Download Implementing a change in Handover utilising an ISBAR

Title
of1 the
Change
Project
Implementing
a change
in Handover
utilising an ISBAR
Header
line
Sheet
Header Communication
line 2
Student
ID. and Accountability Tool
Geoghegan, RCSI Institute of Leadership
Header line MSc
3 James
in Healthcare Management,
Institute of Leadership, Royal College of Surgeons in Ireland
Abstract
As patients move from nurse to nurse it is critical that timely, accurate information about the patient’s care plan,
treatment and any recent or anticipated changes goes with them. Therefore accurate communication during nursing
handover is a key element in the safety and quality of patient care. This nursing handover takes place in all
healthcare facilities where patient care is transferred between healthcare professionals, in both structured and semistructured events in active and busy environmental settings. There have been a large number of reviews which have
reported adverse events to patients, noting that communication was the root cause of 65 to 70% of these incidents.
A number of communication barriers were identified which included a lack of structure, policies and procedures
related to the content and timing of the report, no shared model or framework for verbal healthcare communication,
differing opinions among nurses to what information should be communicated during the handover, frequent
interruptions and distractions.
Utilising a standardised approach to handover would aid in promoting clarity of purpose and the content of the
handover, which by extension would improve the continuity of care, reduce errors and potential harm to the patient.
There are various communication tools as a basis for a structured handover.
The ward developed such a communication sheet based on the ISBAR (Identify, Situation, Background, Assessment,
Recommendation with an accountability tool.
The HSE’s Directorate of Quality and Safety ‘Quality and Performance Improvement Tool’ was used to evaluate the
change. Theme Two (Standard Two) – Effective Care and Support (Care is planned and delivered to meet the
individual service user’s initial and ongoing assessed healthcare needs). The finding showed that to date the project
has completed two of the four performance levels. The findings noted assessment of need is undertaken and
identified on nursing handover, information provided by service user and inputs from other healthcare professionals.
Care and treatment decisions are discussed with the patient and are in accordance with agreed Handover Protocols.
There are arrangements in place to identify and respond rapidly to clinical deterioration through the implementation
of the National Early Warning.
To ensure sustainability of the project ongoing evaluation of the handover through the Quality and Performance
Improvement tool process will have to be undertaken until it reaches performance level four.
Implementing a change in Handover utilising an ISBAR
Communication Sheet and Accountability Tool
James Geoghegan, RCSI Institute of Leadership
Introduction & Background
Methodology
• Handovers have been defined as
“The transfer 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” 1.
The HSE Model was used, as It
would ensure that staff were able to
engage in working together to
improve the service and promote a
consistent approach to the change
in handover planned (2008).
Figure 2: HSE Change Model 2
• There has been a move in the
literature towards standardising
handover, which has been shown
to improve consistency and
reliability of outcomes.
• The Change project was set on a
medical ward in a Level Four
hospital, with a current system of
office based handovers.
Initiation:
•
Aims & Objectives
The requirement for the change
was acknowledged. Key
stakeholders were identified.
The Aim of the Change Project
Planning:
• To provide a structured approach
to handover on the ward by
implementing an end of bed
handover, with a prepared ISBAR
communication
sheet
and
accountability tool.
•
The Objectives of the Change
Project
• Develop a Standardised Guideline
for Handover between nursing
staff.
• Develop
a
standardised
communication sheet using the
HSE’s ISBAR tool with a new
accountability sign off sheet.
Pt
N
a
m
e
Co
ns
ult
ant
Situation
Presenting
symptoms
Backgro
und
Assessment/
Recommendation
Relevant
history
Plan of
care/Problem
Agreed Action
Focus on the organisation wide
commitment, momentum and
capacity for change.
Implementation:
•
Lewin’s (1951)3 Three stage
model of change used to assist
staff adapting and embracing the
new change to the handover.
Mainstreaming:
•
Figure 1. ISBAR communication sheet.
Identify
Figure 3. Quality and Performance
Improvement Tool
Support and ongoing evaluation
is required to ensure that the
changes are embedded to the
everyday activity of the ward.
Evaluation
Quality
and
Performance
Improvement Tool, (2012), Theme 2
used for evaluation (Fig, 2).
•
•
Focus Groups utilised to assess
the staff nurses perception of the
change in handover practice
Audits of Handover and accurate
use of accountability tool.
Level Of
Quality
Guiding Prompts
Emerging
Improvement
Level One
Assessments reflect patients’
initial and ongoing assessed
needs and
agreed outcome goals.
Continuous
Improvement
Level Two
Audit results inform training
programmes and
improvement plans.
Sustained
Improvement
Level Three
Consistent achievement of
outcome goals is
demonstrated.
Excellence
Level Four
Learning from national and
international investigations
and reports
informs improvements
Select
Organisational Impact
The ward has incorporated the end
of bed handover utilising the ISBAR
sheet and accountability tool. This
project can be used on all hospital
wards with adequate training.
Conclusion
The project has provided a
standardised approach to undertake
handover on the ward. Staff have
embraced the change. Ongoing
audits and evaluation using the
Quality and Performance
Improvement are required to ensure
sustainability. Future projects should
consider increased IT resources to
expand the handover hospital wide.
References
1. British Medical Association. Safe handover: Safe patients
Guidance on clinical handover for clinicians and managers.
London, United Kingdom; BMA House; 2004.
2. Health Service Executive. Improving our services- A User’s
Guide to Managing Change in the Health Service Executive.
Dublin:HSE; 2008.
3. Lewin, K. Field theory in Social Science. New York, USA:
Harper and Row; 1951.