[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: The Joint Commission International Patient Safety Goal 2 states that effective communication between health care workers needs to improve. The aim of this study was to determine the effect of SBAR (= Situation, Background, Assessment, Recommendation) on the incidence of Serious Adverse Events (SAE's) in hospital wards. METHOD: In 16 hospital wards nurses were trained to use SBAR to communicate with physicians in cases of deteriorating patients. A pre (July 2010 and April 2011) and post (June 2011 and March 2012) intervention study was performed. Patient records were checked for SBAR items up to 48hours before a SAE. A questionnaire was used to measure nurse-physician communication and collaboration. RESULTS: During 37,239 admissions 207 SAE's occurred and were checked for SBAR items, 425 nurses were questioned. Post intervention all four SBAR elements were notated more frequently in patient records in case of a SAE (from 4% to 35%; p<.001), total score on the questionnaire increased in nurses (from 58 (range 31-97) to 64 (range 25-97); p<.001), the number of unplanned Intensive Care Unit (ICU) admissions increased (from 13.1/1000 to 14.8/1000 admissions; Relative Risk Ratio (RRR)=50%; 95% C.I. 30-64; p=.001) and unexpected deaths decreased (from .99/1000 to .34/1000 admissions; RRR=-227%; 95% C.I. -793- -20; NNT 1656; p<.001). There was no difference in the number of Cardiac Arrest Team calls. CONCLUSION: After introducing SBAR we found increased perception of effective communication and collaboration in nurses, an increase in unplanned ICU admissions and a decrease in unexpected deaths.
[Show abstract][Hide abstract] ABSTRACT: Handoff of patient information during shift report between nurses is a time of risk and liability. A quality improvement project was conducted on a 23-bed inpatient unit to measure the value of a bedside change-of-shift report in improving the effectiveness of shift report. Indicators including end-of-shift overtime, call light usage, nurse perceptions, and patient satisfaction were impacted by the change in process.
The Journal of nursing administration 03/2013; 43(3):160-5. · 1.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: For hospitalized patients, handoffs between providers affect continuity of care and increase the risk of medical errors. Most commercial electronic health record (EHR) systems lack dedicated tools to support patient handoff activities. We developed a collaborative application supporting patient handoff that is fully integrated with our commercial EHR. The application creates user-customizable printed reports with automatic inclusion of a variety of EHR data, including: allergies, medications, 24-hour vital signs, recent common laboratory test results, isolation requirements, and code status. It has achieved widespread voluntary use at our institution (6,100 monthly users; 700 daily reports generated), and we have distributed the application to several other institutions using the same EHR. Though originally designed for resident physicians, today about 50% of the application users are nurses, 40% are physicians/physician assistants/nurse practitioners, and 10% are pharmacists, social workers, and other allied health providers.
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