Using an SBAR - keeping it real! Demonstrating how improving safe care delivery has been incorporated into a top-up degree programme

A survey on the effects of patient safety training programs based on SBAR and FMEA techniques on the level of self-efficacy and observance of patient safety culture in Iran hospital, Shiraz in 2022-2023

BACKGROUND AND OBJECTIVE

Patient safety and medical personnel self-efficacy are among the main factors involved in providing quality health services. Moreover, safety culture in an organization is considered one of the most critical factors regarding patients' safety. Therefore, the present study aimed to determine the effects of patient safety programs based on Situation, Background, Assessment, Recommendation (SBAR) and Failure Model Effects Analysis (FMEA) techniques on self-efficacy and patient safety culture in Iran Hospital of Shiraz in 2022-2023.

MATERIALS AND METHODS

This two-stage quasi-experimental study was conducted in 2022-2033. Considering inclusion criteria, the present study included 80 nurses working in Iran Hospital. The participants were divided into groups of SBAR (40 participants) and FMEA (40 participants). All the data were collected using a Hospital Survey on Patient Safety Culture questionnaire and Sherer General Self-Efficacy Scale. Then, the collected data were analyzed using SPSS 13, Fisher's exact test, paired t-test, and independent t-test with a significant level of P < 0.05.

RESULTS

The mean score of total patient safety culture between the two groups was insignificant before the intervention (P = 0.58). However, it was more significant in the FMEA group than the SBAR group after the intervention (P < 0/05). In addition, the mean self-efficacy score between the two groups was insignificant before the intervention (P = 0.80). However, after the intervention, the mean score of the FMEA group was significantly higher than the SBAR group (P < 0.05).

CONCLUSION

According to the findings of this study, there is a meaningful relationship between patient safety training programs based on SBAR and FMEA techniques on patient safety and self-efficacy of nurses; however, FMEA training has more positive effects on self-efficacy and patient safety compared to other techniques. As a result, these techniques, along with other plans, are recommended to authorities in order to help improve patient safety.

SBAR Shift Report Training Program and its Effect on Nurses' Knowledge and Practice and Their Perception of Shift Handoff Communication

Introduction: Handover is a key factor in the continuity of care and is the most vital communication means among nurses. Using an identical method for this can enhance the quality of the handover. Objective: To evaluate the effect of a shift reporting training program using the Situation, Background, Assessment, Recommendation tool on nurses' knowledge and practice and their perception of shift handoff communication in noncritical departments. Methods: A quasiexperimental research design. The study was held in noncritical departments on 83 staff nurses. Researcher used a knowledge questionnaire, an observation checklist, and two perception scales were used to collect data. Statistical data analysis was performed with SPSS using descriptive, chi-square or Fisher exact tests, correlation coefficient, multiple linear regression model. Results: Nurses varied in age from 22 to 45 years old, with 85.5% of them being female. After the intervention, their knowledge rose from 4.8% to 92.8% (p < .001), the adequate practice reached 100%, and their perception of the process had significant improvement (p < .001). Using multivariate analysis, the study involvement was the main significant independent positive predictor of nurses' knowledge and scores, and these latter were positive predictors of their perception. Conclusion: Using the shift work reporting method had a significant effect among the study participants using Situation, Background, Assessment, and Recommendation tool and improved their knowledge, practice and perception of shift handoff communication.

[Nursing home-sensitive conditions and approaches to reduce hospitalization of nursing home residents]

BACKGROUND

Interventions to reduce potentially risky hospitalizations among nursing home residents are highly relevant for patient safety and quality improvement. A catalog of nursing home-sensitive conditions (NHSCs) grounds the policy recommendations and interventions.

METHODS

In two previous research phases, an expert panel developed a catalog of 58 NHSCs using an adapted Delphi-procedure (the RAND/UCLA Appropriateness Method). This procedure was developed by the North American non-profit Research and Development Organisation (RAND) and clinicians of the University of California in Los Angeles (UCLA). We present the third phase of the project focused on the development of interventions to reduce NHSCs starting with an expert workshop. The workshop results were then evaluated by six experts from related sectors, supplemented, and systematically used to produce recommendations for action. Possible implementation obstacles were considered and the time horizon of effectiveness was estimated.

RESULTS

The recommendations address communication, cooperation, documentation and care competence as well as facility-related, financial, and legal aspects. Indication bundles demonstrate the relevance for the German healthcare system. To increase effectiveness, the experts advise a meaningful combination of individual recommendations.

DISCUSSION

By optimizing multidisciplinary communication and cooperation, combined with an- also digital - expansion of the infrastructure and the creation of institution-specific and legal prerequisites as well as remuneration structures, an estimated 35% of all hospitalizations, approximately 220,000 hospitalizations for Germany, could be prevented. The implementation expenditure could be refinanced by avoided hospitalization savings amounting to 768 million euros.

The patient safety in extracorporeal blood purification treatments of critical patients

Today, health systems are complex due to both the technological development in diagnostic and therapeutic procedures and the complexity of the patients that are increasingly older with several comorbidities. In any care setting, latent, organizational, and systematic errors can occur causing critical incident harmful for patients. Management of patients with acute kidney injury (AKI) requires a multidisciplinary approach for the diagnostic-therapeutic-rehabilitative path that can also require an extracorporeal blood purification treatment (EBPT). The complexity of these patients and EBPT require a clinical risk analysis and the introduction of protocols, procedures, operating instructions, and checklists to reduce clinical risk through promotion of the safety culture for all care providers. Caregivers must acquire a series of tools to evaluate the clinical risk in their reality to prevent incidents and customize patient safety in a proactive and reactive way. Established procedures that are made more needed by the COVID-19 pandemic can help to better manage patients in critical care area with intrinsic higher clinical risk. This review analyzes the communication and organizational aspects that need to be taken into consideration in the management of EBPT in a critical care setting by providing tools that can be used to reduce the clinical risk. This review is mostly addressed to all the caregivers involved in the EBPT in Critical Care Nephrology and in the Intensive Care Units.

Effects of flipped-learning-based simulation for nursing students: a retrospective survey

This study analysed whether Situation-Background-Assessment-Recommendation (SBAR) simulation, which uses a flipped learning method, improves undergraduate nursing students' academic performance and core competencies when applied in the mental health nursing practicum, as compared with traditional in-person simulations. To this end, a retrospective survey was employed. A group of 37 students who participated in the flipped learning-based SBAR simulation practicum was compared with a group of 37 students who participated in the practicum using a traditional learning method, in terms of their academic performance and core competencies. The 90-h practicum included four three-hour SBAR simulation sessions. Students were assessed at baseline, immediately after the two-week practicum, and four weeks later. The effects of group, time, and group-by-time interactions between the groups were verified using generalized estimating equations with an autoregressive correlation structure. Data were collected between March and July 2017, in South Korea. The results indicated that SBAR simulation significantly improved nursing students' communication performance compared with the traditional learning method. The clinical practicum based on SBAR improved core competencies at the post-practicum and four weeks later. In conclusion, the application of the flipped learning-based SBAR simulation can improve nursing students' communication skills and can be utilized as an effective teaching method to promote higher order competencies to apply, analyse, and evaluate knowledge beyond simple understanding and information recall. This study has addressed how academic performance and core competencies in nursing can be improved through SBAR simulation using a flipped learning method and shown its positive impact on nursing students' communication skills and higher order competencies.

Optimal NHS service delivery to care homes: a realist evaluation of the features and mechanisms that support effective working for the continuing care of older people in residential settings

Background

Care homes are the institutional providers of long-term care for older people. The OPTIMAL study argued that it is probable that there are key activities within different models of health-care provision that are important for residents’ health care.

Objectives

To understand ‘what works, for whom, why and in what circumstances?’. Study questions focused on how different mechanisms within the various models of service delivery act as the ‘active ingredients’ associated with positive health-related outcomes for care home residents.

Methods

Using realist methods we focused on five outcomes: (1) medication use and review; (2) use of out-of-hours services; (3) hospital admissions, including emergency department attendances and length of hospital stay; (4) resource use; and (5) user satisfaction. Phase 1: interviewed stakeholders and reviewed the evidence to develop an explanatory theory of what supported good health-care provision for further testing in phase 2. Phase 2 developed a minimum data set of resident characteristics and tracked their care for 12 months. We also interviewed residents, family and staff receiving and providing health care to residents. The 12 study care homes were located on the south coast, the Midlands and the east of England. Health-care provision to care homes was distinctive in each site.

Findings

Phase 1 found that health-care provision to care homes is reactive and inequitable. The realist review argued that incentives or sanctions, agreed protocols, clinical expertise and structured approaches to assessment and care planning could support improved health-related outcomes; however, to achieve change NHS professionals and care home staff needed to work together from the outset to identify, co-design and implement agreed approaches to health care. Phase 2 tested this further and found that, although there were few differences between the sites in residents’ use of resources, the differences in service integration between the NHS and care homes did reflect how these institutions approached activities that supported relational working. Key to this was how much time NHS staff and care home staff had had to learn how to work together and if the work was seen as legitimate, requiring ongoing investment by commissioners and engagement from practitioners. Residents appreciated the general practitioner (GP) input and, when supported by other care home-specific NHS services, GPs reported that it was sustainable and valued work. Access to dementia expertise, ongoing training and support was essential to ensure that both NHS and care home staff were equipped to provide appropriate care.

Limitations

Findings were constrained by the numbers of residents recruited and retained in phase 2 for the 12 months of data collection.

Conclusions

NHS services work well with care homes when payments and role specification endorse the importance of this work at an institutional level as well as with individual residents. GP involvement is important but needs additional support from other services to be sustainable. A focus on strategies that promote co-design-based approaches between the NHS and care homes has the potential to improve residents’ access to and experience of health care.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Evaluation of Situation, Background, Assessment, Recommendation Tool During Neonatal and Pediatric Interfacility Transport

OBJECTIVE

We aimed to determine if the implementation of Situation, Background, Assessment, Recommendation (SBAR) training improved the quality of real-life telephone communication. We evaluated interfacility neonatal and pediatric transports performed by registered nurses, respiratory therapists, and physicians (MDs).

METHODS

This was a quality improvement study performed to evaluate telephone communication before and after SBAR training. Training consisted of lectures, review of audio files, and simulated role-playing. Recorded audio files of real-life transports were evaluated for clarity and content by 3 raters using a standardized scoring tool.

RESULTS

Ninety-four and ninety-three calls were evaluated before and after the intervention, respectively. The total item scores were higher posttraining (mean ± standard deviation [pre: 15.06 ± 2.60, post: 17.60 ± 2.61], P < .001). Global rating scores ≥ 4 were higher in the posttraining group (pre: 50.0% vs. post: 66.7%; P = .02; odds ratio = 1.43; 95% confidence interval, 1.04-1.97). There was no significant difference in the duration of calls (mean ± SD [pre: 9.29 ± 4.59 minutes, post: 9.70 ± 4.65 minutes). In subgroup analysis, the total item score was significantly improved posttraining for registered nurses and respiratory therapists but not MDs.

CONCLUSION

Standardized SBAR training was effective in improving telephone communication by RNs and RTs. The inclusion of SBAR training routinely within the educational curriculum of transport programs can enhance communication.

Validation of a modified early warning score-linked Situation-Background-Assessment-Recommendation communication tool: A mixed methods study

AIMS AND OBJECTIVES

To develop and validate a modified Situation-Background-Assessment-Recommendation communication tool incorporating components of the Cape Town modified early warning score vital signs chart for reporting early signs of clinical deterioration.

BACKGROUND

Reporting early signs of physiological and clinical deterioration could prevent "failure to rescue" or unexpected intensive care admission, cardiac arrest or death. A structured communication tool incorporating physiological and clinical parameters allows nurses to provide pertinent information about a deteriorating patient in a logical order.

DESIGN

Mixed methods instrument development and validation.

METHODS

We used a sequential three-phase method: cognitive interviews, content validation and inter-rater reliability testing to validate a self-designed communication tool. Participants were purposively selected expert nurses and doctors in government sector hospitals in Cape Town.

RESULTS

Cognitive interviews with five experts prompted most changes to the communication tool: 15/42 (35.71%) items were modified. Content validation of a revised tool was high by a predetermined ≥70% of 18 experts: 4/49 (8.2%) items were modified. Inter-rater reliability testing by two nurses indicated substantial to full agreement (Cohen's kappa .61-1) on 37/45 (82%) items. The one item achieving slight agreement (Cohen's kappa .20) indicated a difference in clinical judgement. The high overall percentage agreement (82%) suggests that the modified items are sound. Overall, 45 items remained on the validated tool.

CONCLUSION

The first modified early warning score-linked Situation-Background-Assessment-Recommendation communication tool developed in South Africa was found to be valid and reliable in a local context.

RELEVANCE TO CLINICAL PRACTICE

Nurses in South Africa can use the validated tool to provide doctors with pertinent information about a deteriorating patient in a logical order to prevent a serious adverse event. Our findings provide a reference for other African countries to develop and validate communication tools for reporting early signs of clinical deterioration.