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Pressure Ulcer and Restraint Reduction Principles
- 1. Principles for Pressure Ulcer Reduction and Restraint Elimination Welcome Culture Change 06.2 Page 1 TEAMSTEPPS 05.2
- 2. Principles for Pressure Ulcer Reduction and Restraint Elimination Georgia, how are we doing? Culture Change 06.2 Page 2 TEAMSTEPPS 05.2
- 3. HowPrinciples for Pressure Ulcer Reduction doand Restraint Elimination you compare? Culture Change 06.2 Page 3 TEAMSTEPPS 05.2
- 4. Principles for Pressure Ulcer Reduction and Restraint Elimination Georgia, how do we rate? Culture Change 06.2 Page 4 TEAMSTEPPS 05.2
- 5. Principles for Pressure Ulcer Reduction How do you compare? and Restraint Elimination Culture Change 06.2 Page 5 TEAMSTEPPS 05.2
- 6. Principles for Pressure Ulcer Reduction Can we do better? and Restraint Elimination Culture Change 06.2 Page 6 TEAMSTEPPS 05.2
- 7. Where have we been Principles for Pressure Ulcer Reduction and where are we going? and Restraint Elimination Culture Change 06.2 Page 7 TEAMSTEPPS 05.2
- 8. Principles for Pressure Ulcer Reduction and Restraint Elimination What will it take? Culture Change 06.2 Page 8 TEAMSTEPPS 05.2
- 9. Principles for Pressure Ulcer Reduction Learning the Lessons? and Restraint Elimination Culture Change 06.2 Page 9 TEAMSTEPPS 05.2
- 10. Principles for Pressure Ulcer Reduction and Restraint Elimination The Sue Sheridan Story Culture Change 06.2 Page 10 TEAMSTEPPS 05.2
- 11. Principles for Pressure Ulcer Reduction and Restraint Elimination Strategies and TeamSTEPPS Tools to Enhance Performance and Patient Safety For Today’s Hospital’s and Nursing Homes Culture Change 06.2 Page 11 TEAMSTEPPS 05.2
- 12. Principles for Pressure Ulcer Reduction and Restraint Elimination Building Trust: Enhances Quality Care Spring 2009 Culture Change 06.2 Page 12 TEAMSTEPPS 05.2
- 13. Principles for Pressure Ulcer Reduction and Restraint Elimination Objectives Recognize that mistrust and poor communication are contributors to medical errors and increase staff and resident dissatisfaction Learn how to increase trust, mutual support and communication among your team Practice techniques that support a ―safety culture‖ Culture Change 06.2 Page 13 TEAMSTEPPS 05.2
- 14. Principles for Pressure Ulcer Reduction and Restraint Elimination Exercise What drives you crazy at work? Culture Change 06.2 Page 14 TEAMSTEPPS 05.2
- 15. Principles for Pressure Ulcer Reduction and Restraint Elimination Things that drive us crazy…… "That's all I What is your Popeye moment can stands, cuz I can't stands ―That’s all I can stands, n'more!" cuz I can’t stands n’more!‖ Or makes you say ―It doesn’t have to be like this‖ Culture Change 06.2 Page 15 TEAMSTEPPS 05.2
- 16. Principles for Pressure Ulcer Reduction and Restraint Elimination What drives you crazy at work? List 2-3 things that drive you crazy at work Share them with a small group Within the small group, agree on the top 1-2 items Report back to larger audience Culture Change 06.2 Page 16 TEAMSTEPPS 05.2
- 17. Principles for Pressure Ulcer Reduction and Restraint Elimination Typical Issues Identified Poor quality of care Staff who don’t show up for work ―Not my job‖ Low staff morale Complicated process that no one follows Risks to patient safety Culture Change 06.2 Page 17 TEAMSTEPPS 05.2
- 18. Principles for Pressure Ulcer Reduction and Restraint Elimination Great leadership does not mean running away from reality. Sometimes the hard truths might just demoralize the company, but at other times sharing difficulties can inspire people to take action that will make the situation better.” John Kotter Culture Change 06.2 Page 18 TEAMSTEPPS 05.2
- 19. Principles for Pressure Ulcer Reduction and Restraint Elimination What’s wrong in healthcare today? Root Cause Analysis (RCA) At the root, is ―every man for himself‖ At the root of ―every man for himself‖ is a profound lack of trust If we, the leaders of a healthcare community can’t earn the trust of each other – how can we systematically improve safety, quality, and outcomes Excerpt from: ―Optimizing Work Environments‖; Brian Wong, MD; Georgia Patient Safety Summit Culture Change 06.2 Page 19 TEAMSTEPPS 05.2
- 20. Principles for Pressure Ulcer Reduction and Restraint Elimination Defining Trust Think of a person whom Think of a person whom you really trust you do not trust Write down some Write down some descriptors descriptors Share with small group Share with small group Within small group arrive at a consensus on 2-3 things in each category Culture Change 06.2 Page 20 TEAMSTEPPS 05.2
- 21. Principles for Pressure Ulcer Reduction and Restraint Elimination Defining Trust Qualities of High Trust Qualities of Low Trust Integrity Misgiving, Strength Suspicion, Ability Suspect Surety No confidence Hope Undependable Follow-through Unreliable Reliable Culture Change 06.2 Page 21 TEAMSTEPPS 05.2
- 22. Principles for Pressure Ulcer Reduction and Restraint Elimination Attributes of Trusted Colleague T = Team Player R = Respectful and Responsive U = Understanding S = Safe T = Talented E = Executes D = Dedicated Excerpt from: ―Optimizing Work Environments‖; Brian Wong, MD; Georgia Patient Safety Summit Culture Change 06.2 Page 22 TEAMSTEPPS 05.2
- 23. Principles for Pressure Ulcer Reduction and Restraint Elimination Trust Trust is both an emotional and logical act. Trust helps you predict what other people will do Trust is certainty based on past experience Help begets help just as trust begets trust.1 Trust is the ability to act on what you see and trusting that you are trained to see what is right or wrong in a situation. Culture Change 06.2 Page 23 TEAMSTEPPS 05.2
- 24. Principles for Pressure Ulcer Reduction and Restraint Elimination Common Approaches That May Impact Trust Adversely Often used to manage conflict; however, typically do not result in the best outcome— Compromise—Both parties settle for less Avoidance—Issues are ignored or sidestepped Accommodation—Focus is on preserving relationships Dominance—Conflicts are managed through directives Culture Change 06.2 Page 24 TEAMSTEPPS 05.2 24
- 25. Principles for Pressure Ulcer Reduction and Restraint Elimination Collaboration Achieves a mutually satisfying solution resulting in the best outcome All Win! Patient Care Team (team members, the team, and the patient) Includes commitment to a common mission Meet goals without compromising relationships Creates Trust! “True collaboration is a process, not an event.” Culture Change 06.2 Page 25 TEAMSTEPPS 05.2 25
- 26. Principles for Pressure Ulcer Reduction and Restraint Elimination Mutual Support Tool Mutual support is the essence of teamwork Protects team members from work overload situations that may reduce effectiveness and increase the risk of error Team members foster a climate in which it is expected that assistance will be actively sought and offered as a method for reducing the occurrence of error. “In support of patient safety, it’s expected!” Culture Change 06.2 Page 26 TEAMSTEPPS 05.2
- 27. Principles for Pressure Ulcer Reduction and Restraint Elimination Enhancing Mutual Support Builds Team Trust and Improves Safety Foster an environment where you seek the support of others and offer assistance to team members Provide feedback to team members to improve performance Be assertive if safety is at risk Culture Change 06.2 Page 27 TEAMSTEPPS 05.2
- 28. Principles for Pressure Ulcer Reduction and Restraint Elimination Please Use CUS Words but only when appropriate! Culture Change 06.2 Page 28 TEAMSTEPPS 05.2 28
- 29. Principles for Pressure Ulcer Reduction and Restraint Elimination When is CUS appropriate? CUS is a signal phrase Other signal words Danger Warning Caution Used to draw attention to the magnitude of the issue. Not to be used casually Culture Change 06.2 Page 29 TEAMSTEPPS 05.2
- 30. Principles for Pressure Ulcer Reduction and Restraint Elimination Your turn to CUS Take a card Find the person with your same card but the opposite color Role play the situation using CUS Switch and role play again Culture Change 06.2 Page 30 TEAMSTEPPS 05.2
- 31. Principles for Pressure Ulcer Reduction and Restraint Elimination Communication Distractions Assumptions Stereotypes Fatigue Culture Change 06.2 Page 31 TEAMSTEPPS 05.2
- 32. Principles for Pressure Ulcer Reduction and Restraint Elimination Real World Communication Both the receiver and sender may have barriers that prevent effective communication including: Language barriers Distractions Physical proximity Stereotypes Personalities Assumptions Workload Fatigue Hierarchy Professional Standing………. Culture Change 06.2 Page 32 TEAMSTEPPS 05.2
- 33. Principles for Pressure Ulcer Reduction and Restraint Elimination Phrases that Signal Bad Communication Whatever you want to do is fine – Complacency/Apathy You need to run that up the chain of command, have you spoken to your supervisor? – Hierarchical You are just a CNA, get the nurse to call me –Professional Standing We always do it this way – Conventional Thinking We will get around to it later – Time/Fatigue/Workload Why do you ask? No one ever told me that –Defensiveness Culture Change 06.2 Page 33 TEAMSTEPPS 05.2
- 34. Principles for Pressure Ulcer Reduction and Restraint Elimination Overcoming Barriers to Communication Culture Change 06.2 Page 34 TEAMSTEPPS 05.2
- 35. Principles for Pressure Ulcer Reduction and Restraint Elimination Standards of Effective Communication Complete Communicate all relevant information Clear Convey information that is plainly understood Brief Communicate the information in a concise manner Timely Offer and request information in an appropriate timeframe Verify authenticity Validate or acknowledge information Culture Change 06.2 Page 35 TEAMSTEPPS 05.2 35
- 36. Principles for Pressure Ulcer Reduction and Restraint Elimination Communication Check List Get the person’s attention Make eye contact, face the person Use the person’s name Express concern Use the communication technique (e.g., SBAR) Verify that they understand the message Re-assert as necessary Decision reached or Escalate if necessary Culture Change 06.2 Page 36 TEAMSTEPPS 05.2
- 37. Principles for Pressure Ulcer Reduction and Restraint Elimination Structured Communications A framework for team members to effectively communicate information to one another Hand-Offs SBAR Closed Loop Communications Culture Change 06.2 Page 37 TEAMSTEPPS 05.2
- 38. Principles for Pressure Ulcer Reduction and Restraint Elimination Communicate in a structured way all the time and it will become common in the case of an emergency Culture Change 06.2 Page 38 TEAMSTEPPS 05.2
- 39. Principles for Pressure Ulcer Reduction and Restraint Elimination Handoff Relevant Information Responsibility– Accountability Reduce Uncertainty Verbal Structure Checklists Electronic Records Acknowledgement Great opportunity for quality and safety Culture Change 06.2 Page 39 TEAMSTEPPS 05.2
- 40. Principles for Pressure Ulcer Reduction and Restraint Elimination Handoff Point of danger ---AND--- Opportunity for error detection and recovery Great opportunity for quality and safety Culture Change 06.2 Page 40 TEAMSTEPPS 05.2
- 41. Principles for Pressure Ulcer Reduction and Restraint Elimination Effective Handoff Strategies Interactive communications Include up-to-date information Culture Change 06.2 Page 41 TEAMSTEPPS 05.2
- 42. Principles for Pressure Ulcer Reduction and Restraint Elimination Effective Handoff Strategies Limited Interruptions Verification Process Required Receiver has opportunity to review relevant data Culture Change 06.2 Page 42 TEAMSTEPPS 05.2
- 43. Building on Skills SBAR
- 44. Principles for Pressure Ulcer Reduction and Restraint Elimination Situation What is going on with the patient? State your name and unit I am calling about (patient name) Patient age Gender Mental status Patient stable/unstable Culture Change 06.2 Page 44 TEAMSTEPPS 05.2
- 45. Principles for Pressure Ulcer Reduction and Restraint Elimination Background What is the clinical background or context? Pertinent medical history Allergies Sensory Impairment/Disabilities Interpreter required Religion/culture Family location Culture Change 06.2 Page 45 TEAMSTEPPS 05.2
- 46. Principles for Pressure Ulcer Reduction and Restraint Elimination Assessment What do I think the problem is? Vitals Isolation required Skin Risk factors Issues I am concerned about Culture Change 06.2 Page 46 TEAMSTEPPS 05.2
- 47. Principles for Pressure Ulcer Reduction and Restraint Elimination Recommendation/Request What would I recommend? Specific care required immediately or soon Priority areas Pain control Culture Change 06.2 Page 47 TEAMSTEPPS 05.2
- 48. Principles for Pressure Ulcer Reduction and Restraint Elimination SBAR Exercise Form groups of 4-5 people Culture Change 06.2 Page 48 TEAMSTEPPS 05.2
- 49. Principles for Pressure Ulcer Reduction and Restraint Elimination Scenario #1 Culture Change 06.2 Page 49 TEAMSTEPPS 05.2
- 50. Principles for Pressure Ulcer Reduction and Restraint Elimination Scenario #2 Culture Change 06.2 Page 50 TEAMSTEPPS 05.2
- 51. Principles for Pressure Ulcer Reduction and Restraint Elimination Scenario #3 Culture Change 06.2 Page 51 TEAMSTEPPS 05.2
- 52. Principles for Pressure Ulcer Reduction and Restraint Elimination Debrief the Exercise Was it easy for you to organize the information you were given into the SBAR? This question is for the listeners: How clear did the information seem to you? Did it seem that you were missing out on any of the information you needed to proceed? Did it prompt you to action? Culture Change 06.2 Page 52 TEAMSTEPPS 05.2
- 53. Principles for Pressure Ulcer Reduction and Restraint Elimination Was there anything missing? Culture Change 06.2 Page 53 TEAMSTEPPS 05.2
- 54. Principles for Pressure Ulcer Reduction and Restraint Elimination Check-Back is… Culture Change 06.2 Page 54 TEAMSTEPPS 05.2 54
- 55. Principles for Pressure Ulcer Reduction and Restraint Elimination In Summary Recognize that mistrust and poor communication are contributors to medical errors and increase staff and resident dissatisfaction Learn how to increase trust, mutual support and communication among your team Practice techniques that support a ―safety culture‖ Culture Change 06.2 Page 55 TEAMSTEPPS 05.2
- 56. Principles for Pressure Ulcer Reduction and Restraint Elimination The Challenge Pick one tool Pick one unit or neighborhood in your facility Pick one shift Find one champion for change Teach the staff how to use the tool Commit together to implement that one tool for one month Evaluate for effectiveness at the end of the month and adjust if needed. Culture Change 06.2 Page 56 TEAMSTEPPS 05.2
- 57. Thanks for Coming Please complete your evaluation see you in the Fall if not before
Editor's Notes
- In review of the data, let’s look first at how we are doing in regards to Low Risk Pressure Ulcers as compared to the national rate and you can see that Georgia is doing better but has been edging back up from a low of 1.5% in Q1 2008 to about 1.6% in Q3 2008.
- We are in Region ___________________ represented by the _________ line. The State average and the National Average are the dashed and dotted lines respectively and your region is doing ____________________ but by no means is the process in control. Next, let’s look at High Risk Pressure Ulcers ---Change Slides
- Georgia is above the national average in High Risk Pressure Ulcers but the gap has narrowed significantly since about Q4-2007. The last 2 quarters show a leveling out while the national rate continues to decline, a run started in Q1-2008. For Georgia, Q3- 2008 the rate was 12.2%.Next, let’s look at the regions – change slides here
- You are in region _______________________ and the state and national rates are dashed and dotted respectively. Your region is ________________________ the state average.Next, we can look at restraints --- Change Slide Here
- Now, this is a great trend dropping from 7.5% to 4.4% in 11 quarters. On top of that, the trend line is declining faster for Georgia than for the national restraint numbers. If you keep up the good work, you will dip under the national level within 2 years. What do the regional graphs look like? Change the slide here.
- Again, you are in region _______________________ and the state and national rates are dashed and dotted respectively. Your region is ________________________ the state average.Next, we can look at Post Acute Care Pressure Ulcers--- Change Slide Here
- Georgia has narrowed the gap between the national rate and the state rate here again and quarter after quarter, you have been working hard to improve. The national average is under 15% now and the Georgia average is very close to that however what if that 15 % included your mother or grandmother, would it still be too high then? Change Slides Here
- Again, you are in region _______________________ and the state and national rates are dashed and dotted respectively. Your region is ________________________ the state average.Overall Georgia is improving but there is still opportunities to do better. Are there any questions or comments on the data before we move on. Use parking lot here if unrelated and be sure to explain parking lot concept.Next, for those of you that were here in the Fall that remembers the video we played at the end of the presentation, -- Change Slides Here
- Recognize that mistrust and poor communication are contributors to medical errors and increase staff and resident dissatisfactionLearn how to increase trust, mutual support and communication among your teamPractice techniques that support a “safety culture” by:Improving understanding in communications.Improving respect and trust among team members.
- This is that tipping point that we all encounter. We sometimes feel that we are forced to make a choice between:Quitting because we can’t take it anymore and we start to believe we cannot make a differenceCommitting to make it betterIgnore it and hope it goes away– or at least try to until we give into 1 or 2
- Say:So, to summarize, a Trusted Co-worker, colleague or friend is Always a team player Respectful and responsive, that means timely or the opposite of a procrastinator Understanding, an empathize with what you are going through Safe—Not prone to overreact or judge you with extreme prejudice, you can share with confidence that it will “go no further” – not prone to gossip Talented– skilled in facilitating collaboration and agreement Executes– When given something to do, you can be sure it will be done and done well. Dedicated – Another word for this is faithful
- 1. The Leadership Challenge – Kouzes and Posner p. 268 “ If we could offer one bit of advice on how to start the process of creating a climate of trust it would be this: be the first to trust. Building trust is a process that begins when one party is willing to risk being the first to open up, being the first to show vulnerability, and being the first to let go of control” 2. Blink, Malcolm Gladwell– p.119-”Trust means allowing people to operate without having to explain themselves constantly enables rapid cognition.” Collaboration is the key to trust
- We are building on the concept of trust and collaboration to move into the next set of tools, Mutual Support.Balancing the workload requires trust, Trust that you can give responsibilities to others, and they can handle it without being overwhelmed and trust that there will be no compromise in care or safety.
- But have you ever had a problem getting the support you need when you need it? How many times in your home life, with your kids or at work do you or people you work with seek out assistance and don’t seem to get it.Have you asked yourself “do they just not hear me or do they just not care?”How do you take your passion or “Righteous indignation” and make it contagious, drawing others into your cause?We are about to work on a tool for that. Many of you may have seen before if you came to the 2008 Fall Council meetings.
- Please Use CUS Words but only when appropriate!We are now going to watch a video clip of the CUS tool in action.DO: Play the video by clicking the director icon on theslide.DISCUSSION:• How was the “challenge” presented?– In the form of a statement, “I am concerned …” and thenfollowed up with additional patient vitals.– The nurse was uncomfortable with the late decelerations– She became concerned and uncomfortable that thepatient’s safety may be at riskAnother way:Some healthcare providers are spelling Cus with two U’s I’m Concerned…I’m Uncomfortable...This is Unsafe...I’m Scared..
- Have an idea of how many in the group there are (i.e. if 30, have them count off 1-15 twice) then have them pair up in twos. Can be done with playing cards eg. If you have 2-26 people use half the deck 13 red and 13 black. Hand them out randomly and have them find the other opposite colored matching card. Just be sure you do not have cards that do not match. The facilitator can set this up in advance.Pairs are given a situation to CUS one to anotherPairs will practice as the cus-er and swap to be the cus-eeDebrief- Did it seem the point of the problem was grasped the first time? How about the second time, did the cus-ee feel like their attention was more drawn to the cus-er? Are there times you could have used this at work or at home in the last few months?Situations do not need to be detailed: Notice bald tires on family car Notice a display of can goods at the grocery store that seems a little unbalanced for your 4 year old to be near it and you want to tell the manager One of your residents seems to be in pain and is not sitting still in her wheelchair You notice a frayed wire on a lamp in a new resident’s room You notice that the pills you remember giving Mrs. Jones was a different color than the ones you just received from the pharmacy You notice that every time Mrs. Smith’s daughter is visiting, Mrs. Smith’s bed is all the way up when your policy is to minimize restraints and all beds are to be lowered to minimize the injury if a resident falls, you need to talk to Mrs. Smith’s daughter. You notice the Mr. Albert is in bed with a wet sheet that extends up his back, he is very overweight and you need to change his sheets but you need someone’s assistance if you do not want to hurt yourself. It is shift change and you are the CNA assigned to Mr. Beckle. He is acting differently from the last time you had his assignment and you are not sure this is normal. Your 15 year old has just gotten her learner’s permit and you are driving down a disserted road a little out of control
- Some things to consider when communicating:• The audience—How might your interaction with a lab technician be different from that with a physician?• The mode of communication—Verbal, non-verbal, written, email• Standards associated with the specific mode of communication (e.g., use of "do not use" abbreviation as prescribed by JCAHO) – Non-verbal communication requires verbal clarification to avoid making assumptions that can lead to error. The simple rule is, "When in doubt, check it out, offer information or ask a question.“• The power of non-verbal communication—The way you make eye contact and the way you hold your body during a conversation are signals that can be picked up by the person with whom you are communicating, although powerful, nonverbal communication does not provide an acceptable mode to verify or validate (acknowledge) information.
- ASK:• What are some barriers to communication that can lessen theeffectiveness of teams?SAY:Challenges may include:• Language barriers—Non-English speaking patients/staff poseparticular challenges• Distractions—Emergencies can take your attention away fromthe current task at hand• Physical proximity• Personalities—Sometimes it is difficult to communicate withparticular individuals• Workload—During heavy workload times, all of the necessarydetails may not be communicated, or they may becommunicated but not verified• Varying communication styles—Healthcare workers havehistorically been trained with different communication styles• Conflict—Disagreements may disrupt the flow of informationbetween communicating individuals• Verification of information—Verify and acknowledge informationexchanged• Shift change—Transitions in care are the most significant timewhen communication breakdowns occur
- Whatever you want to do is fine – Complacency/Apathy You need to run that up the chain of command, have you spoken to your supervisor? – Hierarchical You are just a CNA,get the nurse to call me –Professional Standing We always do it this way – Conventional Thinking We will get around to it later – Time/Fatigue/Workload Why do you ask? No one ever told me that –DefensivenessCan you think of any other signals? How about at home? With your teenagers?
- What causes medical errors? The Joint Commission, which accredits the majority of hospitals in this country and some nursing homes and other facilities, analyzes the root causes of sentinel or critical events. Miscommunication is the most common cause of patient injury or death. Some forms of Structured Communications that address one of the most problematic areas is handoffs and how SBAR applies along with Closed Loop Communications to assure that the message was received.
- HANDOFF CommunicationSAY:Key Forces Driving Handoff ChangesPatient HarmJCAHO timelineOpportunity to design handoffs based on quality and safety principlesSAY:JCAHO NPSG 2E requires facilities to implement a standardized approach to handoff communications, including an opportunity to ask and respond to questions. The rationale is stated by the Joint Commission: “The primary objective of a handoff is to provide accurate information about a patient's/client's/resident's care, treatment and services, current condition, and any recent or anticipated changes. The information communicated during a handoff must be accurate to meet patient safety goals.”A proper handoff includes the components listed on this slide.• Responsibility—When handing off, it is your responsibility to know that the person who must accept responsibility is aware of assuming responsibility.• Accountability—You are accountable until both parties are aware of the transfer of responsibility.• Uncertainty—When uncertainty exists, it is your responsibility to clear up all ambiguity of responsibility before the transfer is completed.• Communicate verbally—You cannot assume that the person obtaining responsibility will read or understand written or nonverbal communications.• Acknowledged—Until it is acknowledged that the handoff is understood and accepted, you cannot relinquish your responsibility.• Opportunity—Handoffs are a good time to review and have a new pair of eyes evaluate the situation for both safety and quality.
- Say:Interactive communications: questions between giver and receiver of informationInclude up-to-date information regarding care, treatment, services, condition, recent or anticipated changesSome observed handoff strategies used to enhance effectiveness includeFace-to-face verbal updates with interactive questioningLimiting any interruptions during update
- Say:Interruptions limited (to prevent information loss) and sufficient time allocated for handoff process Require verification process: repeat-back or read-back as appropriateReceiver has opportunity to review relevant historical data, including previous care, treatment, servicesIn Summary, the best most effective observed handoff strategies include:Face-to-face verbal updates with interactive questioningLimiting any interruptions during updateAdditional updated information from teammates (other than one beingreplaced)Topics initiated by oncoming as well as outgoingLimit initiation of operator actions during update (wait until after handoff)“Check-back” to ensure that information was accurately receivedInclude outgoing team’s stance/opinion toward (oncoming’s) changes to plans and contingency plans
- SBAR (Pronounced S-Bar) is a formalized method of communicating with other healthcare practitioners that is sweeping the country. Its use is spreading within hospitals, and may soon become so commonplace that it will be recognized as close to, if not a standard of care. SBAR was developed by Kaiser Permanente of Colorado, and has been increasingly adopted by hospitals through the United States. SBAR is used to report to a healthcare provider a situation that requires immediate action, to define the elements of a hand off of a patient from one caregiver to another, such as during transfers from one unit to another or during shift report, and in quality improvement reports. Liability issues may surround the communication that occurred in any clinical situation, but particularly when unexpected changes in a patient’s condition occur. It is often difficult to determine what the healthcare prescriber (physician, physician assistant, nurse practitioner) was told. An inexperienced or fatigued nurse may omit specific important information. One of the goals of SBAR is to provide a structure for such communication. The elements of SBAR are explained below and applied to contacting a prescriber.http://www.medleague.com/Articles/medical_errors/sbar.htm
- CHECK-BACK IS… CommunicationSAY:A check-back is a closed-loop communication strategy used to verify and validate information exchanged. The strategy involves the sender initiating a message, the receiver accepting the message and confirming what was communicated, and the sender verifying that the message was received.Typically, information is called out anticipating a response on any order which must be checked back.Example:• Information call-out “BP is falling, 80/48 down from 90/60.” The sender expects the information to be verified and validated and to receive a follow-on order that must be acknowledged with a check-back.DO: Play the video by clicking on the top director icon on theslide.DISCUSSION:• Identify the sender and receiver?– Pharmacist was the sender– Resident was the receiver• How did the sender and receiver “close the loop?”– The doctor says “Correct”.• What communication errors were avoided?– Pharmacist did not rely on memory to give correct dosing information– Resident wrote the exact dosing instructions to avoid dependence on memory and was able to check-back using notes since the dosing was more complicated by dilution – Similar sounding drugs errors as well as dosing units of measure errors are avoided using this tool
- Give a quick rundown of what they were taught todayRemind them of Sue Sheridan's experience and challengeIf time, ask them to share any experiences with any of these tools or tools that were presented in the Fall of 2008.Let them know, they can make a differencePrepare them for the challenge on the next slide.