ISBAR Presentation for senior staff Disclaimer ISBAR tools and templates are intended for informational purposes only. VMIA encourages the free transfer, copying, alteration and printing of ISBAR tools and templates if such activities support the purpose and intent for which the ISBAR tools and templates were developed. The ISBAR tools and templates are protected by VMIA's Copyright Licence. © VMIA 2010. ISBAR tools developed by Southern Health in partnership with VMIA.

for clear communication ISBAR for clear communication A standardised structured communication tool to improve patient safety 2

ISBAR - a structured communication tool Identify: Name, position & location. Ask to speak to the correct person. Patient details: unique ID number, ward & bed Situation: Why you are calling? What is currently happening? If URGENT, say so! Background: Tell the story eg: admission diagnosis and date Brief relevant medical history and treatment summary Assessment: Vital signs, your clinical impressions and what you think is going on Request: State what you want from them - come and review the patient? Management advice?

ISBAR - background Healthcare: increasingly complex, fast paced, multiple interactions Communication failure is a major factor in 60-70% adverse events (JCAHO, 2004) Southern Health complaints and adverse events: 35 % are related to communication WHO has made clinical communications one of its ‘High 5’ priorities to improve patient safety Australia has taken a leading role in this initiative All too often effective communication is personality or situation dependant. Leonard at Kaiser Permanente In the US noted that Effective communication and team work is Assumed whilst formal training and assessment in these areas is largely absent . Deeply embedded is the belief that quality of care and error free clinical performance are the result of being well trained and trying really really hard – all this contributes to the fact that when the inevitable mistakes occur, they are viewed as personal failure and also someone to blame . Which ,while psychologically satisfying for some What does this result in? Nobody owns up to errors and the events and situations which continually create the same sets of errors –regardless of staff – lay undiscussed and ready to reproduce another incident. When JACHO reviewed these cases they continually found clinicians had very divergent opinions on what was supposed to happen. To create an effective communication and team work we need a common mental model 1_ “Everyone watching the same Movie” 2 . Safety – enable all staff to speak up so everyone on the same movie with no surprises – surprises in Health care are usually bad news 3. Communication styles Nurses taught to be broad –paint big picture –never diagnose give all information MO are taught – Bullet points –get to point quickly – so immediate conflict between recipient and giver 4. Heirarchy – Authoritarian styles discourage communication need to flatten to open communication producing the “Hint and hope” style which is fraught with risk. 5. ISBAR promotes politeness between staff. 4 4

ISBAR – background Southern Health Simulation Centre adapted SBAR from US Navy. ‘I’ was added for identification of self , location, receiver and patient Structured method of communication in High Reliability Industries (HRI): Air traffic control, nuclear power generation & military Currently HRI error rating 1:10,000 Healthcare Globally error rating 1:10 to 1:15 5

ISBAR - the evidence Simulation Centre : Medical students taught ISBAR ISBAR trainees out performed non trainees each time 88% of Junior Staff using ISBAR tool six months later Marshall et all Qual Saf Health care 2009,18(2):137-40 There is leading evidence that ISBAR promotes improved patient safety and outcomes Sim Centre Study Med students (un knowingly ) divided into two groups One group trained in ISBAR the other was not The groups attended the simulation sessions and asked to make a referral which was recorded and analysed. Consistently over a 3 year period even lowest performing ISBAR trained people ALWAYS out performed the best NON ISBAR person when making a referral. 6 month follow up by SIM centre showed junior staff still using the ISBAR technique in their practice And they reported it gave them structure and confidence when reporting to senior or other colleagues Ask Staff to start using ISBAR when they return to work after this session and encourage teach and practice technique in their clinical The power of ISBAR lies in its standardisation – a technique that everyone uses. There are other techniques but few with such a track record such as ISBAR which has a 30 year track record in the high reliability industries Such as Air traffic control, nuclear power generation and the military. 6

ISBAR - Southern Health project Rolled out as a QUALITY Improvement project 7001 Medical Nursing & Allied Health staff trained in ISBAR technique 4760 attended face to face sessions 2813 evaluation forms were completed Staff feedback 94.08% worthwhile, 91.66% relevant to them 93.85% relevant to colleagues Conclude that the power of ISBAR lies in its standardisation – a technique that everyone uses. There are other techniques but few with such a track record such as ISBAR which has a 30 year track record in the high reliability industries Such as Air traffic control, nuclear power generation and the military. 7 7 7 7

ISBAR in practice Diagnostic Imaging: reduction in errors (Interim results - Southern Health 2009 ) Reduced inpatient misidentification: 9% to 2 % Reduced incorrect procedure verification: 30% to 4% Reduced incorrect side and site verification: 55% to 5% Referrer Audit: improved compliance. Clinical details provided 100% of time Contact details: non conformance reduced: 15% to 2% These are the interim results since ISBAR was introduced into the Diagnostic Imaging form in 2008. These are significant improvements.

ISBAR forms Emergency Dept to ward transfer form Emergency surgery booking form Medical Referral Form Pain Consultancy Request Form New ISBAR forms discovered during evaluation Birth Suite record of telephone contact Wound Assessment Request 9

Receiving a referral How you can help – If you want good communication, please ask for it! Are we using the ISBAR format? Can you give this to me in ISBAR format please? Can you please identify ….? the patient’s name, location What is the Situation? What is the Background? What is your Assessment? What do you think needs to happen?

How can senior staff help? Provide leadership by modelling behaviour - Please use ISBAR! Check your staff have attended training - ask them at ‘rounds’ Make it an expectation that the tool is used when communicating about your patients The power of ISBAR lies in its standardisation – a technique that everyone uses. There are other techniques but few with such a track record such as ISBAR which has a 30 year track record in the high reliability industries Such as Air traffic control, nuclear power generation and the military. 11

Questions? Further training can be organised as required (insert your contact details) Thank you for supporting the use of ISBAR in our organisation ISBAR tools (2010) – developed by Southern Health in partnership with the VMIA The power of ISBAR lies in its standardisation – a technique that everyone uses. There are other techniques but few with such a track record such as ISBAR which has a 30 year track record in the high reliability industries Such as Air traffic control, nuclear power generation and the military. 12