1. ISBAR in our Communication Clinical Governance Long Presentation

2. 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

3. Clinical Governance – Pursuing Quality, Safety and Excellence
Background

4. 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)

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

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

12. Clinical Governance – Pursuing Quality, Safety and Excellence

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

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

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

16. 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

17. Training - So what is ISBAR?
Clinical Governance – Pursuing Quality, Safety and Excellence
Training - So what is ISBAR?
Introduction
Situation
Background
Assessment
Recommendation

18. 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

19. Clinical Governance – Pursuing Quality, Safety and Excellence
ISBAR
Introduction

20. Clinical Governance – Pursuing Quality, Safety and Excellence
ISBAR
Situation

21. Clinical Governance – Pursuing Quality, Safety and Excellence
ISBAR
Background

22. Clinical Governance – Pursuing Quality, Safety and Excellence
ISBAR
Assessment

23. Clinical Governance – Pursuing Quality, Safety and Excellence
ISBAR
Recommendation

24. 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

25. 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 s
Personal interactions

26. Clinical Governance – Pursuing Quality, Safety and Excellence

27. 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

28. 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….

29. Everything should be made as simple as possible but no simpler

30. Clinical Governance – Pursuing Quality, Safety and Excellence

31. Clinical Governance – Pursuing Quality, Safety and Excellence
Think Talk
Write ISBAR

32. Clinical Governance – Pursuing Quality, Safety and Excellence