ISPP 2015

Career Opportunities in Pharmacy
Clinical Handover – Care 24/7

Working quietly behind the scenes the
care 24/7 team has been investigating ways of providing integrated seamless care to
patients across all our hospital sites one of the priorities identified by the
team has been the formalization of the clinical handover process between teams
and shifts but what does this formalisation process involve? how can
it make care more consistent and safe? what impact does it have for staff?
patients don’t come to the hospital between nine o’clock in the morning and 5
o’clock at night they’re coming 24 hours a day seven days a week and the people
that meet them in the front line tend to be the junior doctors nurses and allied
healthcare professionals and so we needed a system to ensure that we were
operating consistently across the 24 hours period failure in handover has been
recognized as a major preventable cause of patient harm and it’s principally due
to human factors of poor communication and these lead to systemic errors in
patient care clinical handover is one of the most dangerous times in the care of
a patient in any environment so addressing handover in a robust way is
really essential in delivering safe and high-quality care we need to provide 24
7 safe care and that’s what we provide if all the team is singing from the same song
sheet we know what’s going across the site then we can provide excellent care the
more we know about the patient the more we can help them and the less chance of
us missing essential piece of information its preventing those crises
occurring in the middle of the night all the patients who are potentially
vulnerable we’re aware of and there’s a plan and so things are much more
controlled and ordered. Central to the successful change to clinical handover
is the use of a standardized clinical communication tool SBAR but what is SBAR? how does it work? what benefits can a standardized
clinical communication tool bring to staff and the handover process? SBAR is an
easy to remember simple tool which formalizes the sort of information that
need to be drawn to the attention of a doctor it’s a very simple tool which allows
people to communicate effectively in high-risk environments it was developed by
the military and it was taken on by the Americans Kaiser Permanente and they
noticed a 50% drop in patient errors when they implemented SBAR so we’re
hoping to replicate that here in Oxford well it offers us the opportunity of a
structured handover so there’s a clear clear sort of formula to follow I think that SBAR help us run things smoothly more smoothly and get information across to
the other members of the team more efficiently The SBAR tool is really useful because one of
the issues that we wanted to try and avoid was dealing with more patients in
the meeting but we didn’t want the meeting to get too long or to get any
longer than it already was so in making the presentations about each patient crisper
and more concise using the SBAR tool we’ve managed to get through more
patients in the same time I think SBAR is about establishing a common language
it’s obvious I think that if we don’t have that then we have a medical equivalent of the Tower of Babel really with different people trying to communicate
concerns about patients or issues that need to be addressed in ways that the
other person does not understand properly SBAR gives us that absolutely
common language and common platform to transmit that information formalizing the handover process using clinical communication tools seems
to bring benefit to both staff and patients but what are the changes like?
what impact do they have on staff? can formalization empower staff and ensure
that their concerns are heard? In the evening switchboard bleep all the core members of
the team the bleeps are really good prompt to get the attendance up
we’ve seen attendance improve a lot since we’ve introduced the bleeping system. We have the MDT meeting at half past nine the handover is given on the patients that have come
through on that day’s take my hand over process role really varies immediately we go in and we have the handover for the patients prior to that I’ve already done a round round the hospital
identifying any patients that the nurses are concerned with but my main thought I
think at the handover meeting is to identify patients that haven’t been identified by
the doctors already or that nurses have called the doctors to see. We go through the list there is a checklist for today and then go through each patient each and everyone and then
also the juniors SHO’s and F1’s who cover the wards they usually handover the sick
patients that the night team needs to be aware of they need to be handed over
very carefully because we need to prioritize people in level of their sickness we’ve now added in a
systematic review all the patients at risk on the ward and we get
advance warning of the patients that are deteriorating and we can actually
proactively jump in and say well actually we need to go and see that
person and maybe take them around to critical care everybody involved seems
to have a positive reaction to the changes to clinical handover but why
should all staff get involved and push for handover to be formalized across all our
hospitals? Can changes to handover really increase patient safety and even
reduce staff workload? by doing it on a formal basis everybody’s bought into it i.e. they will all turn
up they know that it will happen and they know that all the patients are
discussed in the handover meeting everybody feels that they’re able to
voice their concerns ask questions everybody feels comfortable to speak I
think you know we’re providing great support to the team and I think patients
are being identified before they get acute stage where you know it is acute quick care needed
we are identifying patients before they get to that crash stage the patients who were
not not doing well on the wards are identified early on and they get reviewed
promptly and that can help to improve their overall well being the patients are
seen by members of the team who have had the opportunity to discuss
them in advance the potential treatment is already been commented upon discussed and
so when they’re seen by whichever member of the team the likelihood of a good outcome is
increased the occasions when patients deteriorate unexpectedly out of hours in
particular and then are found to have had problems that were identified
previously but had not been acted on following a handover will become a thing
of the past as we have patient safety at the heart of everything we do getting this right is really important
for the whole of the organization it’ll also lead to efficiencies efficiencies of
time we use our time which is precious much more efficiently because we’ll do less
unnecessary investigations less incorrect treatments and so on and so forth so I
think for the organization as a whole this process can only lead to strategic benefit
because if we can prevent things from happening obviously we are then providing Safe 24/7 care for the patient and that’s our ultimate aim this is a
critical part of what we do we know we’ve got to provide safe reliable
high-quality care to patients at all times of the day and night as a key
element of delivering compassionate excellence mission and I’m confident
that staff will recognise that and really embrace this

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