Download Patient Hand Off Tool Kit

Patient Hand Off Tool Kit
SBAR-Situation Background Assessment Recommendations
Public Information Educational Resource Committee
Problem
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An estimated 80 percent of serious
medical errors involve
miscommunication between caregivers
when patients are transferred or
handed-off.
http://www.centerfortransforminghealthcare.org/assets/4/6/CTH_HOC_Fact_Sheet.pdf
Universal Process across disciplines
SBAR is an evidenced-based communication
model developed in the military and is
widely used in many industries including
aviation and health care to make sure:
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the right information gets to
the right people in
the shortest timeframe
SBARSituation Background Assessment Recommendations
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These guidelines outline the priority
information that needs to be relayed during
patient care handoff to the receiving
healthcare provider so that critical
information is not missed.
SBAR-
Situation Background Assessment Recommendations
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This format emphasizes urgent concerns be
brought to the forefront –Patients who meet
Point of Entry protocols –should have
complaint stated first
Empowers the EMS provider to advocate for
the patient
SBAR-
Situation Background Assessment Recommendations
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These guidelines are to be used in a
flexible way that meets the needs of the
situation encountered
Region IV EMS Communication
Policy is based on SBAR
Situation:
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ETA
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Urgent Concerns/ Point of entry pts
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Age
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Sex
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Chief Complaint:
Background: (history of present illness) High Risk medications
Assessment:
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General impressions
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Pertinent findings
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Vital signs
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Pain level
Recommendations/Recap
 Treatment provided
 Response to treatment and interventions
 Recap
Massachusetts EMS Region IV
Communications Policy
Entry Notes
Hail Metro-Boston CMED on MED 4
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CMED name x 2
Service, call sign, current level of ambulance
Reason for request (Priority Level, Medical Control, ALS entry
note, BLS entry note, declaration of disaster, radio test)
Physical Location
•For Example: “Metro-Boston-CMED, Metro-BostonCMED. This is Bedford A-2 requesting a priority one
BLS entry note to the Lahey from Route 62 in Bedford”
Massachusetts EMS Region IV
Communications Policy
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Await channel assignment from MetroBoston CMED (ie “Shift and
acknowledge MED 3”)
Once a channel has been assigned,
shift to that channel and acknowledge
CMED standing by. (ie “Metro-Boston
CMED, Bedford A-2 standing by on
MED 3”).
Massachusetts EMS Region IV
Communications Policy
Metro-Boston CMED will advise unit that the
requested hospital(s) are on-line and for
them to proceed with their transmission.
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Make the entry note as clear, concise, and short as
possible
Rule of thumb, no more than two minutes
Immediately request notification of Stroke, Cardiac,
Trauma team, or other specialty services
(language, vent required, etc..) if appropriate
(following Point of Entry Protocols (POE)
When reporting a patient’s condition, the radio
report should include the following - SBAR
Format
Massachusetts EMS Region IV
Communications Policy
When provider has completed entry note:
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Provider should acknowledge hospital(s)
Inform Metro-Boston CMED you are leaving
the assigned MED channel and returning to
MED 4
Relinquish the assigned MED channel to
CMED on MED 4
Transmit Call sign and time clearing
assigned channel
How SBAR works….
S
State agency name and unit #
Point of Entry* or High Risk pt*ETA- age and sex of the pt
Urgent concerns and immediate needs upfront
B
Mechanism of Injuries sustained/LOC/or Onset of illness
Include complicated medical hx and or High Risk medications
A
Vital Signs – and pertinent findings
R
Treatment and patient response
Recap
Request any further instructions
Point of Entry- Trauma Adult/Pedi, Stroke, STEMI, Sepsis
High Risk Meds – anticoagulants (Coumadin,Plavix,Aspirin ect)
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Let’s practice!
EMS Scenario (Example 1)
You have responded to a home for a report
of elderly female unwitnessed fall.
An 88 year old female is found on the floor, awakeFamily states heard “thud” found pt on floor –report
no LOC,
Pt complaining of left hip and shoulder pain.
EMS Scenario (Example 1)
Left lower extremity is rotated outward, has a
positive pedal pulse, warm to the touch-pink in
color
Left shoulder without obvious deformity, Color
Sensation normal, states-“hurts to move my left
arm”
Past Medical History: osteo arthritis
CVA, a-fib
Medications: Coumadin, Digoxin
EMS Scenario (Example 1)
Pt was placed in a cervical collar-log rolled onto
back board and pillows to support LLE
Secured on backboard- ice to shoulder
Pt states uncomfortable on the board, but the ice
helps
Vital Signs: B/P-172/88 HR-58(irr) Resp-18
SBAR Report…..
(assume you have Hailed
CMed - and patched into
receiving facility…you
have identified your unit
#... Proceed
Entry Note
(should take no more than 2 minutes-following the region IV policy)
Situation:
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ETA – 17 min
Urgent Concerns/ Point of entry pts : Elderly Trauma
 Age - 88
 Sex – female
 Chief Complaint: Fall with left hip and shoulder pain
Background: (history of present illness-)
 Unwitnessed fall, Found on floor- left leg and
shoulder pain, family reports no LOC, pt is on
Coumadin for A fib and Stroke
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Entry Note
(should take no more than 2 minutes-following the region IV policy)
Assessment:*
 General impressions: Elderly conscious female
 Pertinent findings: Alert- left leg rotated outward-+
pulses, left shoulder pain-no obvious deformity
 Vital signs: B/P-172/88 HR-58(irr) Resp-18
 Pain level: Rates pain 5/10
Recommendations/Recap*
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Treatment provided - C-spine immobilized, ice to shoulder,
immobilized LLE
Response to treatment and interventions – pain improved with
immobilization and ice
Recommendations – Will update with any changes-any questions?
Emergency Department
Arrival “Hand Off”
Situation:
 Urgent Concerns/Point of entry pts : Elderly Trauma
 Age - 88
 Sex - female
 Chief Complaint: Fall with left hip and shoulder pain
Background: (history of present illness-detailed history)
 Unwitnessed fall, Found on floor- left leg and shoulder
pain, family reports no LOC, pt is on Coumadin and
Digoxin for A fib and Stroke
 States tripped and fell-alert to baseline per family
Emergency Department
Arrival “Hand Off”
Assessment:*
 General impressions: Pleasant elderly female
 Pertinent findings: Alert- left leg rotated outwardleft shoulder pain no deformity, warm pink
and pulses in both extremities- No c/o neck or
back pain Vital signs: B/P-172/88 HR-58(irr) Resp-18
 Pain level: Rates pain 5/10
Emergency Department
Arrival “Hand Off”
Recommendations/Recap:*
 Treatment provided - C-spine immobilized,
ice to shoulder, immobilized LLE
 Response to treatment and interventions –
pain improved with immobilization and ice
–pt states she in uncomfortable on the
backboard
 Recap- no changes enroute
SBAR- Interfacility Transfer
Expectations for “Hand Off” from :
Acute Care Facility
Rehabilitation Facilities
Skilled Nursing Facility or
Community Health Center
SBAR-
Situation Background Assessment Recommendations
Situation:
 Urgent Concerns
 Age
 Sex
 Chief Complaint
Background: History of present illness –
 Include Resuscitation Status (MOLST -Medical
Orders for Life Sustaining Treatment)
http://www.molst-ma.org/ Comfort Care DNR
SBAR-
Situation Background Assessment Recommendations
Assessment:
 General impressions
 Pertinent findings
 Vital signs
 Pain level
Recommendations/Recap:
 Treatment provided
 Response to treatment and interventions
 Recap
Scenario Example #2
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You are called to a Skilled Nursing Facility- you
receive the following report from the staff:
Mr. Jones is an 76 male- transferred 1 week ago
from XYZ hospital s/p left knee replacement. For
the past few days he has become increasing
more fatigued and agitated
He is not eating well and has intermittent fevers
SBAR- Interfacility Transfer
Situation:
 Urgent Concerns –change on mental
status
 Age- 76
 Sex - male
 Chief Complaint :fever change in mental
status
SBAR- Interfacility Transfer
Background:
History of present illness –
 2 weeks s/p left knee replacement-2
days hx of intermittent fevers- 99.5102.3
 today lethargic, confused and agitatedgenerally alert and oriented todaysleeping not eating, agitated
SBAR- Interfacility Transfer
Assessment:
 General impressions: lethargic, warm to
the touch-combative with stimulation
 Pertinent findings-temp 102.3, decreased
urine output, tachypnic
 Vital signs – HR 102, B/P 112/60, R-28
Temp 102.3
 Pain level- 5/10 flank pain
SBAR- Interfacility Transfer
Recommendations/Recap:
 Treatment provided-acetaminophen and
called EMS
 Response to treatment and interventionsno change at this time
 Recap – 76 m, altered mental statusconfused-agitated, 2 week s/p left knee
replacement - fever no response to
acetaminophen
SBAR- Interfacility Transfer
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EMS transports to closest appropriate
emergency department
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Let’s practice!
SBAR- Interfacility Transfer Entry Note
(should take no more than 2 minutes-following the region IV policy)
Situation:
 ETA – 20 min
 Urgent Concerns/ Point of entry pts : n/a
 Age - 76
 Sex – male
 Chief Complaint: fever- change in mental
status
SBAR- Interfacility Transfer
Background: (history of present illness-)
 2 weeks s/p left knee replacement –
 2 days hx of intermittent fevers- 99.5102.3 today lethargic, confused and
agitated- generally alert and oriented
today-sleeping not eating, agitated
SBAR- Interfacility Transfer
Assessment:*
 General impressions: Ashen in color-lethargic,
warm to the touch-combative with stimulation Pertinent findings: increased agitation with
bilateral flank palpation, l knee wound site dry
and intact, patient incontinent with foul urine Vital signs: HR 102, B/P 112/60, R-28 Temp
102.3
 Pain level: 5/10 flank pain
SBAR- Interfacility Transfer
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Recommendations/Recap*
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Treatment provided – 2L Oxygen via nasal cannula ,
position of comfort
Response to treatment and interventions – no changes
Recommendations – Will update with
any changes-any questions?
Emergency Department
“Hand Off”
Situation:
 Urgent Concerns/Point of entry pts :
 Age - 76
 Sex - male
 Chief Complaint: fever- change in mental
status
Emergency Department
“Hand Off”
Background: (history of present illness-)
 2 weeks s/p left knee replacement –
 2 days hx of intermittent fevers- 99.5102.3 today lethargic, confused and
agitated- generally alert and oriented
today-sleeping not eating, agitated
Emergency Department
“Hand Off”
Assessment:*
 General impressions: Ashen in color-lethargic,
warm to the touch-combative with stimulation Increased agitation with bilateral flank
palpation, left knee wound site dry and intact,
patient incontinent with foul urine Vital signs: HR 102, B/P 112/60, R-28 Temp
102.3
 Pain level: 5/10 flank pain
Emergency Department
“Hand Off”
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Recommendations/Recap*
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Treatment provided – 2L Oxygen via nasal cannula ,
position of comfort
Response to treatment and interventions – no changes
Do you have any questions?
SBARSituation Background Assessment Recommendations
Thank you
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References:
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http://www.centerfortransforminghealthcare.org/assets/4/6/CTH_HOC_Fact_Sheet.pdf
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http://www.mbemsc.org/files/provider_info_items/Entry_NotesApproved_MADPH_OEMS_2_3_10
.doc
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http://www.psnet.ahrq.gov/resource.aspx?resourceID=4195
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Contra Costa EMS