Shift Handover Progress
Outline
Introduction
Tools used
Scoring system
Results
Responsible bodies
Way forward
Introduction
Saint Peter Specialized Hospital, one of the five federal hospitals in
the nations capital Addis Ababa, is located in the north-western part of
the city in Gulelle subcity area around 5-6km away from the center.
The hospital was established in 1953 E.C with the main purpose of
treating Tb patients.
Currently the hospital has broadened its service and is giving
comprehensive care in line with the direction of FMOH.
Continued
Clinical governance and quality unit which is one core clinical
and administrative branch of Saint Peter Specialized Hospital,
whose main responsibility is assuring over all quality of service
provision.
In line with its responsibilities the quality unit together with
supervisor nurses has undertaken assessment of clinical shift
handover practice of the facility.
Tools used
Check list
Mode of evaluation
Interview (staff and clients)
Document/protocol verification
Chart verification
Observation
Scoring system
Very strong – Above 85%
Strong – Between 75% AND 84.9%
Suboptimal – Below 75%
TEAM
Strong -
Optimal – MDR
Suboptimal – ER, surgical, icu, mch, pedi, nicu, psych, medical, tb,
toxo,OR
Hospital responsibility Department responsibility
Id badge preparation Timely staff arrival
Round protocol preparation Concept of team
establishment( physicians, nurses,
cleaners, porters, guards)
Uniform availability Round start hour monitoring
Team
95.00%
85.00%
75.00%
65.00%
55.00%
45.00%
35.00%
25.00%
15.00%
5.00%
ADULT ER ADULT NICU MCH OR PEDI SURGICAL MEDICAL TB MDR1 TOXICOL- PSYCHIA-
ICU OGY TRY
AM 0.5833 0.5 0.5952 0.5557 0.5238 0.4405 0.5 0.5 0.5476 0.619 0.5595 0.4167
PM 0.6905 0.7143 0.7143 0.5595 0.619 0.5595 0.7619 0.6429 0.7778 0.9048 0.6619 0.619
TOTAL 0.6369 0.6071 0.6548 0.5476 0.5714 0.5 0.631 0.5714 0.6607 0.7619 0.6607 0.5179
RESOURCE
Strong – er, icu, nicu, psych, tb, mdr, toxo, or
Optimal – surgical, mch, pedi, medical,
Suboptimal –
Hospital responsibility Department responsibility
Some drugs missing. i.e. Preparing emergency drugs and supplies
diclofenac, Mgso4, Diazepam,
Haloperidol, Regular Insulin,
CPZ.
Some medical equipment Availing necessary patient care formats
missing. i.e. Glucometer,
Thermometer
Replacing used drugs and supplies
Resource
110.00%
90.00%
70.00%
50.00% AM
PM
TOTAL
30.00%
10.00%
ADULT ER ADULT NICU MCH OR PEDI SURGICAL MEDICAL TB MDR1 TOXI- PSYCHIA-
ICU COLOGY TRY
AM 0.8095 0.8452 0.9048 0.75 0.8452 0.738 0.7738 0.75 0.8333 0.7976 0.881 0.7738
PM 0.9762 0.9405 0.9881 0.8333 0.8929 0.9524 0.869 0.881 1 0.9643 0.9881 0.9286
TOTAL 0.8929 0.8929 0.9464 0.7917 0.869 0.8452 0.8214 0.8155 0.9167 0.881 0.9345 0.8512
IPPS
Strong – nicu, toxo
Optimal – er, icu, pedi, tb, mdr, or
Suboptimal – surgical, mch, psych, medical
Hospital responsibility Department responsibility
Availing adequate antiseptic Using antiseptic hand rub b/n patients
&detergent
Tap water availability Waste segregation must be as per protocol
Facility based cleaning protocol Instruments must be timely processed, labeled and
provision packed.
Personal protective equipment Inadequate waste segregation materials. i.e. trash
IPPS
95.00%
85.00%
75.00%
65.00%
55.00%
45.00%
35.00%
25.00%
15.00%
5.00%
ADULT ER ADULT N ICU MCH OR PEDI SURGICAL MEDICAL TB MDR TOXICOL- PSYChia-
ICU OGY try
AM 0.683 0.6473 0.8661 0.6964 0.7188 0.7188 0.6652 0.6071 0.6875 0.6741 0.7545 0.5476
PM 0.8795 0.8517 0.9911 0.75 0.7857 0.817 0.8259 0.683 0.8661 0.8571 0.9464 0.7373
TOTAL 0.7813 0.75 0.9286 0.7232 0.7522 0.7679 0.7455 0.6451 0.7768 0.7656 0.8504 0.6405
Communication & counseling
Strong – ER, ICU, MDR1, MDR2, PSYCH, MEDICAL, TB, NICU, OR, SURG
Optimal – MCH, TOXO, PEDI
Suboptimal
Hospital responsibility Department responsibility
Introducing one’s name and calling
clients by name
Appropriate information and health
education
Communication
95.00%
85.00%
75.00%
65.00%
55.00%
45.00%
AM
35.00% PM
TOTAL
25.00%
15.00%
5.00%
ADULT ER ADULT NICU MCH OR PEDI SURGI- MEDICAL TB MDR1 TOXI- PSYCHIA-
ICU CAL COLOGY TRY
AM 0.8571 0.8571 0.9567 0.8452 0.8373 0.7857 0.7738 0.7976 0.7976 0.8333 0.8095 0.7857
PM 0.9871 0.9643 1 0.8452 0.869 0.9643 0.8571 0.8929 1 0.9643 0.9405 0.9286
TOTAL 0.9226 0.9107 0.9583 0.8452 0.8512 0.875 0.8155 0.8452 0.8988 0.8988 0.875 0.8571
Patient care
Strong – icu, nicu, toxo
Optimal – er, surgical, mch, pedi, medical, tb, mdr
Suboptimal – psych, or,
Hospital responsibility Department responsibility
Clinical pharmacy professional Pertinent history and P/E
documentation
Round, Consultation, Transportation All medications by nurses ( PO, IM,
protocol IV)
Central drug cabinet provision Clients close follow up (V/S - QID)
Daily Progress note
Patient care
95.00%
85.00%
75.00%
65.00%
55.00%
45.00%
AM
35.00% PM
TOTAL
25.00%
15.00%
5.00%
ADULT ER ADULT NICU MCH OR PEDI SURGI- MEDICAL TB MDR1 TOXI- PSYCHIA-
ICU CAL COLOGY TRY
AM 0.7857 0.8056 0.881 0.797 0.6984 0.7778 0.782 0.7698 0.7341 0.7937 0.8214 0.5556
PM 0.9048 0.9087 0.9603 0.7594 0.6746 0.9167 0.8496 0.8452 0.9206 0.8889 0.9365 0.6071
TOTAL 0.8452 0.8571 0.9206 0.778 0.6865 0.8472 0.8158 0.8075 0.8274 0.8413 0.879 0.5813
Medical Equipment
Strong – er, icu, nicu, pedi, tb, mdr, toxo, or
Optimal – surgery, mch, psych, medical,
Suboptimal –
Hospital responsibility Department responsibility
Non-functional equipment repair Work order for curative
maintenance
Preventive maintenance practice
Medical equipment
95.00%
85.00%
75.00%
65.00%
55.00%
45.00%
AM
35.00% PM
TOTAL
25.00%
15.00%
5.00%
ADULT ER ADULT NICU MCH OR PEDI SURGI- MEDICAL TB MDR1 TOXI- PSYCHIA-
ICU CAL COLOGY TRY
AM 0.8949 0.8214 0.9286 0.8214 0.8571 0.8214 0.8214 0.7857 0.8571 0.8214 0.7857 0.7857
PM 0.9643 0.9286 0.9643 0.8214 0.8923 0.9643 0.8571 0.8929 0.9643 0.9643 0.9286 0.8571
TOTAL 0.9286 0.875 0.9464 0.8214 0.875 0.8929 0.8393 0.8393 0.9107 0.8929 0.8571 0.8214
FACILITIES
Strong – NICU
Optimal – pedi, medical, toxo,
Suboptimal – ICU, ER, MCH, MDR1, TB, OR,SURGERY
Hospital responsibility Department responsibility
Non functional toilets and hand
washing sinks
Water availability/ alternative
source
Hospital food quality
Bedsheet and blanket provision
Facilities
95.00%
85.00%
75.00%
65.00%
55.00%
45.00%
AM
35.00% PM
TOTAL
25.00%
15.00%
5.00%
ADULT ER ADULT NICU MCH OR PEDI SURGI- MEDICAL TB MDR1 TOXI- PSYCHIA-
ICU CAL COLOGY TRY
AM 0.619 0.6673 0.8519 0.5663 0.5655 0.7041 0.5612 0.4592 0.6319 0.5714 0.7602 0.8264
PM 0.7679 0.8112 0.9735 0.7816 0.5417 0.8061 0.7296 0.526 0.6114 0.7677 0.898 0.7088
TOTAL 0.6935 0.7372 0.9127 0.574 0.5536 0.7551 0.6454 0.7886 0.6236 0.6676 0.8291 0.6676
INCIDENT
Strong – ER, ICU, mdr, toxo, PSYCH, TB, NICU, PEDI, OR
Optimal – MCH, SURGERY, psych, or
Suboptimal – medical
Hospital responsibility Department responsibility
Physician to patient ratio on duty Work force plan not known
hours
Incident
95.00%
85.00%
75.00%
65.00%
55.00%
45.00%
AM
35.00% PM
TOTAL
25.00%
15.00%
5.00%
ADULT ER ADULT NICU MCH OR PEDI SURGI- MEDICAL TB MDR1 TOXI- PSYCHIA-
ICU CAL COLOGY TRY
AM 0.8786 0.8143 0.85 0.8286 0.8429 0.8286 0.7571 0.7571 0.8214 0.8143 0.8857 0.7786
PM 0.9857 0.9643 0.8857 0.8113 0.85 0.9227 0.8429 0.7286 0.9571 0.9214 0.9571 0.8786
TOTAL 0.9321 0.8893 0.8679 0.8214 0.8464 0.875 0.8 0.7429 0.8893 0.8679 0.9214 0.8286
DOCUMENTATION
Strong – ER, ICU,surgery ,tb, mdr, TOXO, PSYCH, NICU, PEDI, OR
Optimal – psych, medical
Suboptimal – MCH
Hospital responsibility Department responsibility
Not all departments have computers Patient format utilization needs
improvement
EMR is not functional HMIS register usage
Documentation
95.00%
85.00%
75.00%
65.00%
55.00%
45.00%
AM
35.00% PM
TOTAL
25.00%
15.00%
5.00%
ADULT ER ADULT NICU MCH OR PEDI SURGI- MEDICAL TB MDR1 TOXI- PSYCHIA-
ICU CAL COLOGY TRY
AM 0.881 0.8395 0.9286 0.631 0.8571 0.8373 0.8095 0.8095 0.7976 0.8333 0.881 0.75
PM 1 0.9405 0.9881 0.6548 0.8571 0.9643 0.8929 0.869 0.9643 0.9524 1 0.8929
TOTAL 0.9405 0.8909 0.9583 0.6429 0.8571 0.8988 0.8512 0.8393 0.881 0.8929 0.9405 0.8214
Department Green Yellow Red Am PM Grand total
1. NICU 8 0 1 85.80% 94.87% 90.33%
2 Toxicology 7 1 1 79.44% 93.03% 86.22%
center
3. Adult ER 5 2 2 75.44% 89.77% 82.40%
4. Adult ICU 6 1 2 74.00% 88.35% 81.18%
5.MDR 1 5 3 1 73.74% 88.55% 80.90%
6. Pediatric ward 4 4 1 73.89% 86.46% 80.19%
7. Tb ward 5 2 2 72.55% 87.17% 79.86%
8. Surgery 1 5 3 70.25% 82.35% 76.30%
9. Operation 4 2 3 72.79% 74.30% 73.34%
Room
10.MCH 0 5 4 71.43% 72.61% 72.02%
11. Medical ward 0 6 3 67.01% 72.28% 69.64%
12. Psychiatry 2 3 4 63.50% 75.44% 69.47%
ward
Grand total
95.00%
85.00%
75.00%
65.00%
55.00%
45.00%
AM
35.00% PM
TOTAL
25.00%
15.00%
5.00%
ADULT ER ADULT NICU MCH OR PEDI SURGI- MEDICAL TB MDR1 TOXI- PSYCHIA-
ICU CAL COLOGY TRY
AM 0.7544 0.74 0.858 0.7143 0.7239 0.7389 0.7025 0.6701 0.7255 0.7324 0.7942 0.635
PM 0.8937 0.8835 0.9487 0.7261 0.743 0.8648 0.8235 0.7228 0.8718 0.8855 0.9303 0.7544
TOTAL 0.824 0.8118 0.9033 0.7202 0.7334 0.8019 0.763 0.6964 0.7986 0.809 0.8622 0.6947
What’s next?
Deserving departments will pass to phase ll evaluation
shortly.
Phase ll will be done every other day
The current shift handover will be continued every other
day for suboptimal departments and once a week for
qualified departments
The current shift handover will be used for improvement
Exemplary departments will be used as benchmarks
Many thanks !!!
