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

Background - Evidence about communication Clinical Governance – Pursuing Quality, Safety and Excellence Background - Evidence about communication 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)

Complaints associated with Communication Reported through IIMS in 2006 Clinical Governance – Pursuing Quality, Safety and Excellence Complaints associated with Communication Reported through IIMS in 2006

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 high-risk 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

Our response to the evidence 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

Results: training had impact for staff! Clinical Governance – Pursuing Quality, Safety and Excellence Results: training had impact for staff!

Clinical Governance – Pursuing Quality, Safety and Excellence

Results – training had impact for patients Clinical Governance – Pursuing Quality, Safety and Excellence Results – training had impact for patients

Results – training improved staff communication Clinical Governance – Pursuing Quality, Safety and Excellence Results – training improved staff communication

Results – patient documentation improved Clinical Governance – Pursuing Quality, Safety and Excellence Results – patient documentation improved

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

Training - So what is ISBAR? 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

What will ISBAR do for me? 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….

Everything should be made as simple as possible but no simpler

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