the ward, but there should be some way that pain relief can be administered as needed if the timing clashes. Not a well run ward if this can happen.

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