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ISBAR Clinical Governance September 2008

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PATIENT SAFETY: WHO (World Health Organisation) HIGH FIVES INITIATIVE ... The unwell patient with a changing condition requiring review. ... – PowerPoint PPT presentation

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Title: ISBAR Clinical Governance September 2008


1
ISBARClinical GovernanceSeptember 2008
2
Situation
  • Communication is an everyday practice
  • Poor communication can harm people

3
PATIENT SAFETY WHO (World Health Organisation)
HIGH FIVES INITIATIVE  
  •  
  •   High-risk handover scenarios a potential for
    multiple levels of failure.
  •  
  • The unwell patient with a changing condition
    requiring review.
  •  
  • Medical and nursing change of shift in high
    patient acuity areas (e.g. emergency departments
    and intensive care units).
  •  
  • Transfer of unwell patients between hospital
    facilities.
  •  
  • Transfer of patients with complex needs from
    acute to primary care.
  • Where information is both shared by patients and
    a number of different providers (e.g. patients
    with chronic disease or obstetric patients).

4
In 2006, HNE Health staff notifying of incidents
identified that clinical communication was an
issue in 728 incidents. Of these 34 concerned
communication around transfer between facilities,
and 32 concerned communication over handover.
Incident Information Management System (IIMS)
5
Awareness of Communication Issues
Data Source IIMS Database 2006-2007 Complaint
Incidents and their corresponding Root Cause
Analysis Final Reports 16/8/07
6
Assessment
  • We need to do better
  • We need to develop better ways to communicate
  • We need to stop harming those we are trying to
    help

7
  • We need something that is
  • Evidence-based
  • Used with success in other hospitals and
    high-risk organisations
  • Something that is
  • Simple
  • Easy to implement
  • Conveys relevant information in a time-limited
    way
  • Can be generalised across a range of settings
  • Part of everyday practice

8
Recommendation
  • We need.
  • ISBAR!

9
JMOs - Patient safety education for interns and
residents
  • Training in team-based healthcare
  • A Standardised Communication format (ISBAR)
  • Applicable in different clinical handover
    contexts
  • Helps optimise safe patient care
  • Supported by the Australian Commission on Safety
    and Quality in Health Care
  • Promoted by HNE Health at all levels of the
    organisation
  • Core elements simple, structural supports,
    self-sustaining and system-wide

10
JMOs - Patient safety education for interns and
residents
Addresses acquisition of ACF-recommended learning
capabilities in Communication and Clinical
Management
11
JMOs - Patient safety education for interns and
residents
  • Training in team-based health care
  • ISBAR Feedback from 38 Interns
  • (after the first 5 weeks of first term)
  • Use of the Handover template has
  • Given me confidence 45
  • Assisted in prioritisation of information
    transfer 42
  • Resulted in positive feedback 21

12
Introduction
  • Who, what and where you are and why are you
    calling.
  • Hello Dr Z, I am Kim Lane
  • I am an RN on the medical ward at Maitland
    Hospital
  • I am calling you because I am concerned that the
    patient I have been caring for has fractured his
    hip.

13
Situation
  • Give the patients age and gender
  • What is the patients current status?
  • Mr X is a 74 year old man, who fell on his way to
    the bathroom and has severe pain in his left hip.

14
Background
  • Give the relevant background details such as
    presenting factors and complications
  • Mr X was admitted yesterday for investigation of
    severe chest pain. He got out of bed to go to the
    bathroom and slipped on a wet area. He has no
    chest pain at this point. His BP is 138/86, pulse
    is 94 and resps are 16. He rates his pain as 8 on
    a 10 point scale and his left foot is rotated
    inward.

15
Assessment
  • Put it all together (current issues, risks and
    needs)
  • I believe Mr X may have a fractured hip and I
    think he needs medication for pain

16
Recommendation
  • Be clear about your recommendation.
  • I would like an order for a X-ray of his hip, an
    orthopaedic consultation and some IM medication
    charted for pain.

17
What will it do for me?
  • Ensures completeness of info and reduces
    likelihood of missed data
  • An easy and focussed way to set expectations for
    what will be communicated
  • Standardises communication between people
    MO-Nurse, Nurse-Nurse, M0-Physio etc
  • Helps you to organise what youre going to say
  • Allows a recommendation
  • Gives confidence

18
Remember ISBAR
  • I Introduction - I am
  • S Situation - Whats going on
  • B Background - Brief, relevant history
  • A Assessment - What I think is happening
  • R Recommendation - What you are asking them to
    do

19
The (I)SBAR template in different handover
contexts
  • Calling for help
  • Transfer of care within teams, between teams and
    between Units
  • Change of shifts
  • Patient movement from ED to Ward/ICU
  • Inter-hospital transfer with clinical handover
  • Discharge from hospital into the community
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