2for clear communication ISBARfor clear communicationA standardised structured communication tool to improve patient safety2
3ISBAR - a structured communication tool Identify: Name, position & location. Ask to speak to the correct person. Patient details: unique ID number, ward & bedSituation: Why you are calling? What is currently happening? If URGENT, say so!Background: Tell the story eg: admission diagnosis and date Brief relevant medical history and treatment summaryAssessment: Vital signs, your clinical impressions and what you think is going onRequest: State what you want from them - come and review the patient? Management advice?
4ISBAR - backgroundHealthcare: increasingly complex, fast paced, multiple interactionsCommunication failure is a major factor in 60-70% adverse events (JCAHO, 2004)Southern Health complaints and adverse events: 35 % are related to communicationWHO has made clinical communications one of its ‘High 5’ priorities to improve patient safetyAustralia has taken a leading role in this initiativeAll too often effective communication is personality or situation dependant. Leonard at Kaiser Permanente In the US noted that Effective communication and team work is Assumed whilst formal training and assessment in these areas is largely absent .Deeply embedded is the belief that quality of care and error free clinical performance are the result of being well trained and trying really really hard – all this contributes to the fact that when the inevitable mistakes occur, they are viewed as personal failure and also someone to blame . Which ,while psychologically satisfying for someWhat does this result in?Nobody owns up to errors and the events and situations which continually create the same sets of errors –regardless of staff – lay undiscussed and ready to reproduce another incident.When JACHO reviewed these cases they continually found clinicians had very divergent opinions on what was supposed to happen.To create an effective communication and team work we need a common mental model1_ “Everyone watching the same Movie”2 . Safety – enable all staff to speak up so everyone on the same movie with no surprises – surprises in Health care are usually bad news3. Communication styles Nurses taught to be broad –paint big picture –never diagnose give all informationMO are taught – Bullet points –get to point quickly – so immediate conflict between recipient and giver4. Heirarchy – Authoritarian styles discourage communication need to flatten to open communication producing the “Hint and hope” style which is fraught with risk.5. ISBAR promotes politeness between staff.44
5ISBAR – backgroundSouthern Health Simulation Centre adapted SBAR from US Navy. ‘I’ was added for identification of self , location, receiver and patientStructured method of communication in High Reliability Industries (HRI): Air traffic control, nuclear power generation & militaryCurrently HRI error rating 1:10,000Healthcare Globally error rating 1:10 to 1:155
6ISBAR - the evidence Simulation Centre : Medical students taught ISBAR ISBAR trainees out performed non trainees each time88% of Junior Staff using ISBAR tool six months laterMarshall et all Qual Saf Health care 2009,18(2):137-40There is leading evidence that ISBAR promotes improved patient safety and outcomesSim Centre StudyMed students (un knowingly ) divided into two groups One group trained in ISBAR the other was notThe groups attended the simulation sessions and asked to make a referral which was recorded and analysed.Consistently over a 3 year period even lowest performing ISBAR trained people ALWAYS out performed the best NON ISBAR person when making a referral.6 month follow up by SIM centre showed junior staff still using the ISBAR technique in their practiceAnd they reported it gave them structure and confidence when reporting to senior or other colleaguesAsk Staff to start using ISBAR when they return to work after this session and encourage teach and practice technique in their clinicalThe power of ISBAR lies in its standardisation – a technique that everyone uses.There are other techniques but few with such a track record such as ISBAR which has a 30 year track record in the high reliability industriesSuch as Air traffic control, nuclear power generation and the military.6
7ISBAR - Southern Health project Rolled out as a QUALITY Improvement project7001 Medical Nursing & Allied Health staff trained in ISBAR technique4760 attended face to face sessions 2813 evaluation forms were completedStaff feedback % worthwhile, % relevant to them % relevant to colleaguesConclude that the power of ISBAR lies in its standardisation – a technique that everyone uses.There are other techniques but few with such a track record such as ISBAR which has a 30 year track record in the high reliability industriesSuch as Air traffic control, nuclear power generation and the military.7777
8ISBAR in practice Diagnostic Imaging: reduction in errors (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 detailsprovided 100% of timeContact details: non conformance reduced: 15% to 2%These are the interim results since ISBAR was introduced into the Diagnostic Imaging form in 2008.These are significant improvements.
9ISBAR forms Emergency Dept to ward transfer form Emergency surgery booking formMedical Referral FormPain Consultancy Request FormNew ISBAR forms discovered during evaluationBirth Suite record of telephone contactWound Assessment Request9
10Receiving a referral How you can help – If you want good communication, please ask for it!Are we using the ISBAR format?Can you give this to me in ISBAR format please?Can you please identify ….?the patient’s name, locationWhat is the Situation?What is the Background?What is your Assessment?What do you think needs to happen?
11How can senior staff help? Provide leadership by modelling behaviour - Please use ISBAR!Check your staff have attended training - ask them at ‘rounds’Make it an expectation that the tool is used when communicating about your patientsThe power of ISBAR lies in its standardisation – a technique that everyone uses.There are other techniques but few with such a track record such as ISBAR which has a 30 year track record in the high reliability industriesSuch as Air traffic control, nuclear power generation and the military.11
12Questions? Further training can be organised as required (insert your contact details)Thank you for supporting the use ofISBAR in our organisationISBAR tools (2010) – developed by Southern Health in partnership with the VMIAThe power of ISBAR lies in its standardisation – a technique that everyone uses.There are other techniques but few with such a track record such as ISBAR which has a 30 year track record in the high reliability industriesSuch as Air traffic control, nuclear power generation and the military.12