SBARCommunicationAuditatPeterboroughCityHospitalMaternityUnit

14thSeptember2016

DrEmilyParker(TrustRegistrar)Supervisor:DrFIsmail(ConsultantAnaesthetist)

Overview

• BackgroundtoSBARandcurrentguidance

• Standards

• Methods

• Results&Recommendations

• Reaudit

• Movingforward

2

BackgroundtoSBAR• ‘Fundamentalbarrierstocommunicationacrossdifferent

disciplinesandlevelsofstaff.’1

• Needtostandardisedcommunication–clear,completeandconcisestructuredformat2

• SBARisastructuredmethodforcommunicatingcriticalinformationthatrequiresimmediateattentionandaction;itimprovescommunication,effectiveescalationandincreasedsafety.1

• SBARreducestheincidenceofmissedcommunications.1Individualscommunicatewitheachotherwithasharedsetofexpectations.2 3

ErrorsinNHS

• ErrorsoccurringoftenduetoHumanFactors.

• FinancialimplicationforNHS.

• Improvingstandardsandpatientsafety.

• Marginalgains.

• Identificationofcommunicationissuewhenstartedobstetricanaesthesiamodule.

4

5

‘Itisimportanttooptimisecommunicationofcriticalinformationasanessentialcomponentofriskmanagementandpatientsafety’4

TrainingforPCH• Humanfactorstraining• SBARformatofboardinDS• SBARbyphones

FigureReference36

AuditStandards

7

Criterion

Target(%)

Exceptions

TitleorReferenceoftheaboveguidance/standard

(EvidenceBase)PleaseinsertNICECGreference

1

SBARcommunicationtoolshouldbeusedasastandardmeansofcommunication

100% ClinicalIndicationnottoperform

RoyalCollegeofObstetriciansandGynaecologists(2010)GoodPracticeNo.12;ImprovingPatientHandoverhttps://www.rcog.org.uk/globalassets/documents/guidelines/goodpractice12patienthandover.pdf

Methods• Datacollected:7/10/15-9/11/15(43days).

• SBARcommunicationtoallObstetricAnaesthetists.

• Spreadsheettorecorddata.• Volunteeredorprompted?

8

Results

9

8

13

48

MidwifeCoreMidwifeObstetrician

Figure1.Whophonecallswerereceivedfrom

• 13fulluseSBAR• 25partialuse/prompted

partially• 10requiredfullprompt

• 3fulluseSBAR• 5partialuse/

promptedpartially

• 1fulluseSBAR• 9partialuse/

promptedpartially• 3requiredfull

prompt

Total69phonecalls Results

• OVERALL:Only17outof69Phonecalls(25%)includedalloftheSBARcomponents.

10

Figure2.ComponentsofSBARandtheinformationprovided.

53

5

5

3

24

24

EpiduralCAT2LSCSCAT3LSCSCannula/BloodsRepairofperonealtearManualremovalofplacentaReviewofpafent

• Nodifferenceinquality/quantityofinformationprovided:• duringday/night• baseduponprocedure• gradeofanaesthetist.

Figure3.Procedurerequested.

KeyPhrasesweheard!

11

‘Room12isgoingforsection’

‘Wearegoingtotheatrewithroom9’

‘Wearebringingourladyforsection’

‘It’snotmypatient’

‘Room2wouldlikeanepidural’

Whatwewouldhavelikedtohaveheard…..

• SITUATION:IamLaura,aMidwifeinRoom9,lookingafterEmmaJones.Sheneedstocometotheatreforanurgentcaesareansectionduetofailuretoprogress.

• BACKGROUND:Emmaisaprimip,whocameinforinductionaspostdates.NoPMH,noallergies.

• ASSESSMENT:Emmahasbeen5cmfor6hourswithnoprogress.TheCTGnowshowssomeabnormalitiesandtheObstetricianswanttodoasection.

• RECOMMENDATION:Canyoucometoseethepatientplease.Ihavecannulatedher,sentaGroup&save.Isthereanythingelseyouwouldlikemetodo?

12Thisonlytook….25seconds!

Limitationsoftheaudit

• Incompletedatacollection– Noteverycallrecordedondatasheet.– Timeofdaynotalwaysrecorded.– Dataentrynotcompletedforeverydaywithin43days.

• Midwifestaffturnover– Newstaffnotyethadtraining?

• Shorttimespan

13

Recommendationsfromfirstcycle• ReminderofSBARverballyandposters.

• DelegatingtoObstetricSpRorSHOiftimeconstraints?

• PromptingofSBARatstartofconversation.

• Ensureadequateinformationcollectedbeforebleeping.

• Communicationappropriatetourgencyofsituation.(Whatwewanttoknowisname,procedure,urgencyforemergencies)

• FurtherTraining–HumanFactorsTraining29/6/16

• Reaudit–July16

14

Recommendationsfromfirstcycle• ReminderofSBARverballyandposters.

• DelegatingtoObstetricSpRorSHOiftimeconstraints?

• PromptingofSBARatstartofconversation.

• Ensureadequateinformationcollectedbeforebleeping.

• Communicationappropriatetourgencyofsituation.(Whatwewanttoknowisname,procedure,urgencyforemergencies)

• FurtherTraining–HumanFactorsTraining29/6/16

• Reaudit–July16

15

Re-auditfindings-July16

Cycle1Nov2015

Cycle2July2016 Difference

Situationprovided77% 82% +5%

Backgroundprovided36% 46% +10%

Assessmentprovided57% 54% -3%

Recommendationprovided

67% 79% +12%

16

• Timespan:31days

• Numberofcalls:39

• Globalimprovementincommunication.

• Roomforfurtherimprovement.

• Stillhearingphrases;‘TheinductioninRoom4is

comingtotheatre’

• 4phonecalls(9%)hadnocomponentsofSBARusedcomparedto19%incycle1.

3

36

Midwives:Obstetricians

Figure3.Whophonecallswerereceivedfromcycle2.

ComparingtoAuditStandards

17

Criterion

Target(%)

AchievedInNov2015

July2016VarianceorCompliancewith

standard

1 SBARcommunicationtoolshouldbeusedasastandardmeansofcommunication

100% 25% 36% -75%(Noncompliant)Improvedto-64%.

FurtherRecommendations• Furthertraining&morefrequenttomaintainstandards.

• Changeinculture–embedSBARcommunicationintopracticeonlabourward.

• Notacceptpoorcommunicationfromanybody,irrespectiveofrole.

SBARpromotessafeandeffectivepatientcare.

References1.NHSInstituteforInnovationandImprovement(2013),SBARpresentation.Availableat:http://www.institute.nhs.uk/safer_care/safer_care/sbar_resources.html

2.SaferHealthcarePartners(2016)Availableat:http://www.saferhealthcare.com/sbar/what-is-sbar/

3.NHSInstituteforInnovationandImprovement(2013),SBARposter.Availableat:http://www.institute.nhs.uk/images//documents/SaferCare/SBAR/Acute_SBAR_POSTER%20A4.pdf

4.RoyalCollegeofObstetricians&Gynaecologists(2010)GoodPracticeNo.12:Improvingpatienthandover.Availableat:https://www.rcog.org.uk/globalassets/documents/guidelines/goodpractice12patienthandover.pdf

18