Clinical Strategies to Improve Patient Outcomes

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Clinical Strategies to Improve Patient Outcomes

• Strategies to Improve Communication With
  Physicians

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Objectives

• Describe physician-nurse communication patterns
• Discuss how SBAR can improve communication
• Introduce new tools to assist agencies with
  physician communication

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Physician-Nurse Communication

• Emergent Care Acute Care Hospitalization link
• More than one physician
• Teamwork
• Collaborative relationship

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Physician-Nurse Communication

• Sign the Plan of Care
• Coordination of Services
• Verbal Orders
• Multidisciplinary Team Member

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Physician-Nurse Communication

• Different Styles
• Nurses are trained to be narrative and
  descriptive
• Physicians are trained to be problem solvers
  what do you want me to do just give me
  the headlines
• Human factors gender, national culture,
  hierarchy/ power distance, prior relationship
• Perceptions of patients need
• Paradigm shift

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What Do Physicians Want To Know?

• Accurate concise information
• All pertinent information available
• The patient was assessed
• Possible solution or recommendation

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Communication Barriers

• Telephone tag
• Unfamiliar with home care
• Incomplete information
• Failure to return telephone calls
• Interruption to daily routine

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Physician Communication

• Establish
• Best method
• Standing orders
• Relationship trust

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SBAR

• Situation
• Background
• Assessment
• Recommendation
• Institute Healthcare Improvement www.ihi.org

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Why SBAR?

• SBAR is similar to the SOAP model
• Provides answers to physicians three main
  questions
• What is the problem?
• What do you need me to do?
• When do I have to respond?
• Standardized approach that promotes efficient
  transfer of
• key information between physicians, nurses and
  other
• members of the team
• SBAR helps create an environment that allows
  clinicians
• to express their concerns

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S Situation

• Identify yourself, home health agency
• Whether you are in the home
• Describe the patient situation
• When the problem started
• Severity

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B Background

• Patients admission to the agency
• Current list of medications, including allergies
• Recent medication changes
• Laboratory values
• Recent ER visits or hospitalizations
• Date of Birth

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A Assessment

• Clinicians current assessment of the situation
• I think the problem is ____________

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R Recommendation

• Recommend what action the clinician wants from
  the physician
• Describe what you are able to do
• Let physician know you will call back with the
  patients response
• Request an extra skilled visit

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SBAR Exercise

• Mr. Nelson is 71 year old male with HTN and COPD.
  Patient c/o being tired and weak the last 2
  days. After the nurse assesses patient she
  determines that has had syncope s/s with sudden
  movements, for the last day or two after starting
  that new medication.

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SBAR Exercise, continued

• BP 102/60(R), 106/62(L), 98/52(L standing) P 72
  bpm, R 24. Previous VS were 164/82(R), 158/80
  (L), P 74 bpm, R 22. Nurse discovers
  that the patients new medication was filled at
  a different pharmacy, and was really the same
  antihypertensive he was already taking.

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SBAR Exercise, continued

• Situation

Dr. Smith, this is Nancy Nurse from ABC Home
Care. I am calling about Mr. James Nelson your
71 year old patient that is now having s/s
syncope.
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SBAR Exercise, continued
Background
ABC Home Health has been seeing for the last 3
weeks for exacerbation of HTN. His previous
vital signs were 164/82(R), 158/80 (L), P 74, R
22. Mr. Nelson has been complaining of
lightheadedness, weakness and syncope with sudden
movement. VS today were BP 102/60(R),
106/62(L), 98/52(L standing) P 72, R 24. Nurse
discovered patient was taking a double dose of
his antihypertensive, XXXX 1 tablet, XX mg, twice
a day for the last 4 days by accident.
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SBAR Exercise, continued
Assessment
Patient accidentally had a refill of the same
antihypertensive filled at another pharmacy. He
is hypotensive from the medication error.
Recommendation
I would like to hold his antihypertensive
medication until tomorrow and schedule two extra
skilled nursing visits starting tomorrow to
recheck his blood pressure and for medication
teaching. Can I have parameters when to restart
the medication?
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If SBAR does not work?

• CUS program
• Im Concerned
• Im Uncomfortable
• This is unSafe..

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Assertion

• Model to guide andimprove assertion inthe
  interest of patient safety

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Why is Assertion So Hard ?

• Hierarchy / power distance
• Lack of common mental model
• Dont want to look stupid
• Not sure Im right
• Other?

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Physician Communication Toolkit

• The Physician Role in Reducing Hospitalizations
• Physician letter
• Guidelines for physician contacts
• SBAR documentation form
• SBAR fax statement to the physician
• Available for download at http//providers.ipro.or
  g/index/homehealth_downloads

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Contact Information

• Sara Butterfield , RN, BSN, CPHQ, CCM
• Project Director
• Phone [phone] ext. 104
• Email sbutterfield_at_nyqio.sdps.org
• Christine Stegel RN, MS, CPHQ
• Performance Improvement Coordinator
• Phone [phone] ext. 113
• Email cstegel_at_nyqio.sdps.org