ISBAR in our Communication Clinical Governance Long Presentation

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ISBAR in our CommunicationClinical
GovernanceLong Presentation
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Situation
Clinical Governance Pursuing Quality, Safety
and Excellence

• 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

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Background
Clinical Governance Pursuing Quality, Safety
and Excellence
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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)
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Clinical Governance Pursuing Quality, Safety
and Excellence
Complaints associated with Communication Reported
through IIMS in 2006
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Root Cause Analysis
Clinical Governance Pursuing Quality, Safety
and Excellence

• 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

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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

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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

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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

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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

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Results training had impact for staff!
Clinical Governance Pursuing Quality, Safety
and Excellence
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Clinical Governance Pursuing Quality, Safety
and Excellence
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Results training had impact for patients
Clinical Governance Pursuing Quality, Safety
and Excellence
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Results training improved staff communication
Clinical Governance Pursuing Quality, Safety
and Excellence
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Results patient documentation improved
Clinical Governance Pursuing Quality, Safety
and Excellence
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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
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Training - So what is ISBAR?
Clinical Governance Pursuing Quality, Safety
and Excellence

• Introduction
• Situation
• Background
• Assessment
• Recommendation

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ISBAR
Clinical Governance Pursuing Quality, Safety
and Excellence

• 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

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ISBAR
Clinical Governance Pursuing Quality, Safety
and Excellence

• Introduction

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ISBAR
Clinical Governance Pursuing Quality, Safety
and Excellence

• Situation

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ISBAR
Clinical Governance Pursuing Quality, Safety
and Excellence

• Background

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ISBAR
Clinical Governance Pursuing Quality, Safety
and Excellence

• Assessment

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ISBAR
Clinical Governance Pursuing Quality, Safety
and Excellence

• Recommendation

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What will ISBAR do for me?
Clinical Governance Pursuing Quality, Safety
and Excellence

• 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

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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

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Clinical Governance Pursuing Quality, Safety
and Excellence
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Remember ISBAR
Clinical Governance Pursuing Quality, Safety
and Excellence

• I Introduction - I am
• S Situation - Whats going on
• B Background - Brief, relevant history
• A Assessment - What I think is happening
• R Recommendation - What you are asking them to
  do

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Exercise
Clinical Governance Pursuing Quality, Safety
and Excellence

• 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.

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Everything should be made as simple as possible
but no simpler
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Clinical Governance Pursuing Quality, Safety
and Excellence
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Clinical Governance Pursuing Quality, Safety
and Excellence

• Think Talk
• Write ISBAR

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Clinical Governance Pursuing Quality, Safety
and Excellence