SBAR communication tool NHS Tayside

1. SBAR communication tool NHS Tayside Kim Mollison, Senior Charge Nurse

2. Background – what was problem/issue? • Unit had an increased number of incidents related to poor communication • Nursing handovers were lacking relevant information • Nursing handovers were not robust, technique often poor, often time consuming

3. Examples of tests/changes Test Four: Encouraged staff to continue using the tool for all handovers taking place but if they were comfortable then they could do verbal instead of written handovers Seems to be well established now in the surgical team Next aim was to implement the SBAR communication tool from Childrens Ambulatory Care Unit to the inpatient unit – this involves medical and nursing staff System being tested Test Three: Kim asked for verbal and written feedback from the staff involved with the handover using SBAR tool Staff seemed to be able to do the handover well using the sheets provided however they complained this was more writing Test Two: Kim to hold informal sessions informing ward staff about SBAR tool , Asked the Charge nurse of the surgical team for feedback regarding handovers, encouraged her to use SBAR when doing handover of patient information Asked staff to write the handover on an SBAR sheet for ease Test One: Kim & Suzie met and discussed plan to implement SBAR communication tool into nursing handovers of patients from ward 30 to ward 29. To inform staff in yellow team and ward 30 about plan to implement on June 28th 2010 Information put out to staff on patient safety board in ward 29 Suzie making example SBAR document for the nursing staff.

4. Using Model for Improvement • What are we trying to accomplish: • good communication skills at handover of patients from one unit to another; • How will we know that a change is an improvement: • Better patient care / less communication errors / less drug errors. Staff feedback about handover information. • What change can we make that will result in improvement: • Introduce SBAR communication tool into nursing handovers. • SBAR example: • Situation:I am nurse from …. Transferring patient x age x • Background:Surgical procedure performed, medical history , allergies, medicine given prior to and during surgery, IV fluids, PCA, Epidural, IV access • Assessment:vital signs post op, pain score, NPEWS, analgesia given, food and fluid intake, activities of daily living • Recommendations:observations required overnight, discharge plan including medications required, follow up plan.

5. Learning from improvement • Staff are receiving a more robust, informative nursing handover • Communication has improved – less drug errors, staff following appropriate care plan for surgical day case children and also giving to take home medicine on discharge • Staff are using the tool when communicating over the phone and find they are more concise in approach when requesting help / advice

6. Next Steps / Aims • Would like to use SBAR for all communication within unit so am currently asking all staff to watch interactive SBAR guide produced by Nottingham University with the NHS Institute for Innovation and Improvement www.nottingham.ac.uk/nmp/sonet/rlos/patientsafety/sbar/ • Encourage medical staff to become more aware of Patient safety initiatives such as SBAR • I have had verbal feedback from staff who are adept at using SBAR and now feel they use it during all communication – so aim is to have all staff comfortable with the technique.