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1 ISBAR for clear communication Clinical communication for health employees.

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Presentation on theme: "1 ISBAR for clear communication Clinical communication for health employees."— Presentation transcript:

1 1 ISBAR for clear communication Clinical communication for health employees

2 2 Aim of ISBAR education is to help you to … further develop your communication skills utilise these skills when making a telephone referral utilise questioning/prompting skills as necessary when receiving a telephone referral standardise the use of a common agreed tool Telephone referral = any telephone conversation made by a clinician (medical, nursing, allied health) to another member of staff that relates to the immediate care of a patient

3 3 Structure of session Introduction Video viewing and critique (X2) Explanation of ISBAR tool Video viewing and critique (x1) ISBAR activity in pairs Conclusion / evaluation

4 4 Why is this topic important? Patient care is dependant on effective communication - including telephone communication between all staff involved in the care of the patient Effective communication has become more important as healthcare has become more complex, highly specialised and team-based JCAHO & Southern Health statistics

5 5 Why is it important to have a standard approach to telephone communication? It is a daily task It is rarely explicitly taught Telephone referrals can be a source of frustration for both the giver and the receiver Ineffective telephone communication can compromise patient care

6 6 How often do you make or receive a telephone referral? Generally, is making a telephone referral easy or difficult? What have you experienced? If sometimes difficult, why? What information would you like when receiving a referral? Some questions for you…

7 7 Some of the challenges People are busy and dont want more work! It can be difficult to summarise a complex case succinctly The person making the referral – is often asked about things they have already said – may not get the help they were expecting The person receiving the referral may – interrupt mid-sentence – make assumptions about the capability of the person making the referral

8 8 What strategies do you already use to assist the process of making or receiving a telephone referral?

9 9 ISBAR A tool used to help provide structure to communication in a number of settings Adapted from SBAR, a tool developed by the US Navy to improve communication We are proposing the use of ISBAR in relation to making and receiving a telephone referral

10 10 By the end of this session you will be able to… describe the use of the ISBAR tool in making a telephone referral prepare for a mock referral demonstrate the successful use of the ISBAR tool to make a mock referral identify possible situations to use ISBAR in your workplace

11 11 Structure of session Introduction Video viewing and critique (x2) – all videos relate to the same case Explanation of ISBAR tool Video viewing and critique (x1) ISBAR activity in pairs Conclusion / evaluation

12 12 What are your thoughts on this doctors attempt at making a referral? What suggestions for improvement would you give him? Video One

13 13 Focused but not prepared The doctor clearly states what he wants – he wants the other doctor to come and see the patient He checks he is talking to the right person but … He doesnt have important information at hand The main problem is lack of preparation – how long does it take to prepare? – what things should be prepared before picking up the telephone?

14 14 What are your thoughts on this doctors attempt at making a referral? What suggestions for improvement would you give him? Video Two

15 15 Prepared but not focused this is an exaggerated vignette to make a point The person on the other end of the phone gave up because the information was neither concise nor organised All the relevant information was included, but … The message was not clear Note: the relevant information needs to be delivered slowly and simply with appropriate emphasis and repetition

16 16 Structure of session Introduction Video viewing and critique (x2) Explanation of ISBAR tool Video viewing and critique (x1) ISBAR activity in pairs Conclusion / evaluation

17 17 ISBAR I - Identify S - Situation B - Background A - Assessment R - Request

18 18 ISBAR Provides a standardised structure for communicating Helps prioritise information for both parties Decreases the chance of forgetting relevant information Helps to decrease assumptions by making the reason for the call obvious at the outset

19 19 I - Identify Identify yourself - name, position, location Identify the person you are talking to if not already done Identify the patient and unique ID number Hello. My name is Jasmine Sass, Im a Division 1 RN working on Ward 2 at …. Hospital. Are you the medical registrar on for ward referrals today? … I didnt catch your name?…Im calling about a patient - Terry Jones - a 56 year old man in our surgical ward at ….. Hospital

20 20 I - Identify continued… Why give your name? – it is polite and professional to do so Why give your position? – helps the information receiver to know at what level to pitch their response/advice Why state where you are calling from? – the information receiver may work at multiple sites Why identify the person you are speaking to? – to make sure it is the appropriate person Why do you need their name? – to document in the notes for future reference Why identify the patient - name, age, sex, location? – helps identify the patient and helps the receiver to develop a mental picture of the patient

21 21 S - Situation Explanation of WHY you are calling I am calling you about a patient, Mr Jones*. He is a 56 year old man, 2 days post hernia repair who has developed new atrial fibrillation with a blood pressure of 105/66. He looks pale and feels unwell. I would like you to come and assess this patient please If urgent, make this clear at the start Mr Jones is a 56 year old man who is 2 days post hernia repair. He has gone into atrial fibrillation. He is stable at present with a blood pressure of 105/66 but he is normally hypertensive. He looks pale and feels unwell. I am concerned about him and would appreciate it if you could come and help us to stabilise him *No need to repeat patients name age and sex if already included in IDENTIFY

22 22 S - Situation Continued Stating the purpose of the call at the start of the conversation helps the receiver focus their attention appropriately when listening to the story

23 23 B - Background Tell the story Ill tell you the story… Ill give you the background information… Provide RELEVANT information only. Deciding what is relevant is a skill that comes with experience Dont forget less is often more – you may get the message across better with less information Include aspects of history, examination, investigations and management where relevant

24 24 B - Background Continued… The volume of information will depend on the situation – Less if the receiver will see the patient themselves shortly. No background may be quite appropriate in this situation. if the receiver already knows the patient – More if you are wanting management advice over the phone without the receiver seeing the patient The receiver can always fill any important gaps in your story with questions

25 25 A - Assessment State what you think is going on. Give your interpretation of the situation Dont leave the receiver to guess what you are thinking - tell them Stating the obvious is helpful here Include your degree of certainty

26 26 A - Assessment cont… … the patient is febrile and I cant find a source of infection The patient has improved but I am concerned they have had a pulmonary embolus The patient has acute coronary syndrome

27 27 R - Request State what you want from them We would be grateful for your opinion regarding the need for surgery I need help urgently, are you able to come now? … If not, who should I call? Ask questions What would be the most appropriate antibiotic in this situation? What are the priority tasks for me while you are on your way?

28 28 Additional points… NB: What you say for Situation may be a concise summary of what you say for Assessment and Request. This repetition is helpful as it emphasises the key purpose of the referral Sometimes the receiver will lead the conversation – you can still use ISBAR as a guide – Dont forget, the receiver may not be familiar with ISBAR

29 29 Preparation for the call Preparation is vital - use ISBAR to prepare Make sure YOU are clear on the reason for referral before calling Write down your questions Document a written referral in the notes if this is the practice for formal referrals in your hospital or include in nursing notes Gather relevant patient details, notes, charts, ECGs, observations etc before making the call Have pen and paper on hand to write down names, numbers and instructions

30 30 Structure of session Introduction Video viewing and critique (x2) Explanation of ISBAR tool Video viewing and critique (x1) ISBAR activity in pairs Conclusion / evaluation

31 31 What are your thoughts on this attempt at making a referral? This is an example of ISBAR in action… Video Three

32 32 ISBAR can be done briefly - 1 I - Hi, Im Joe, an intern in ED S - I would like to refer a 66 year old man with pneumonia B - He has been on oral antibiotics for 1 week with no improvement. He is stable and we have commenced IV antibiotics A - His presentation of pneumonia is classic R - Are you able to see him with a view to admission?

33 33 ISBAR can be done briefly - 2 I - Hi, Im Sue, an ANUM on Ward 2 S - I would like you to come and see a 21 year old man who has had a significant skin reaction to an IV antibiotic B - He was admitted this morning for treatment of an appendicectomy wound infection. He is a type 1 diabetic. He has just had his first dose of Gentamicin, Metronidazole and Ampicillin A - He is anxious and appears flushed with an erythemous rash on his chest and arms. His blood pressure is normal R - Are you able to see him urgently? What would you like me to do in the meantime?

34 34 If you are receiving the referral Dont forget you can help – Are we using the ISBAR format? – Can you give this to me in ISBAR format? – Can you please identify ….? patients name, location – What is the Situation? – What is the Background? – What is your Assessment? – What do you think needs to happen?

35 35 Structure of session Introduction Video viewing and critique (x2) Explanation of ISBAR tool Video viewing and critique (x1) ISBAR activity in pairs Conclusion / evaluation

36 36 Other applications of ISBAR Making a written referral Presenting a case on a ward round Handing over a complicated patient to covering staff When transferring or receiving a patient from ED Standardised Forms development

37 37 Structure of session Introduction Video viewing and critique (x2) Explanation of ISBAR tool Video viewing and critique (x1) ISBAR activity in pairs Conclusion / evaluation

38 38 Conclusion ISBAR is a simple tool that enables a standardised approach to telephone referrals 7001 Medical Nursing & Allied Health staff trained at Southern Health 4760 attended sessions, 2813 evaluations completed 94.08% worthwhile, 91.66% relevant to them 93.85% relevant to colleagues

39 ISBAR in Practice Diagnostic Imaging: reduction in error (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%

40 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 1. Birth Suite record of telephone contact 2.Wound Assessment Request

41 ISBAR in practice Simulation Centre Study : Medical students assessed in SIM Centre. ISBAR trainees outperformed non trainees each time. 88% of Junior Staff using ISBAR tool six months later Marshall et all Qual Saf Health care 2009,18(2): There is leading evidence that ISBAR promotes improved patient safety and outcomes

42 Questions? Thank you for supporting the use of ISBAR in our organisation ISBAR tools (2010) – developed by Southern Health in partnership with the VMIA


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