Welcome Using SBAR in handovers Main title slide page Co-brand logo here Welcome Using SBAR in handovers

Situation Welcome Magnolia took on the initiative to improve the quality of their handovers in April 2017. Prior to the changes the standard of handovers varied in quality. The previous SBAR tool often included 'cut and pastes' of progress note entries and often did not include all relevant details and recommendations or plans for the person Recommendation from Nurse Consultant for WAA to trial a more reliable version of the SBAR handover tool Main title for slide set Optional sub title or name

Welcome Benefits to patient and staff Main title for slide set Staff are more informed of relevant needs, risks, and plans for the people using services for the next 24hour period All staff will be more confident in their knowledge of the patient Having a good handover will propel staff to proactively and purposefully engage with people Improved outcomes for people on the ward as a result of people feeling reassured that staff know about their care and treatment plans and awareness of their needs. Reduction in incidents, Reduction in complaints Main title for slide set Optional sub title or name

3 Key questions What are we trying to accomplish? To work with staff to improve the quality of clinical handovers by using the SBAR tool in 100% of all clinical handovers by 30th August 2017. How will we know that a change is an improvement? Outcome measures of average reliability of handover Reduction in length of handovers Effectiveness of SBAR in informing staff to focus on key priorities for the day from perspectives of different members of MDT Self rating of the quality of the handovers received using counter system What changes can we make that will result in improvement? Implementing new SBAR. Set of standards and expectation for delivery of SBAR. Observer Reliability questionnaires. Self rating counter system.

Welcome Assessment Main title for slide set Optional sub title or name AIM PRIMARY DRIVERS SECONDARY DRIVERS Welcome Whole team approach and involvement Main title for slide set Optional sub title or name All staff to understand the SBAR Improvement Lead/ Champion and QI nurse providing guidance and teaching of SBAR to all staff including temporary staff Set of standards for the delivery of the SBAR To work with staff to improve the quality of clinical handovers by using the SBAR tool in 100%of all clinical handovers by 30th August 2017. Clear Standards and Expectations for delivery of SBAR Guidance and rationale for the use of the SBAR Tool Handover evaluation/ audit tool with a clear system for Data collection with clear responsibilities Clear Process of Evaluating Handovers Use of feedback from team members Team members to see the project as their own within a positive culture of psychological safety to enable change Staff Motivation to succeed Positive changes to be shared with the teams

Welcome SBAR is embedded Update Welcome SBAR is embedded Staff are engaged and motivated to be involved in Qi initiatives on their ward Sustained improvement in reliability and hence quality of handovers Staff experience of handovers is good Main title for slide set Optional sub title or name

Welcome Outcome Measurement Main title for slide set Special cause variation – May 2017 Main title for slide set Optional sub title or name Project started April 2017 Graph showing the average reliability scores from observed handovers from April 2017 when the project began. Graph demonstrates a shift in reliability at the beginning of May which has been sustained. Average reliability has not fallen below 80%. We continue to work towards improving this score.

Welcome PDSA Testing Ramps for:…… Main title for slide set DATA FEEDBACK TO FRONTLINE STAFF Welcome Main title for slide set Optional sub title or name 1E: Collate information review PDSA Cycle 1D: To observe the impact of this tool in informing the MDT of their key priorities Cycle 1C: Using the SBAR to a better standard Cycle 1B: Nursing Staff using the SBAR Cycle 1A: Introduction to SBAR

Welcome Recommendations Some challenges and barriers: Positive aspects of the team’s keenness and motivation to implement the tool meant baseline data was unavailable. Overcoming this by getting retrospective feedback of staff experience prior to the changes Steps since then were embedded before moving forward. Use of the SBAR has been limited to the nursing handovers and as yet has not included rest of MDT. One of our next test of change would be to observe the impact of this tool would have on informing the MDT of their key priorities Main title for slide set Optional sub title or name

“get everyone on board and involve everyone in the improvements” Key improvement message learnt Welcome “Sustaining Quality Improvements is a process, start small from the beginning, learn from the changes and ensure embedded before moving on to the next challenge.” “get everyone on board and involve everyone in the improvements” Main title for slide set Optional sub title or name