‘He did what? Well that wasn't handed over!’ Communicating risk in mental health


  • R. MILLAR RPN MAdvNursPrac (Mental Health) BNurs (Honours),

    Corresponding author
    1. Registered Psychiatric Nurse, Department of Nursing, School of Health Sciences, University of Melbourne, Parkville
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    1. Associate Professor, School of Nursing and Midwifery, Faculty of Health, Deakin University, Waterfront Campus, Geelong, Vic., Australia
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R. Millar, 1/12 Marine Pde, Abbotsford, Vic. 3067, Australia, E-mail: rlmillar@optusnet.com.au


Accessible summary

  • • This paper reports on a study that was conducted in an acute psychiatric unit investigating how and what information is communicated at nursing handovers that relates to a patients risk status.
  • • Nursing handovers are conducted in an ad hoc manner and may not effectively communicate information required for management of patient risks.
  • • A consistent and evidenced-based approach to mental health nursing handovers is required, in order to promote best nursing practice.


Mental health inpatient units are dynamic, complex environments that provide care for patients with heterogeneous ages, diagnoses and levels of acuity. These environments commonly expose clinicians and patients to many potential risks. Despite extensive research into risk assessment, prediction and management, no study has investigated how risk information is communicated at handover in acute mental health settings. Given the pivotal role handover plays in informing risk management, this evidence gap is significant. This paper reports on a study that investigated the practices of communicating risk at handover in an Australian acute mental health inpatient unit. The aim of this research was to identify the frequency and type of risk information communicated between nursing shifts, and the methods by which this communication was performed. A secondary aim was to identify effective and ineffective risk communication practices. This study involved an observational design method using a 14-item Clinical Audit Tool derived from handover principles outlined by World Health Organization. Five hundred occasions of patient handover were observed. Few risk information items were observed to be communicated in any method. Risk communication practice was inconsistent, and a key recommendation from the study is the use of standardized handover tools that ensures risk information is adequately reported.