TINJAUAN PELAKSANAAN HANDOVER DI RUMAH SAKIT: TINJAUAN PUSTAKA Overview of The Implementation of Handover in Hospital: Literature Review Diwa

Background: Handover is an activity to deliver and receive reports regarding the patient's condition. Handover implementation consists of three stages, namely the preparation stage, implementation stage and post handover. Handover as an important element in providing nursing care and has a role in patient safety. Objective: This study aims to identify the results of previous studies regarding the stages of implementing nurse handovers in hospitals. Methods: The method used in this study is a literature review with an assessment using the JBI Critical Appraisal Checklist for Analytical Cross Sectional Studies. Search using Google scholar and Library of the Faculty of NursingUM.


Background
Handover is a routine activity as a form of handover of managed patients between one shift and another before and after the nurse carries out their duties (Mugianti, 2016) 1. Patient handover activities should be carried out by nurses who are directly responsible for providing nursing care to nurses who will be responsible for providing care for the next shift. This is intended to avoid neglect or errors in the service activities that will be provided to patients (Mugianti, 2016) 1. A well-executed handover can help identify errors and facilitate continuity of patient care.In addition, communication on handovers has a very important relationship in ensuring continuity, quality and safety in health care for patients (Morika, 2017) 2.
Handover activities consist of three stages, namely the preparation stage, the implementation stage and the post handover stage (Nursalam, 2015) 3.Patient handovers must be carried out as effectively as possible by explaining briefly, clearly, and completely about the independent actions of nurses, collaborative actions that have been taken / not. , and the patient's development at that time (Nursalam, 2015) 3. The information submitted must be accurate so that the continuity of nursing care can run perfectly. Receipt is carried out by primary nursing nurses to primary nurses (person in charge) in the afternoon or evening services in writing and orally (Nursalam, 2015) 3.Effective patient handover supports important information and continuity of care, treatment, and has an impact on patient safety (Kamil, 2011) 4. Handover as an important element in providing nursing care has a role in ensuring patient safety, it is a major. contributing factor in errors and delays in service to the next patient (Herawati, 2018) 5.Communication disturbances can occur when handing over patient care is carried out which can result in incidents that occur. adverse events or sentinel events (SNARS 2017) 6.Ineffective handovers can contribute to errors and violations in patient care safety, including medication errors, surgery errors, and patient deaths (Kamil, 2011) 4. Medication errors lead to significant fear, contributing to the patient's loss of confidence in the system (Christiansen, 2019) (2019) 10. handover suitability in the morning, afternoon and evening shifts is the most appropriate implementation of the morning shift, due to the participation of the head of the room and the team leader so that most team members carry out the appropriate flow from the place where nurses or nurses gather. nurse room to the treatment room or patient room and back again to the nurse room or nurse station. Based on some of the above studies and the absence of research on the implementation of handovers using the literature review method, the authors are interested in conducting research on "Overview of Nurse Handovers in Inpatient Rooms at Government Hospitals: Literature Review"

Research methods
This study is a systematic review of the existing literature to determine the results of previous studies. The search was conducted through Google Scholar and the Library of the Faculty of Nursing, UMJ.
The search for articles in the database uses the "AND" and "OR" operators combined with the keywords used, namely the combination of nurse AND handover OR weigh accept. Keywords are taken based on PICOT. The inclusion criteria for search were studies conducted in hospitals, nurse respondents or nursing teams working in inpatient rooms, nurse respondents or nursing teams working in intensive care rooms, journals in Indonesian or English, and full text journals. The assessment of the quality of each article is carried out using the standard format of the JBI Critical. Appraisal Checklist for Analytical Cross Sectional Studies which is in Indonesian which consists of eight checklist items of questions used with a choice of answers that are yes or no or unclear or not applicable.

Result
Based on the results of searches conducted through Google Scholar and the Library Journal of the Faculty of Nursing-UMJ, it was found that 1573 journals were used with the keywords used, namely the combination of nurse AND handover OR weigh accept with the time span of the journals published in the last ten years (2010-2020). The process of selecting and eliminating articles is illustrated in the form of a flowchart (PRISMA, 2009). Then only five articles were left that met the inclusion and exclusion criteria. In the five articles, there are similarities and differences from the number of respondents, the place of research, the research methods, the instruments used and the results of the research.

DISCUSSION
From the five articles from the literature review results, an overview of the implementation of the handover is obtained, namely one article with a sufficient category (41.7%), one article with a good category (63.3%) and three articles with an average implementation of the value range from 50% to 75. 71%. The four articles use three stages of handover, namely preparation, implementation and post handover with the values in each stage, namely the preparation stage with a value range of 12.39% -63.3%, at the implementation stage with a value range of 26.39% -88% and at the evaluation stage with a value range of 14.5% -38.8%. One article for each stage is the preparation stage (70.57%), the introductory stage (94.33%), the information exchange stage (8.59%), the observation stage 77.30%) and the safety scan stage (51.24%). In the four articles, the implementation of handovers at the preparation stage, most of the nurses did not arrive on time so that the implementation of the weigh-in was not carried out on time this was due to a lack of motivation in the nurses, a lack of nurses in the room and a lack of appreciation from the hospital, nurses always gathered In the nurse sation before they serve, most of the nurses always prepare special notes about what the previously guarded nurses will delegate. According to Nursalam (2015) 3 the implementation of handovers in the preparation stage consists of Weighing and receiving carried out every shift of shift / operant, the principle of weighing accept, all new patients enter and patients who are received, especially patients who have problems that have not been resolved and who need observation further and PA / PP convey the consideration to the PP (who received the delegation) next. The handover implementation stage of the nurse handover implementation only weighed the nurse's acceptance, the nurse did not observe the patient. In addition, the handover was not attended by all nurses, the information conveyed focused on the results of the history, medical diagnosis, physical examination and supporting examinations for patients with serious problems. Meanwhile, information related to nursing diagnoses, actions that have been taken, and recommendations for further action plans were not submitted because they were considered not very important. According to Nursalam (2015) 3 things that need to be conveyed in Handover, namely the number of patients, patient identity and medical diagnosis, data (complaints / subjective and objective), nursing problems that still arise, nursing interventions that have and have not been implemented (in general), interventions collaborative and dependent; general plans and preparations that need to be done (preparation for operations, supporting checks, and other programs). Operant activities should be followed by the head of the room, the team leader and all the nurses on duty at that time and who will be on duty, this is intended to be able to provide clear (real) information about the situation and condition of the patient and make it easier to receive overload of tasks, as well as input when carrying out pre conference (Mugianti, 2016) 1. Handovers should not only be carried out in nurse stations, but must also do beside handovers. Patients are more satisfied with the beside handover method compared to handover using traditional methods (Nur et al, 2016) 11. The post handover stage records or reports problems to the on duty doctor to get the lowest possible implementation due to several factors, one of which is because the on duty doctor does not stay (standby) in each inpatient installation but the nurse still reports conditions related to the patient via telephone. This is not in line with post handover activities according to Nursalam (2015) 3 which consists of discussions, reports for Handovers are written directly in the Handover format signed by the PP who is on duty at that time and the PP that is on guard next is known by the Head of the Room, closed by KARU. Conclusion of patient handovers, discussing patient data with other nurse friends needs to be considered so that the patient data obtained is more accurate (Manopo, 2013) 14.
In the research of Maurisa.A and Yuswari (2019) 12 four stages have been carried out and one stage has not been carried out. Implementation of handovers in the preparation stage (70.57%). According to Maurisa.A and Yuswani (2019) 12 these studies are in line with the statement of Chaboyer et al (2010) 13 explaining that good and correct preparation will make nurses appropriate in carrying out handover actions and be able to explain the patient's latest condition. There are four aspects in the preparation stage for the implementation of handovers, namely the allocation of staff and patients, updating the handover sheet, notifying patients and families and other visitors (Chaboyer et al, 2008) 1. The delinquency at the introductory stage (94.33%) according to Maurisa.A and Yuswari (2019) 12 introducing the next team when changing shifts is a routine activity. Handover is led by the team leader who is going home, the team leader introduces the nurse who will be on duty next to the patient and the patient's family (Chaboyer et al, 2008) 13. Implementation of bedside handover at the information exchange stage (8.59%). The delivery of information between the nurse administrators during the bedside handover is carried out briefly and clearly, as well as the delivery of information to patients, by avoiding word choices that are difficult to understand and medical terms that are not understood by the patient (Maurisa.A and Yuswani, 2019) 12. According to Chaboyer et al (2008) 13 The information conveyed during the handover at the information exchange stage is the date and reason for administration, relevant medical history including new referrals, investigations, treatment and patient response, nursing care plans and patient responses, safety issues, discharge planning and recommendations for further treatment. In addition, at the information exchange stage, the effective communication format SBAR or ISOBAR can be used.
The implementation of bedside handover at the observation stage was 77.30%)%. According to Maurisa.A and Yuswani (2019) 12 the results of their research are in line with the statements of Sand-Jecklin and Sherman (2013), it is said that the implementation of bedside handovers by ensuring that patients are well informed, allows patients to contribute more to their own care. During the handover, the patient should be given the opportunity to seek clarification, ask questions and the nurse confirms the information, family members should be invited to participate in handover with the patient's consent (Chaboyer et al, 2008) 13. Implementation of bedside handover at the safety scan stage (51.24%) was not implemented. This is because the results are different from the study of Chaboyer et al. (2010) 13 which states that the things that need to be done during bedside handover are patient safety scans such as call bells must be within the reach of the patient, patient comfort, the latest bedside communication boards, checking equipment is functioning properly (e.g. oxygen hoses), alarm parameters, Access to mobility aids, and urine catheter checked (records insertion date and removal plan), wound, GCS completion, Circulation observation, diet modification, fluid balance chart and other devices in close proximity to the patient. CONCLUSION Based on the five articles that have been reviewed, it is obtained an overview of the implementation of the handover as a whole, namely one article with a sufficient category (41.7%), one article with a good category (63.3%) and three articles on average implementation in the range of values from 50% to 75.71%. The four articles use three stages of handover, namely preparation, implementation and post handover with the lowest score at the post handover stage with a value range of 14.5% to 38.8% and the highest value at the implementation stage of 59.4% -88%. One article uses five stages, namely the stage of preparation, introduction, exchange of information, observation and safety scan with the lowest value range at the social scan stage of 51.24% and the highest value at the introduction stage of 94.33%. SUGGESTION The hospital holds seminars or training on handover implementation. The head of the room recalculates the needs of nurses in his room, conducts supervision, provides rewards and punishments for the nurse's performance. The results showed that the handover had been implemented (75.71%). Which consists of the preparation stage (70.57%), the introductory stage (94.33%), the information exchange stage (8.59%), the observation stage 77.30%) and the safety scan stage (51.24%).