Clinical Handover

Standard 6: Clinical Handover

Clinical Handover
The Victorian Department of Health is making this document freely available on the
internet for health services to use and adapt to meet the National Safety and Quality
Health Service Standards of the Australian Commission on Safety and Quality in
Health Care. Each health service is responsible for all decisions on how to use this
document at its health service and for any changes to the document. Health services
need to review this document with respect to the local regulatory framework,
processes and training requirements
The author disclaims any warranties, whether expressed or implied, including any
warranty as to the quality, accuracy, or suitability of this information for any particular
purpose. The author and reviewers cannot be held responsible for the continued

Clinical Handover
currency of the information, for any errors or omissions, and for any consequences
arising there from.

Published by Sector Performance, Quality and Rural Health, Victorian Government,

Department of Health

June 2014

Acknowledgements
The Department of Health Victoria acknowledges the contribution of medical and
health specialists, Victorian health services, and members of the National Safety and
Quality Health Service Standards: Educational Resources Project project team,
Steering Group and Advisory Committee.
The Educational Resources Project Steering Group members comprised:
Associate Professor Leanne Boyd, Steering Group Chair; Director of Education,
Cabrini Education and Research Precinct, Cabrini Health
Ms Madeleine Cosgrave, Project Manager
Ms Susan Biggar, Senior Manager, Consumer Partnerships, Health Issues Centre
Mr. David Brown, Consumer representative
Dr Jason Goh, Medical Administration Registrar - Cabrini Health
Mr Matthew Johnson, Simulation Manager, Cabrini Education and Research
Precinct, Cabrini Health
Ms Tanya Warren, Educator, Cabrini Education and Research Precinct, Cabrini
Health
Ms Marg Way, Director, Clinical Governance, Alfred Health
Mr Ben Witham, Senior Policy Officer, Quality and Safety, Department of Health
Victoria

The Educational Resources Project Advisory Committee members comprised:

Associate Professor Leanne Boyd, Advisory Committee Chair; Director of
Education, Cabrini Education and Research Precinct, Cabrini Health
Ms Madeleine Cosgrave, Project Manager
Ms Margaret Banks, Senior Program Director, Australian Commission on Safety
and Quality in Health Care

Clinical Handover
Contents

Ms Marrianne Beaty, Oral Health National Standards Advisor, Dental Health

Services Victoria)
Ms Susan Biggar, Senior Manager, Consumer Partnerships, Health Issues Centre
Mr David Brown, Consumer representative
Dr Jason Goh, Medical Administration Registrar, Cabrini Health
Ms Catherine Harmer, Manager, Consumer Partnerships and Quality Standards,
Department of Health, Victoria
Ms Cindy Hawkins, Director, Monash Innovation and Quality, Monash Health
Ms Karen James, Quality and Safety Manager, Hepburn Health Service
Mr Matthew Johnson, Simulation Manager, Cabrini Health
Ms Annette Penney, Director ,Quality and Risk, Goulburn Valley Health
Ms Gayle Stone, Project Officer, Quality Programs, Commission for Hospital
Improvement, Department of Health Victoria
Ms Deb Sudano, Senior Policy Officer, Quality and Safety, Department of Health
Victoria
Ms Tanya Warren, Educator, Cabrini Health
Ms Marg Way, Director, Clinical Governance, Alfred Health
Mr Ben Witham, Senior Policy Officer, Quality and Safety, Department of Health
Victoria

Clinical Handover 3
Introduction 3
Learning outcomes 3
National Standards 3
Aim of Standard 6 3
Policies and procedures 3
Background 4
Principles of clinical handover 4

Clinical Handover
Structure of clinical handover 5
Your role in clinical handover 6
Engaging with patients and carers 7
Audit and evaluation 7
Reporting adverse events 8

Summary 9

Test Yourself 10

Answers 11

References 12

Appendix 1: Examples of structured clinical handover tools 13

iSoBAR13
ISBAR 15
SBAR 16
SHARED 17
Hand me an ISOBAR Handover Tool 18

Clinical Handover
Clinical Handover
Introduction
This module relates to the National Safety
and Quality Health Service (NSQHS)
Standard 6: Clinical Handover.
Learning outcomes
On completion of this module, clinicians
will be able to:
1. Discuss the importance of timely,
relevant and structured clinical
handover.
2. Discuss the clinical handover
process including the use of a
structured handover tool.
3. Describe your responsibilities in
clinical handover.
4. Describe the process for engaging
patients and carers in clinical
handover.
Clinical Handover
National Standards
The Australian Commission on Safety and
Quality in Health Care (ACSQHC)
developed the 10 NSQHS Standards to
reduce the risk of patient harm and
improve the quality of health service
provision in Australia. The Standards
focus on governance, consumer
involvement and clinically related areas
and provide a nationally consistent
statement of the level of care consumers
should be able to expect from health
services.
Aim of Standard 6
The intention of Standard 6: Clinical
Handover is to ensure that a timely,
relevant and structured clinical handover
occurs that is appropriate to the clinical
setting and context of the handover.
Standard 6 also relates to Standard 1:
Governance for Safety and Quality in
Health Service Organisations and
Standard 2: Partnering with Consumers.
The principles in these Standards are
fundamental to all Standards and provide
a framework for their implementation.
ACSQHC, 2012
Criteria to achieve Standard 6:
Governance and leadership for
effective clinical handover
Health service organisations implement
effective clinical handover systems.
Clinical handover processes
Health service organisations have
documented and structured clinical
5
handover processes in place.
Patient and carer involvement in
clinical handover

Health service organisations establish

mechanisms to include patients and
carers in the clinical handover processes.

Table 1: Criteria to meet Standard 6 (ACSQHC),

2012

Policies and procedures

There are numerous policies, procedures
and resources within health care services
to assist you with clinical handover. It is
important to access, read and adhere to
systems, policies and procedures within
your organisation.

Clinical Handover 6
Background
Clinical handover is practised every day,
in a multitude of ways, in all health care
settings.
Poor or absent clinical handover, or a
failure to transfer information,
responsibility and accountability, can have
extremely serious consequences for
patients.
It can result in:
delays in diagnosis, treatment and
care
tests being missed or duplicated
incorrect treatment or medication
ACSQHC, 2011
Current handover practices are highly
variable and unreliable across all
disciplines. This can lead to discrepancies
in the content and accuracy of information
provided.
Principles of clinical
handover
The aim of clinical handover is to ensure
the accurate and timely transfer of
information, responsibility and
accountability. The key principles include:
PATIENT AND CARER INVOLVEMENT
Where possible, clinical handover should
actively involve the patient and carer as
well as clinicians. Patients and carers can
provide information that is not necessarily
available to clinicians.
It is important that clinicians listen to
patients and carers to gain an
understanding of this information. It is also
essential that patients and carers
understand current progress, treatment
options and the plan of care.
The risk of a patient experiencing an
adverse event is reduced by actively
involving them in their own care.
ACSQHC, 2012

Other barriers to communication within

health care organisations include
hierarchy, gender, ethnic background and
differences in communication styles.
These inconsistencies in communication
cause considerable risk to patient safety
and care.

Standardisation of handover content and

processes improves patient safety by
ensuring consistency in the exchange of
critical information.
ACSQHC, 2010

Clinical Handover 7
HANDOVER REQUIRES PREPARATION
Handover requires preparation prior to
handover time.
Handover should occur at an allocated
time and venue which enables all
necessary staff to attend. Documents and
progress notes should be updated and
available at handover time. It is
recommended that verbal handover is
supported by documentation such as
handover sheets.
Staffing levels and allocations should
ensure that patient care is attended to
while handover is occurring.
ACSQHC, 2010
HANDOVER NEEDS TO BE WELL
ORGANISED
Handover should be led by a designated
staff member who is responsible for
ensuring the exchange of all relevant
communication in a timely manner.
Punctuality is important as handover is:
crucial to patient safety
paid and protected time for
employees
ACSQHC, 2010
Clinical Handover
HANDOVER SHOULD PROVIDE
ENVIRONMENTAL AWARENESS
The incoming team need to be informed of
any environmental issues (particularly
occupational health and safety issues),
which might impact on the shift.
Handover should always include
notification of:
patients who may require significant
levels of care or immediate
attention
high acuity patients
patients who are deteriorating or at
risk of deterioration
patients who require extra safety
measures e.g. infective or bariatric
patients
potential or scheduled patient
transfer or discharge
staffing numbers and arrangements
e.g. allocations and activities
ACSQHC, 2010
8
HANDOVER MUST INCLUDE TRANSFER
OF ACCOUNTABILITY AND
RESPONSIBILITY FOR PATIENT
CARE
Patient handover must ensure the transfer
of responsibility and accountability
between clinicians and health services.
A standard structure and content for
clinical handover assists in accurately
communicating critical information
between clinicians.
ACSQHC, 2010
Structure of clinical
handover
All clinical handover processes need to be
structured and documented. This ensures
that all participants know the purpose of
the handover, the required information
and documentation they need to share.
Handover requires the transfer of standard
information between:
clinicians within a discipline
from one discipline to another
wards or departments within a
health service
Clinical Handover
health services
Handover should occur:
at change of shift
from one ward to another ward or
department
at patient transfer to another
facility
on patient discharge
when a patients condition warrants
it
CLINICAL HANDOVER TOOLS
A number of handover tools have been
developed to assist health care
professionals to conduct clinical
handovers in a structured and
comprehensive way.
Structured handover tools are used to
ensure that staff are sharing relevant,
concise and focused information.
They also:
encourage patient assessment
facilitate effective communication
reduce the need for repetition
save time for clinicians
NHS, 2013
These tools are checklists which can assist
to standardise handover. Acronyms can
be used to assist clinicians to remember
the information required for handover.
9
Some examples can be found in Appendix
1.
Minimum datasets are required for all
forms of handover. This is the minimum
information and content required for a
particular type of handover.
ACSQHC, 2010
HANDOVER METHODS
Face to face handover is recommended
wherever possible as it allows interaction
and clarification of information. This
should be guided by the agreed patient
handover tool and supported by a
summary of updated patient information.
Using only verbal handover is high risk
because it relies heavily on memory. The
addition of supportive tools and
documentation can:
minimise the risk of omitting
information
improve retention of information
minimise repetition
reduce the length of handover
ACSQHC, 2010
It is important to ensure that the person
receiving handover has understood
correctly.
A written handover is suitable for patients
who are stable, but the sending clinician
should be available to provide clarification
Clinical Handover
of patient information if required to do so
by the receiving team.
Your role in clinical
handover
There are some important points to
consider when giving or receiving
handover.
It is vital to maintain the confidentiality of
patient information and patient privacy at
all times.
If the patient is to be escorted to a
department by a non-clinical staff member
a clinician must provide a verbal handover
to a nominated member of the receiving
department. This staff member will then
assume responsibility and accountability
for the patient.
GIVING HANDOVER
If you are giving handover ensure you
have:
Communicated with the patient and
carer
Discuss details of planned transfers and
discharges with the patient and carer.
Communicated with the receiving
clinician
It is important that the receiving clinician
and department are prepared to accept
the patient and are aware of the
10
estimated time and details of patient
arrival.
Checked and assessed your patient
Confirm your patients identification
details and assess your patient to ensure
they are stable and prepared for
handover, transfer or discharge.
Completed documentation
All required documentation needs to be
updated and completed. This includes:
preparation of handover forms
updating progress notes
completing any transfer or
discharge forms including
information regarding:
o treating doctor
o admission date and diagnosis
o key events during admission
o discharge summary
o risks and prevention strategies
o referrals
Ensure all necessary documentation is
kept with the patient.
RECEIVING HANDOVER
If you are receiving handover, ensure you
have:
Communicated with the patient and
carer
Clinical Handover
Introduce yourself to the patient and carer
and orientate them to the environment.
Communicated with the clinician
providing handover
You should be aware of the estimated time
of patient arrival and have the
environment prepared to receive the
patient. Ensure you understand all
relevant patient details and clarify
anything you are unsure about.
Checked and assessed your patient
On arrival, you should perform a baseline
head-to-toe assessment on the patient
and document findings in the progress
notes.
Any areas of concern or points that require
clarification should be discussed with the
clinician providing handover before
accepting responsibility for the patient.
Completed documentation
Ensure that all necessary documentation
has arrived with the patient. All
documentation, including medication and
fluid charts, should be checked for
accuracy and completion.
Responsibility and accountability for the
patient must be accepted at the
completion of clinical handover.
11
Engaging with patients and
carers
Patients and carers should be educated
about the need for clinical handover and
their role in the process.
This collaboration enables an opportunity
for patients, carers and clinicians to share
information which may impact on the
effectiveness of treatment and care and
raise any issues of concern.
You should consider the following when
discussing clinical handover with patients
and carers:
patients and carers can provide
information that is not necessarily
available to clinicians as carers are
more familiar with the patient and
may spend more time at the
bedside.
ensuring patients and carers
understand current progress,
treatment options and the plan of
care
explaining the need for clinical
handover
explaining the patient and carers
role in clinical handover, and
encouraging them to raise
questions and concerns with the
health care team
offering information in languages
other than English and not
assuming literacy
Clinical Handover
providing an opportunity for
patients and carers to ask questions
and have them answered
You should ensure that the patient and
carer understand the course of the care
and have up to date information about the
discharge date and plan.
ACSQHC, 2012
Audit and evaluation
You may be required to participate in audit
activities which could include examination
of:
patient clinical records
handover documentation
You may be observed in clinical practice
when performing clinical handover.
The purpose of audit is to measure
compliance with policies and protocols
and to monitor the frequency and severity
of adverse events in relation to clinical
handover. This information can be used to
improve practice.
Reporting adverse events
All adverse events relating to poor or
absent clinical handover should be
reported to the nurse/midwife in charge,
the attending medical officer (if
necessary) and be documented in the
clinical record. They should also be
reported on your organisations risk or
incident management system.
12
 Summary
Patients and carers should be fully
informed of any adverse events and the
organisations open disclosure processes
implemented.
Information trends can then be used to
inform quality improvement activities such
as system, policy, protocol and equipment
improvements and education and training
activities.
ACSQHC, 2012
Clinical handover is the focus of Standard
6 in the National Safety and Quality Health
Service Standards.
The key messages are:
1. Clinical handover is practised every
day, in a multitude of ways, in all
health care settings.
2. Poor or absent clinical handover, or
a failure to transfer information,
responsibility and accountability,
can have extremely serious
consequences for patients.
3. Current handover practices are
highly variable and unreliable
across all disciplines. This can lead
to discrepancies in the content and
accuracy of information provided.
4. The aim of clinical handover is to
ensure the accurate and timely
transfer of information,
responsibility and accountability.
5. Where possible, clinical handover
should actively involve the patient
and carer as well as clinicians.
Patients and carers can provide
Clinical Handover
information that is not necessarily
available to clinicians.
6. The key principles include:
handover requires
preparation
handover needs to be well
organised
handover should provide
environmental awareness
handover must include
transfer of accountability and
responsibility for patient care
7. Structured handover tools are used
to ensure that staff are sharing
relevant, concise and focused
information.
8. Minimum datasets are required for
all forms of handover. This is the
minimum information and content
required for a particular type of
handover.
9. Face to face handover is
recommended wherever possible as
it allows interaction and clarification
of information.
10.It is vital to maintain the
confidentiality of patient
information and patient privacy at
all times.
11.Patients and carers should be
educated about the need for clinical
handover and their role in the
process.
13
 12.All adverse events relating to poor
or absent clinical handover should
be reported in the risk or incident
management system.

Clinical Handover 14
 Test Yourself
Answers

Fill in the blanks

1. Standardisation of handover _____________ and processes improves patient safety

by ensuring _____________ in the exchange of critical information.
2. Where possible, clinical handover should __________ involve the patient and carer
as well as clinicians.
3. ______________ and carers can provide _______________ that is not necessarily
available to clinicians.
4. It is recommended that __________ handover is supported by ________________ such
as handover sheets.
5. Handover should always include notification of patients who may require
significant levels of _______ or immediate _______________.
6. Patient handover must ensure the transfer of ________________ and
___________________ between clinicians and health services.
7. _________________ handover tools are used to ensure that staff are sharing
____________, concise and focused information.
8. Minimum datasets are required for _____ forms of handover. This is the
_______________ information and content required for a particular type of handover.
9. Face to face handover is recommended wherever possible as it allows
______________ and _______________ of information.
10. A standard structure and content for clinical handover assists in
_________________ communicating ____________ information between clinicians

1. content, consistency

Clinical Handover
References

2. actively
3. patients, information
4. verbal, documentation
5. care, attention
6. responsibility, accountability
7. structured, relevant
8. all, minimum
9. interaction, clarification
10. accurately, critical

Australian Commission on Safety and Quality in Health Care (2010). OSSIE Guide to
Clinical Handover Improvement. Sydney. ACSQHC, 2010.
Australian Commission on Safety and Quality in Health Care (2012). Safety and Quality
Improvement Guide Standard 6: Clinical Handover (October 2012). Sydney. ACSQHC,
2012. Sydney. Commonwealth of Australia
Australian Commission on Safety and Quality in Health Care (2013). Clinical Handover,
Standard 6: Fact Sheet (October 2012). Sydney. ACSQHC, 2012. Sydney. Commonwealth
of Australia
NHS Institute for Innovation and Improvement, 2013. SBAR Overview. Accessed at
http://www.institute.nhs.uk/safer_care/safer_care/situation_background_assessment_reco
mmendation.html#why
The Victorian Quality Council: Safety and Quality in Health (2012). Guide to patient
transfer: Principles and minimum requirements for non-time critical inter-hospital patient
transfer. Victorian Government Department of Health, Melbourne, Victoria. Accessed at
http://docs.health.vic.gov.au/docs/doc/Guide-to-Patient-Transfer-Principles-and-Minimum-
Requirements-for-non-time-critical-inter-hospital-patient-transfer-December-2012

Clinical Handover
Appendix 1: Examples of structured
clinical handover tools
iSoBAR
iSoBAR was initially developed for use during inter-hospital transfer, specifically where
handover occurred over the phone. Please refer to Table 2 for details of the iSoBAR
acronym. iSoBAR was trialled in Western Australia and remains in use for many handover
scenarios because it was found to be easy to adapt and integrate into existing work
processes (ACQSHC, 2010).

i IDENTIFY Introduce yourself and your patients

S SITUATION Describe the reason for handing over
o OBSERVATIO Include vital signs and assessments
NS
B BACKGROUN Pertinent patient information
D
A AGREE A Given the situation, what needs to
PLAN happen
R READBACK Confirm shared understanding
Table 2: iSoBAR handover tool (Porteous, Stewart-Wynne, Connolly and Crommelin, 2009)

I = IDENTIFCATION OF PATIENT
This step should include positive confirmation of the patients identity using at least three
identifiers: for example patient name, date of birth and medical record number.

S = SITUATION AND STATUS

This step includes the patients current clinical status (e.g. stable, deteriorating,
improving), advanced directives and patient-centred care requirements including the
prospect of discharge or transfer.

O = OBSERVATION
This step ensures the incoming team is informed of the latest observations of the patient
and when they were taken. It serves as a checking mechanism to identify deteriorating
patients for emergency response assistance. Unit members need to be aware of local
emergency response call criteria and processes.

Why introduce O for observation?

Clinical Handover
In some handover acronyms, observation is included under S (Situation). However,
handover research in several Australian states showed that old or inaccurate
observations were frequently handed over. There are numerous reported cases where
assistance was not called for patients who suffered serious deterioration or death.
Observations that should have prompted a call for assistance were sometimes recorded
over a long period of hours, including across shift handover. The explicit introduction of
O is therefore designed to ensure that if patients meet call criteria for an emergency
response team or process that handover at least will trigger that call.

B = BACKGROUND AND HISTORY

This step provides the incoming team with a summary of background; history (the
presenting problem, background problems and current issues); evaluation (physical
examination findings, investigation findings and current diagnosis); as well as
management to date and whether it is working.

A = ASSESSMENT AND ACTIONS

This step is to ensure that all tasks and abnormal or pending results are clearly
communicated. Most importantly, there must be an established and agreed
management and escalation of care plan, which could include:
a shared understanding of what conditions are being treated or, if the diagnosis is
not known, clear communication of this fact to everyone
tasks to be completed
abnormal or pending results (must include recommendations and the agreed plan
and who to call if there is a problem)
a plan for communication to the senior in charge
clear accountability for actions

R = RESPONSIBILITY AND RISK MANAGEMENT

Clinical handover must include the transfer of responsibility as staff are leaving the
institution. This can only be achieved through acceptance of tasks by the incoming
team, which is best ensured by face-to-face handover. Where risks are identified for a
patient, clinical risk management strategies (such as for infectious disease alerts or
alerts for DVT prophylaxis) should be clearly communicated.
ACQSHC, 2010

Clinical Handover
ISBAR
ISBAR was trialled for interhospital transfer within NSW. Health professionals reported
the tool was simple, memorable and portable (ACQSHC, 2010) and has since been
implemented in a number of hospitals within NSW. In Victoria, a partnership between the
VMIA and Southern Health developed resources to assist in implementing ISBAR in Health
Services. These resources are available at: http://www.vmia.vic.gov.au/Risk-
Management/Risk-partnership-programs/Projects/ISBAR.aspx

Figure 1: ISBAR handover tool (ACQSHC, 2010)

There is an ISBAR application available to download free from ITunes app store. The
application provides health professionals with handover prompts for a variety of clinical
handovers including:

Clinical Handover
 medical
surgical
mental health
obstetrics and gynaecology
paediatrics
deteriorating patient

The app facilitates the development of individual handover prompts for other specialties,
consistent with the flexible standardisation implementation methodology.

SBAR
This handover tool has been used in many communication situations, including executive
briefings and incident reports and was trialled in SA, WA and Vic. The tool was utilised to
facilitate shift to shift handover and nurse to doctor communication. Results supported
its utilisation with 80% of respondents noting that handover had improved and reporting
more confidence when communicating with doctors (ACSQHC, 2010). SBAR reduces the
incidence of missed communications that occur through the use of assumptions, hints,
vagueness or reticence they may be caused by the authority gradient.

1. It helps to prevent breakdowns in verbal and written communication, by creating a

shared mental model around all patient handovers and situations requiring
escalation, or critical exchange of information.
2. SBAR is an effective mechanism to level the traditional hierarchy between doctors
and other care givers by building a common language platform for communicating
critical events, thereby reducing barriers to communication between health care
professionals.
3. As a memory prompt, it is easy to remember and encourages prior preparation for
communication.
4. Used during handover SBAR can reduce the time spent on this activity thereby
releasing time for clinical care (NHS Institute for Innovation and Improvement,
2013).

The mnemonic is detailed in Table 3.

Clinical Handover
S Situation
What is the situation? (Chief complaint, current status)

B Background
What is the clinical background? (Previous history)

A Assessment
What is the problem? (Results of assessment, vital signs and symptoms)

R Request/ Recommendation
What do I recommend/request to be done? (Suggested and anticipated changes,
critical monitoring)

Table 3: SBAR handover tool (ACSQHC, 2010)

Clinical Handover
SHARED
The SHARED handover tool was trialled in Queensland to address the communication
issues associated with the critical time around the following points of care within
maternity services:
Referral from the midwife to the doctor when a change in the womans
condition is diagnosed.
Referral from the doctor to the recovery nurse/midwife post Caesarean section.
The project found that the SHARED tool provided a standardised approach that
defined the minimum dataset. Improvements in accuracy and appropriateness of
information were noted (ACSQHC, 2010). Details of the tool can be found in Table 4.

S Situation

Reason for admission/phone call/change in condition; diagnosis specific

information

H History

Medical/surgical/psychosocial/recent treatment/responses and events

A Assessment

Results/blood tests/X-rays scans/observations/severity of condition

R Risk

Allergies/infection control/literacy/cultural/drugs/skin
integrity/mobility/falls

E Expectation

Expected outcomes; plan of care; timeframes; discharge plan; escalation

Clinical Handover
D Documentation

Progress notes; care path; relevant electronic health record/database

Table 4: Shared handover tool (ACSQHC, 2010)

Hand me an ISOBAR Handover Tool

HAND ME AN ISOBAR
The major principles of clinical handover have been combined with the ISOBAR handover
tool to form the acronym HAND ME AN ISOBAR. This reflects what needs to occur and
what information needs to be exchanged during shift to shift nursing handovers.

Step 1: HAND H Hey, its handover time!

(prepare for A Allocate staff for continuity of patient care
handover)
N Nominate participants, time and venue/s
D Document on written sheets and patient notes

Step 2: ME M Make sure all participants have arrived

(organise handover) E Elect a leader

Step 3: AN A Alerts, attention and safety

(patient and safety N Nothing about me, without me......INVOLVE THE PATIENT
focus)

Step 4: ISOBAR I Identification of patient

Clinical Handover
HAND ME AN ISOBAR
The major principles of clinical handover have been combined with the ISOBAR handover
tool to form the acronym HAND ME AN ISOBAR. This reflects what needs to occur and
what information needs to be exchanged during shift to shift nursing handovers.

(provide handover S Situation and status

for individual
patients) O Observations of patient (+/-need for emergency calls)
B Background and history
A Action, agreed plan and accountability
R Responsibility and risk management

Table 5: Hand Me an ISOBAR (ACSQHC, 2010)

Clinical Handover
Clinical Handover