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Patient Hand Off Tool Kit

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Presentation on theme: "Patient Hand Off Tool Kit"— Presentation transcript:

1 Patient Hand Off Tool Kit
SBAR-Situation Background Assessment Recommendations Public Information Educational Resource Committee

2 Problem An estimated 80 percent of serious medical errors involve miscommunication between caregivers when patients are transferred or handed-off. Facts about the Hand-off Communications Project ,

3 Universal Process across disciplines
SBAR is an evidenced-based communication model developed in the military and is widely used in many industries including aviation and health care to make sure: the right information gets to the right people in the shortest timeframe It is currently the communication standard of care in many emergency departments in the United States because it has been so effective in improving communication between all types of health care providers.

4 SBAR- Situation Background Assessment Recommendations
These guidelines outline the priority information that needs to be relayed during patient care handoff to the receiving healthcare provider so that critical information is not missed.

5 SBAR- Situation Background Assessment Recommendations
This format emphasizes urgent concerns be brought to the forefront –Patients who meet Point of Entry protocols –should have complaint stated first Empowers the EMS provider to advocate for the patient We will give examples through this presentation…

6 SBAR- Situation Background Assessment Recommendations
These guidelines are to be used in a flexible way that meets the needs of the situation encountered

7 Region IV EMS Communication Policy is based on SBAR
Situation: ETA Urgent Concerns/ Point of entry pts Age Sex Chief Complaint: Background: (history of present illness) High Risk medications Assessment: General impressions Pertinent findings Vital signs Pain level Recommendations/Recap Treatment provided Response to treatment and interventions Recap

8 Massachusetts EMS Region IV Communications Policy
Entry Notes Hail Metro-Boston CMED on MED 4 CMED name x 2 Service, call sign, current level of ambulance Reason for request (Priority Level, Medical Control, ALS entry note, BLS entry note, declaration of disaster, radio test) Physical Location •For Example: “Metro-Boston-CMED, Metro-Boston-CMED. This is Bedford A-2 requesting a priority one BLS entry note to the Lahey from Route 62 in Bedford” Region IV protocol- follow your regions Communication Policy

9 Massachusetts EMS Region IV Communications Policy
Await channel assignment from Metro-Boston CMED (ie “Shift and acknowledge MED 3”) Once a channel has been assigned, shift to that channel and acknowledge CMED standing by. (ie “Metro-Boston CMED, Bedford A-2 standing by on MED 3”).

10 Massachusetts EMS Region IV Communications Policy
Metro-Boston CMED will advise unit that the requested hospital(s) are on-line and for them to proceed with their transmission. Make the entry note as clear, concise, and short as possible Rule of thumb, no more than two minutes Immediately request notification of Stroke, Cardiac, Trauma team, or other specialty services (language, vent required, etc..) if appropriate (following Point of Entry Protocols (POE) When reporting a patient’s condition, the radio report should include the following - SBAR Format POE Stroke, STEMI ,Trauma most acute care facilities request a 10 minutes heads up on ANY pt who while require immediate response upon your arrival. This INCLUDES INTERFACILITY TRANSFERS, behavioral Health requiring security- CPAP, intubated-vented pts !!

11 Massachusetts EMS Region IV Communications Policy
When provider has completed entry note: Provider should acknowledge hospital(s) Inform Metro-Boston CMED you are leaving the assigned MED channel and returning to MED 4 Relinquish the assigned MED channel to CMED on MED 4 Transmit Call sign and time clearing assigned channel

12 How SBAR works…. S State agency name and unit #
Point of Entry* or High Risk pt*- ETA- age and sex of the pt Urgent concerns and immediate needs upfront B Mechanism of Injuries sustained/LOC/or Onset of illness Include complicated medical hx and or High Risk medications A Vital Signs – and pertinent findings R Treatment and patient response Recap Request any further instructions Point of Entry- Trauma Adult/Pedi, Stroke, STEMI, Sepsis High Risk Meds – anticoagulants (Coumadin,Plavix,Aspirin ect)

13 Let’s practice!

14 EMS Scenario (Example 1)
You have responded to a home for a report of elderly female unwitnessed fall. An 88 year old female is found on the floor, awake- Family states heard “thud” found pt on floor –report no LOC, Pt complaining of left hip and shoulder pain.

15 EMS Scenario (Example 1)
Left lower extremity is rotated outward, has a positive pedal pulse, warm to the touch-pink in color Left shoulder without obvious deformity, Color Sensation normal, states-“hurts to move my left arm” Past Medical History: osteo arthritis CVA, a-fib Medications: Coumadin, Digoxin

16 EMS Scenario (Example 1)
Pt was placed in a cervical collar-log rolled onto back board and pillows to support LLE Secured on backboard- ice to shoulder Pt states uncomfortable on the board, but the ice helps Vital Signs: B/P-172/88 HR-58(irr) Resp-18

17 SBAR Report….. (assume you have Hailed CMed - and patched into receiving facility…you have identified your unit #... Proceed

18

19 Entry Note (should take no more than 2 minutes-following the region IV policy)
Situation:  ETA – 17 min Urgent Concerns/ Point of entry pts : Elderly Trauma Age - 88 Sex – female Chief Complaint: Fall with left hip and shoulder pain Background: (history of present illness-) Unwitnessed fall, Found on floor- left leg and shoulder pain, family reports no LOC, pt is on Coumadin for A fib and Stroke

20 Entry Note (should take no more than 2 minutes-following the region IV policy)
Assessment:* General impressions: Elderly conscious female Pertinent findings: Alert- left leg rotated outward-+ pulses, left shoulder pain-no obvious deformity Vital signs: B/P-172/88  HR-58(irr)  Resp-18 Pain  level: Rates pain 5/10  Recommendations/Recap* Treatment provided - C-spine immobilized, ice to shoulder, immobilized LLE Response to treatment and interventions – pain improved with immobilization and ice   Recommendations – Will update with any changes-any questions?

21 Emergency Department Arrival “Hand Off”
Situation: Urgent Concerns/Point of entry pts : Elderly Trauma Age - 88 Sex - female Chief Complaint: Fall with left hip and shoulder pain Background: (history of present illness-detailed history)   Unwitnessed fall, Found on floor- left leg and shoulder pain, family reports no LOC, pt is on Coumadin and Digoxin for A fib and Stroke States tripped and fell-alert to baseline per family

22 Emergency Department Arrival “Hand Off”
Assessment:* General impressions: Pleasant elderly female Pertinent findings: Alert- left leg rotated outward-left shoulder pain no deformity, warm pink and  pulses in both extremities- No c/o neck or back pain- Vital signs: B/P-172/88  HR-58(irr) Resp-18 Pain  level: Rates pain 5/10 

23 Emergency Department Arrival “Hand Off”
Recommendations/Recap:* Treatment provided - C-spine immobilized, ice to shoulder, immobilized LLE Response to treatment and interventions – pain improved with immobilization and ice –pt states she in uncomfortable on the backboard Recap- no changes enroute *ALS assessment include EKG (a-fib) *Recommendations /Recap- ALS interventions such as IV initiated and medications given and response to treatment interventions

24 SBAR- Interfacility Transfer
Expectations for “Hand Off” from : Acute Care Facility Rehabilitation Facilities Skilled Nursing Facility or Community Health Center

25 SBAR- Situation Background Assessment Recommendations
Urgent Concerns Age    Sex Chief Complaint   Background: History of present illness – Include Resuscitation Status (MOLST -Medical Orders for Life Sustaining Treatment) Comfort Care DNR

26 SBAR- Situation Background Assessment Recommendations
General impressions      Pertinent findings  Vital signs   Pain  level   Recommendations/Recap: Treatment provided     Response to treatment and interventions       Recap   

27 Scenario Example #2 You are called to a Skilled Nursing Facility- you receive the following report from the staff: Mr. Jones is an 76 male- transferred 1 week ago from XYZ hospital s/p left knee replacement. For the past few days he has become increasing more fatigued and agitated He is not eating well and has intermittent fevers

28 SBAR- Interfacility Transfer
Situation: Urgent Concerns –change on mental status Age- 76   Sex - male Chief Complaint :fever change in mental status

29 SBAR- Interfacility Transfer
Background: History of present illness – 2 weeks s/p left knee replacement-2 days hx of intermittent fevers today lethargic, confused and agitated- generally alert and oriented today-sleeping not eating, agitated   

30 SBAR- Interfacility Transfer
Assessment:  General impressions: lethargic, warm to the touch-combative with stimulation   Pertinent findings-temp 102.3, decreased urine output, tachypnic  Vital signs – HR 102, B/P 112/60,  R-28 Temp 102.3 Pain  level- 5/10 flank pain 

31 SBAR- Interfacility Transfer
Recommendations/Recap: Treatment provided-acetaminophen  and called EMS    Response to treatment and interventions- no change at this time      Recap – 76 m, altered mental status- confused-agitated, 2 week s/p left knee replacement - fever no response to acetaminophen   

32 SBAR- Interfacility Transfer
EMS transports to closest appropriate emergency department

33 Let’s practice!

34

35 SBAR- Interfacility Transfer Entry Note (should take no more than 2 minutes-following the region IV policy) Situation:  ETA – 20 min Urgent Concerns/ Point of entry pts : n/a Age - 76 Sex – male Chief Complaint: fever- change in mental status

36 SBAR- Interfacility Transfer
Background: (history of present illness-) 2 weeks s/p left knee replacement – 2 days hx of intermittent fevers today lethargic, confused and agitated- generally alert and oriented today-sleeping not eating, agitated   

37 SBAR- Interfacility Transfer
Assessment:* General impressions: Ashen in color-lethargic, warm to the touch-combative with stimulation-   Pertinent findings: increased agitation with bilateral flank palpation, l knee wound site dry and intact, patient incontinent with foul urine- Vital signs:  HR 102, B/P 112/60,  R-28 Temp 102.3 Pain  level:  5/10 flank pain

38 SBAR- Interfacility Transfer
Recommendations/Recap* Treatment provided – 2L Oxygen via nasal cannula , position of comfort Response to treatment and interventions – no changes Recommendations – Will update with any changes-any questions?

39 Emergency Department “Hand Off”
Situation: Urgent Concerns/Point of entry pts : Age - 76 Sex - male Chief Complaint: fever- change in mental status

40 Emergency Department “Hand Off”
Background: (history of present illness-) 2 weeks s/p left knee replacement – 2 days hx of intermittent fevers today lethargic, confused and agitated- generally alert and oriented today-sleeping not eating, agitated   

41 Emergency Department “Hand Off”
Assessment:* General impressions: Ashen in color-lethargic, warm to the touch-combative with stimulation- Increased agitation with bilateral flank palpation, left knee wound site dry and intact, patient incontinent with foul urine- Vital signs:  HR 102, B/P 112/60,  R-28 Temp 102.3 Pain  level:  5/10 flank pain

42 Emergency Department “Hand Off”
Recommendations/Recap* Treatment provided – 2L Oxygen via nasal cannula , position of comfort Response to treatment and interventions – no changes Do you have any questions? *ALS assessment include EKG (a-fib) *Recommendations /Recap- ALS interventions such as IV initiated and medications given and response to treatment interventions

43 SBAR- Situation Background Assessment Recommendations

44 Thank you References: Contra Costa EMS


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