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Improving handover in the ED setting “SBAR“

Improving handover in the ED setting “SBAR“. Objectives of the “ SBAR Squad from A&E ”. Where we are Where we need to be What do our staff think How far have we got Where are we going. TAPS questions (Additional). “ The SBAR Squad from A&E ”

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Improving handover in the ED setting “SBAR“

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  1. Improving handover in the ED setting “SBAR“

  2. Objectives of the “SBAR Squad from A&E” • Where we are • Where we need to be • What do our staff think • How far have we got • Where are we going

  3. TAPS questions (Additional) • “The SBAR Squad from A&E” • What we were trying to achieve and why it was important: • What worked well: • What we have learned to take this forward:

  4. Where we are?

  5. STRATEGIC PLANNING AND EVALUATION IN THE EMERGENCY DEPARTMENT Our Target: Our Objective: To deliver high quality, evidence-based, effective, efficient andpatient-centred care for ALL patients in the Emergency Department. Patient arrival to discharge MUST BE WITHIN 4 HRS for all patients. PHASE 1INITIAL ASSESSMENT PHASE 2DETAILED ASSESSMENT & TREATMENT PHASE 3MANAGEMENT & DISCHARGE PLANNING PHASE 4ED EXIT – PLANNING & DELIVERY –SBAR 3-4hr window 0-15min window 90mins-3hrs Window 15mins-90mins Window • Assessment - initial (complaint, physiology and allocate prioritisation) • Planning -(investigations needed/ordered, obvious decision to admit - DTA, start now if appropriate) • Treatment -(immediate treatment/resuscitation required) If delay in discharge from ED for any reason, inform appropriate person. • Detailed assessment • Chase results of investigations ordered • Instigate further investigations if required EARLY • Start treatment plan • Management plan defined and delivered (with diagnosis, treatment plan and discharge plan) Start Processes To: A) Discharge Home from ED using SBAR B) Admit to In-hospital Specialty Bed Base SBAR C) Admit to ED Observation Ward/CDU SBAR • ED Senior Nurse SBAR • ED SpR or Cons SBAR • Duty Bed Manager • If there is a breach (>4hrs in the Dept) in your area, please identify ways to prevent it in the future) If delay in discharge from ED for any reason, inform appropriate person. TARGET TIMES TO SEE A DOCTOR DAILY & WEEKLY PERFORMANCE RESULTS FOR EACH PHASE Category 1 (Resuscitation) = Immediate Category 2 (Emergency) = Within 10mins Category 3 (Urgent) = Within 1hr Category 4 (Non-urgent) = Within 1hr

  6. What are the causes of error Fletcher NPSA 2008

  7. Juliette Cosgrove: Q. “are we reporting enough?”

  8. UCD IR1s 2011 [chart]

  9. Where we need to be Knowledge application • Process & system design • Teamworking & LEADERSHIP • Training • Measuring • success

  10. What do our staff think? “a methodical order: name, age, gender, condition, plan, any risk to staff or patient” - nurse, grade 5. “simple clear patient details - complaint \ problem \ plan \ what needed \ & additional info.” – CSW. “everyone needs to handover following the same structure in the trust.” – Sister grade 6. “any further documentation needs to be short & concise. Already stress on 'time factors' with many other requirements for patients in ED; throughout [ED] stay and d/c to ward.” – Sister grade 7. “S: PC B: Meds & PMH A: impression / exam R: plan “ - SpR in ED.

  11. What do our staff think? Please indicate the level of risk you perceive to be associated with the following patient events : Q12. Discussion with other speciality nursing or medical colleagues In the hospital. Q1. The Emergency Department is a busy environment where the safety systems in place are robust and require no change.

  12. How far have we got? • Audit ( ED Cons Shift Team Leader snapshots x2) • SBAR templates for key areas of the ED • Developing context specific SBAR

  13. Audit of practice • Applied a development SBAR tool ( sticker in the ED notes) • 10% and 15% adherence – not good! • Positives: • Allowed refinement of tool • Embedded SBAR in minds of staff • Led to discussion and outcome to embed in ED notes

  14. SBAR template embedded into ED Notes • EMERGENCY DEPT PLANNING & HANDOVER • Situation • Likely diagnosis & • other possible Dx? • Background • Co-morbidities? • Assessment • Present physiology (MEWS, GCS)? • Active problems • Investigations completed & those still required? • Recommendations • Acute therapy given? • Further therapy required and when? • Handover to (their name, grade, specialty) : • Your name, grade & time of referral?

  15. Senior Handover SBAR

  16. SBAR for CDU protocols

  17. Where are we going! • Embedding SBAR into ED notes • Developing context specific SBAR within umbrella of improved handover • Development of better communications with rest of hospital around SBAR • Developing a tool for adherence and quality of content of SBAR in context specific situations

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