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

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Presentation on theme: "Patient Hand Off Tool Kit Public Information Educational Resource Committee SBAR-Situation Background Assessment Recommendations."— Presentation transcript:

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

2 Problem An estimated 80 percent of serious medical errors involve miscommunication between caregivers when patients are transferred or handed-off.

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

4 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. SBAR- Situation Background Assessment Recommendations

5 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

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

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 patients condition, the radio report should include the following - SBAR Format

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…. SState agency name and unit # Point of Entry* or High Risk pt*- ETA- age and sex of the pt Urgent concerns and immediate needs upfront BMechanism of Injuries sustained/LOC/or Onset of illness Include complicated medical hx and or High Risk medications AVital Signs – and pertinent findings RTreatment 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 Lets 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

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 Situation: 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 Assessment: 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 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 Lets 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 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 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?

43 SBAR- Situation Background Assessment Recommendations

44 Thank you References: Contra Costa EMS


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