Transcript Communication - Alaska State Hospital and Nursing Home

Communication
Your keys to safe patient care
Objectives
O Understand the role of communication in
providing safe care of the surgical patient.
O Demonstrate the use of SBAR
communication tool
O Describe the elements of the surgical safety
checklist and when to perform them.
“We have learnt over the last decade that adverse events
occur not because bad people intentionally hurt patients but
rather that the system of health care today is so complex that
the successful treatment and outcome for each patient
depends on a range of factors, not just the competence of an
individual health-care provider. “
- World Health Organization
O In 2010 a Joint Comission study analying
over 4800 medical errors over 15 years
found that communication was the #1 top
contributing factor and handoffs were
involved in 80% of serious preventable
adverse events.
Handoffs associated with
surgical procedures
O PreOp Nurse Circulator
O Circulator Circulator
O Circulator  PACU
That’s a lot of
handoffs in a day
Elements of Effective Communication:
SBAR
O Situation
O Background
O Assessment
O Recommendations
Situation
O Who is the patient?
O What’s their diagnosis/procedure to be
performed?
O Where is the patient?
Ex: John Doe is a 34 year-old male with a rightsided tibial plateau fracture. He is in the ER
awaiting ORIF surgery on his fracture.
Background
O Pt medical history pertinent to procedure (NOT
HIS ENTIRE HISTORY)
O Medications taken daily/so far today
O Allergies
O Lab values (HCG for women, EKG for pts over 65)
O Vitals
O Code status
Ex: Fracture sustained snowboarding, pt has a PCN allergy, he last
ate breakfast at 7am, so far has had 2 g of morphine in the ER for
pain control, CBC was normal, Type and Screen sent to lab 20
minutes ago. He is a full code.
Assessment
O Patient’s understanding of procedure
O Specific needs or precautions
O Pain control
O Cultural needs
Ex: He is able to transfer himself from one bed
to another with minimal assistance. He is
nervous about going under and has a lot of
questions.
Recommendations
O Patient’s readiness for surgery.
O Orders completed.
O Equipment/Implants available
O Opportunity for questions.
Ex: “The patient was seen and marked by the surgeon. The
surgeon is concerned about blood loss please have 2 units of
RBCs on standby, he did not order antibiotics. Do you think he
will ask for preop antibiotics?”
SBAR exercise 1
A 53 y/o woman is admitted to the ER with
RUQ abdominal pain which began last night
after dinner, she has been unable to eat
anything since but has been keeping down
water. Her last PO intake was 4 hours ago. She
is evaluated by the general surgeon and
scheduled for a Laparoscopic Cholecystecomy
this evening. She rates her pain at 4/10.
The following info obtained by the ER is in her
chart:
Diagnosis: Acute Cholecystitis
Ht 65in; Wt 160lbs
HR: 93, BP:148/92, temp: 98.5 O2 sat 98% RA
Hg 11, Hct 34, WBC 9,000, HCG neg.
Meds at home: Lipitor, HCTZ
Meds in ER: 50mg fentanyl IV, LR 120ml/hr IV.
Medical History: HTN, hyperlipidemia, preterm
delivery at 32 weeks in 2007
Surgical History: Appendectomy at age 21.
SBAR exercise #2
You are 45 minutes into an ORIF on a 67 y/o
woman with a right-sided femoral neck fracture
resulting from a fall from standing. A type and
screen was done prior to surgery but no blood
products are ordered. Pre-op her H&H was 10&34,
a recent repeat H&H has just come back 8.2 and
33.1. Her vital signs are stable but the anesthesia
provider has requested you turn up the
temperature in OR, twice. History significant for
1ppd smoker x 38y and ORIF ankle 3 years ago. A
relief nurse comes along to offer you a much
needed lunch break.
Sign in, Time Out, Sign out
Sign in /Debriefing
O Pt confirms Identity procedure & consent.
Introduce pt to people in the room.
O State allergies
O Pt specific surgical risks (airway, aspiration,
blood loss). The goal is to prevent errors not
scare the patient.
O Anesthesia machine functioning.
Time Out
O All team members are present have a role
O Confirm patient identity with 2 identifiers
O Confirm procedure and side
O Antibiotic prophylaxis
O Equipment/implants/images
O Length of procedure, anticipated EBL
O Patient specific safety concerns.
***various facilities may add to this list
Sign Out
As the case is closing confirm:
O Procedure done, it may not be the one you
set out to do.
O Counts
O Any specimens for lab or pathology
O Problems with equipment to be addressed?
CMS Never Events
O Objects left behind during surgery
O Mediastinitis after CABG
O DVT/Pulmonary Embolism
O CAUTI
O Use of incompatible blood products
And many more
Who Else Should be “In the
Loop”?
O Surgeon(s) and assistant(s)
O Anesthesia Providers
O Charge Nurse
O House Supervisor?
O Lab?
O Radiology?
O Equipment/Implant Reps
O Anyone else associated with patient specific
procedure.
Documentation as
Communication
Documentation is more than just CYB in case
you get sued…
O It is a reminder if the elements of good
patient care.
O It fills in gaps left by person to person
report.
… and yes, it proves you did your job correctly
so don’t just blow through it. Make sure it is
accurate, complete, and accessible to others.
Listening is Communication
too
O Surgeons HATE being asked the same
question again and again (everyone does)
O Read the H&P, read the consent
O Write it down!!
O Having your eyes on the chart and your ears
on the surgical case is hard at first, but you
will get there.
Close the Loop
Patient Communication
O Don’t be fooled, patients are nervous, their
families are nervous.
O You don’t have to know all the answers but
you must be willing to find them out.
O It is your job to make sure they know what is
on their consent.
O Talk to kids about their surgery when
appropriate.
Sources
O Berry & Kohn's Operating Room
Technique._11th edition, by N. Phillips
O Alexander’s Care of the Patient in Surgery
14th edition by Jane C. Rothrock
O Debbie Popovich (2011)Cultivating Safety in
Handoff Communication, Pediatric Nursing,
37(2):55-60. retrieved from
http://www.medscape.com/viewarticle/746
070_2