Transcript Power Point for long ISBAR presentation

ISBAR in our Communication
Clinical Governance
Long Presentation
Clinical Governance – Pursuing Quality, Safety and Excellence
Situation
Communication is an everyday practice
Poor communication can harm people
Today
Background
– Evidence about communication
– What we did in response to that evidence
– Results
Assessment
Recommendation
– Training
Clinical Governance – Pursuing Quality, Safety and Excellence
Background
Clinical Governance – Pursuing Quality, Safety and Excellence
Background - Evidence about communication
Communication Incidents
Interpersonal
communication
principles and
processes
2%
Timely transf er of
investigations to those in
charge
3%
Speaking up f or saf ety
reasons regardless of
status
7%
Relaying concerns
about about a
deterioration condition to
a senior clinician
6%
Formal documentation of
systems of
communication
1%
Com m unicating at
handover
32%
Policies communicated
adequately
8%
Communication w ith
patients and carers
regarding processes
2%
Communication w ith
patients and carers
regarding clinical
inf ormation
5%
Com m unication on
transfer betw een
facilities
34%
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)
Clinical Governance – Pursuing Quality, Safety and Excellence
Complaints associated with Communication Reported through IIMS in 2006
speaking up for safety
regardless of status.
1%
formal documentation systems
of communication
4%
Relaying concerns about a
deteriorating condition to a
communicating at handover
senior clinician
policies communicated
3%
3%
adequately
3%
timely transfer of investigations
to those in charge
1%
communication on transfer
between facilities
patients
communication with4%
and carers regarding
processess
11%
interpersonal communication
principles and processes
53%
communication with patients
and carers regarding clinical
information
17%
Clinical Governance – Pursuing Quality, Safety and Excellence
Root Cause Analysis
• 127 reviewed
• 96 identified communication as a
contributing factor
• Only 1 in 4 of those 96 had identified
communication as a contributing cause in
the initial incident notification
Clinical Governance – Pursuing Quality, Safety and Excellence
At that time it was assessed that
• We needed to do better
• We needed to develop better ways
to communicate
• We needed to prevent harm to those
we are trying to help
Clinical Governance – Pursuing Quality, Safety and Excellence
• We needed something that was
– Evidence-based
– Used with success in other hospitals and highrisk 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
Clinical Governance – Pursuing Quality, Safety and Excellence
Our response to the evidence
In March 2008 Clinical Governance was
funded to develop, train staff to use
and evaluate the utility of a simple
communication framework: ISBAR
Clinical Governance – Pursuing Quality, Safety and Excellence
ISBAR inter-hospital transfer project March 2008-March
2009
Tracked 77 patient transfers TMH to JHH/ RNC, before
and after staff were trained in ISBAR
Staff training evaluated
Asked clinical, ward and transport staff and patients and
carers to rate quality of communication concerning
transfer
Clinical Governance – Pursuing Quality, Safety and Excellence
Results: training had impact for staff!
ISBAR Pre Post Education Survey Interval Plot of confidence
Likert scale (1-7)
95% CI for the Mean
6.0
6.0
5.5
5.5
5.0
5.0
4.5
4.5
4.0
4.0
e
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n
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do
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co
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de
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t
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se
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Clinical Governance – Pursuing Quality, Safety and Excellence
graph of use of a systematic approach to giving a handover by intervention status
post
20
10
0
Percent
30
40
pre
1
2
3
4
5
6
7
1
2
3
4
use of a systematic approach to giving a handover
Graphs by int_status
5
6
7
Clinical Governance – Pursuing Quality, Safety and Excellence
Results – training had impact for patients
Patient's Average Likert Scale (1-7) Response
1 = least satisf action and 7 = most satisf action
Satisfaction with information on current condition
7.00
6.00
Personal experience of transfer
5.00
Confidence in asking questions
4.00
3.00
2.00
1.00
Respect and Courtesy during transfer
A contact for future information
Details of how the transfer will occur
Patient (Baseline)
Reason for transfer
Patient (Implementation)
Clinical Governance – Pursuing Quality, Safety and Excellence
Results – training improved staff communication
Non Medical Average Likert Scale (1-7) Responses
1 = least satisfaction and 7 = most satisfaction
Clarity about reason for transfer
7.00
6.00
5.00
Timeliness of being told of the transfer
4.00
Description of Current Condition
3.00
2.00
1.00
Courtesy
Clarity about Transfer plan
Confidence to ask Questions
Non Medical Sending (Baseline)
Non Medical Sending (Post Implementation)
Non Medical Receiving (Baseline)
Non Medical Receiving (Post Implementation)
at
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Clinical Governance – Pursuing Quality, Safety and Excellence
Results – patient documentation improved
ISBAR File Audits - Information Present in File (Implementation and Baseline)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Baseline
Implimentation
Clinical Governance – Pursuing Quality, Safety and Excellence
Assessment
The data were assessed by the AET as compelling
Recommendation
Clinical Governance recommended that all staff be trained
to use ISBAR for professional communication
In response to the data and the recommendation Clinical
Governance has been charged with leading an Area-wide
program to train all staff to use ISBAR for professional
communication
Clinical Governance – Pursuing Quality, Safety and Excellence
Training - So what is ISBAR?
• Introduction
• Situation
• Background
• Assessment
• Recommendation
Clinical Governance – Pursuing Quality, Safety and Excellence
ISBAR
• Introduction
– Who, what and where you are and why are you
calling
• Situation
– What is happening now
• Background
– What led to the situation
• Assessment
–
What you think the problem is
• Recommendation
– What should we do to correct the problem
Clinical Governance – Pursuing Quality, Safety and Excellence
ISBAR
Introduction
Clinical Governance – Pursuing Quality, Safety and Excellence
ISBAR
Situation
Clinical Governance – Pursuing Quality, Safety and Excellence
ISBAR
Background
Clinical Governance – Pursuing Quality, Safety and Excellence
ISBAR
Assessment
Clinical Governance – Pursuing Quality, Safety and Excellence
ISBAR
Recommendation
Clinical Governance – Pursuing Quality, Safety and Excellence
What will ISBAR do for me?
• Ensures completeness of info and reduces likelihood of
missed data
• Is an easy and focussed way to set expectations for
what will be communicated
• Standardises communication between everyone –
Doctor-Nurse, Nurse-Nurse, Doctor-Physio as well as
wardsmen, housekeeping and clerical staff
• Helps organise what needs to be said
• Ensures a recommendation is clear and professional
• Gives confidence in communication
Clinical Governance – Pursuing Quality, Safety and Excellence
The ISBAR format can be used in all forms of
communication:
 Clinical Handover
 Referrals
 Reports (Ward, AET etc)
 Protocols, memos and emails
 Personal interactions
Clinical Governance – Pursuing Quality, Safety and Excellence
Clinical Governance – Pursuing Quality, Safety and Excellence
Remember ISBAR
•
•
•
•
•
I – Introduction - I am
S – Situation - What’s going on
B – Background - Brief, relevant history
A – Assessment - What I think is happening
R – Recommendation - What you are asking
them to do
Clinical Governance – Pursuing Quality, Safety and Excellence
Exercise
Think of how you may write a brief précis about this meeting.
Use the page provided to write down elements of the day.
• Introduction – I am … and I attended a meeting this week in
my capacity as…
• Situation – the purpose of the meeting was to…
• Background- the meeting had been organised to….
• Assessment – the outcome was …
• Recommendation – (I am telling you this because) I am
asking you to/ I would like you to/ I am requesting that….
Clinical Governance – Pursuing Quality, Safety and Excellence
Clinical Governance – Pursuing Quality, Safety and Excellence
Think Talk
Write ISBAR
Clinical Governance – Pursuing Quality, Safety and Excellence