Communication Handover - Copy (1) PDF

Introduction to Communication Applications in Practice - Clinical Handovers - Introduction to Psychology and Communication NMHS10490 Dr John P. Gilmore He/They Assistant Professor in Nursing Learning Outcomes RECAP So...

Introduction to Communication Applications in Practice - Clinical Handovers - Introduction to Psychology and Communication NMHS10490 Dr John P. Gilmore He/They Assistant Professor in Nursing Learning Outcomes RECAP So far we have covered Learning objectives Keywords Definitions of communication Modes of communication Standards Principles of good verbal communication Considerations in Paraverbal and non-verbal communication Considerations for written and visual communication Learning Outcomes Today’s session By the end Learning of this session you will: objectives Keywords o Implement a standardised approach to communicating for clinical handover and critical information Standards o Appraise the usefulness of standardised approaches to communication in the clinical environment Learning Outcomes Who do we communicate with? Learning objectives Keywords Standards Learning Outcomes How do we structure communication in the clinical environment ? Learning objectives Keywords Handovers transfer Standards of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another person or professional group on a temporary or permanent basis. HSE 2017  Learning Outcomes When might we ‘handover’ care? Learning objectives Keywords End of shift handover of caseload Temporary handover of care of individual patient (procedure) Standards Transfer of individual patient to another area Communication to other team members Delegation of tasks to team members Escalation of care to another practitioner Learning Outcomes What kind of communication model might we use? Learning objectives Keywords Standards Learning Outcomes Learning objectives Keywords White Boards Asynchronous Synchronous Multidisciplinary Meeting Referral Ward Round (Written) Standards Handover Patient Notes Referral (Verbal) Recorded Impromptu Handovers Conversations Learning Outcomes For Synchronous Handovers: Learning objectives Keywords 1. conducted face to face where possible, 2. conducted verbally, 3. supported with relevant, accurate, up-to- Standardsdate documentation 4. facilitate two-way communication processes HSE, 2017 Learning Outcomes Considerations for Synchronous Handovers: Learning objectives Keywords 1. Patient safety 2. Confidentiality 3. Task prioritisation 4. Physical Space Standards 5. Mode of communication 6. Protected time from introduction  Learning Outcomes Potential reputational impacts of unstructured communication Learning objectives Keywords Physicians frustrations with nurse communication Nurses frustrations with physician communications Nurses’ disorganisation with information Physicians seemed inattentive Nurses’ illogical flow of content Physicians seemed unwilling to discuss goals of care Nurses’ lack of preparation to answer questions Nurses felt they could only discuss a list of signs and Standards symptoms instead of stating the problem Nurses’ inclusion of extraneous or irrelevant Nurses wanted to give a recommendation but lacked information authority Nurses’ delay in getting to the point Nurses felt a hierarchy or difference in power Physicians wanted know the nurse’s overall impression Nurses were unsure how much or how little detail to provide Nurses had different communication styles Nurses lacked confidence and experience Nurses did not see new orders Nurses lacked a structure and standardization Foronda et al. 2016 Physicians wanted to hear relevant data Nurses feared being incorrect or humiliated Learning Outcomes Potential Adverse outcomes of poor/unstructured communication Learning objectives Keywords Up to 80% of serious, preventable adverse events Standards are related to mis/poor communication between healthcare professionals Petersen et al 2013 HIQA, 2013 Learning Outcomes I Introduction Learning objectives Keywords S Situation B Background Standards A Assessment The SBAR tool originated from the US Navy and was adapted for use in healthcare by Dr M Leonard R Recommendation and colleagues from Kaiser Permanente, Colorado, USA. Learning Outcomes Benefits of structured communication Focused Learning objectives Communication Keywords Improved Patient Outcomes Reduced Near Miss/Adverse Incidents Reduced Repetition Improved Patient Satisfaction Rates Enhanced Safety and Effectiveness in the Delivery of Care Standards Improved Quality of Information Disseminated Reduced Length of time for communication Subsequent Increase in the Amount of Time available to provide Care Directly to Patients HSE 2017 Learning Outcomes Challenges in structured communication Summarising Learning objectives Keywords a complex case or need might be difficult – especially for more junior practitioners There may be a need to repeat information – the recipient may interrupt or make assumptions about the sender Standards Recommendations aren’t always taken on board by the recipient ISBAR is a brief communication tool but doesn’t negate the need for more comprehensive documentation – may be seen as duplication Burgess et al 2020 Learning Outcomes Learning objectives Keywords Introduction State who you are Standards Confirm who you are speaking to I Confirm who you are speaking about Learning Outcomes Learning objectives Keywords Situation S Standards A brief (one line) summation of why you are handing over this patient – what’s the overall issue Learning Outcomes Learning objectives Keywords Background B Standards A brief summary of why the patient is in Baseline condition prior to the call Learning Outcomes Learning objectives Keywords Assessment Give a summation of your clinical A Standards assessment with relevant parameters Maybe useful to give your nursing/midwifery diagnosis * Remember these will be discipline and event specific Learning Outcomes Learning objectives Recommendation Keywords What do you want the recipient to do Standards R *May be useful to gain clinical guidance but be cautious with verbal orders Learning Outcomes For clinical handovers Learning objectives Keywords Recommendation Read Back R Standards 3 Risks Learning Outcomes Example Learning objectives Keywords Hi it’s John here in ward one, I want you to come to review a patient I The patient seems to be deteriorating, he has just gone down a lot since I came onto shift S Standards The man came in for bowel surgery, his obs were fine earlier but when I did them they had B changed He’s gone off a bit, his SaO2 is ok actually, his resps are a bit high at 22, his Blood pressure is A 130/75mmHg, his heart rate is 95. He looks a bit pale I think Could you come to review the patient soon please R Learning Outcomes Example Learning objectives Keywords Hi it’s John here a staff nurse on ward 1, can I just check that I’m speaking to ICU Outreach I Nurse on call? Thanks I’m calling about one of the post operative patients, Mr Smith in bed 18. In the last hour Mr Smith seems to have deteriorated and I would like you to come to review S him as his iNEWS2 score is elevated to 5 Standards Mr Smith is a 70 year old man, day 2 post his bowel resection. He had been progressing well B with very little pain. His drain was draining minimally. His NEWS score was 0 this morning and he was in good form. Mr Smith’s INEWS2 is now 5, he has some new confusion, his respiratory rate is eleveated A and his heart rate is elevated at 95 with a bounding pulse. His blood pressure and oxygen are within normal parameters but he has some new confusion, he doesn’t know where he is. He is looking pale and he has abdominal pain. I’m worried Mr Smith may have some bleeding or infection could you please come to see R him as soon as possible. Is there anything I can do while I wait for you to review Learning Outcomes Some tips for handovers Learning Write out your objectives handover briefly (be mindful to comply Keywords with GDPR Guidelines) Be succinct Be mindful Standards of professional language and jargon Prioritise the most important information Be mindful to link your Background and Assessment to your Recommendation PRACTICE Learning Outcomes In summary Structured Learning communication objectives in clinical practice Keywords Saves time Improves patient safety Improves clinical outcomes Standards Improves patient satisfaction Improves professional collaboration References Burgess, A., van Diggele, C., Roberts, C., & Mellis, C. (2020). Teaching clinical handover with ISBAR. BMC medical education, 20(Suppl 2), 459. Foronda, C., MacWilliams, B., & McArthur, E. (2016). Interprofessional communication in healthcare: An integrative review. Nurse education in practice, 19, 36–40 HIQA (2013) Patient Safety Investigation Report into Services at University Hospital Galway (UHG) HIQA, Dublin, Ireland. HSE (2017) Resource Manual & Facilitator Guide For Clinical Handover: An Inter- disciplinary Education Programme Petersen, Mary A. MS, RN; Blackmer, Michelle MSN, RN, FNP-BC; McNeal, Joanne PhD, RN, ACNS-BC; Hill, Pamela D. PhD, RN, FAAN What makes handover communication effective?, Nursing Management (Springhouse): January 2013 - Volume 44 - Issue 1 - p 15- 18