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@SAFE_QI
Chapter 3
Using Structure Communication
@SAFE_QI
Chapter 3: Using Structured Communication
A key approach to improving patient safety is
improving communication.
This Chapter will focus on understanding where
communication can break down and the tools
that can be used to establish effective
communication.
@SAFE_QI
Resources
• Situation Background Assessment
Recommendation (SBAR)
• Concern, Uncomfortable, unSafe, Stop (CUSS)
@SAFE_QI
What is effective communication?
Effective communication is an open dialogue, in
which everyone leaves with a shared mental
model
@SAFE_QI
Is this effective communication?
@SAFE_QI
Was the message structured in an easy to follow format?
?
@SAFE_QI
Is this effective communication?
@SAFE_QI
Understanding why breakdown in communication occurs
• Not including all stakeholders in the
conversation
• Individuals are afraid of speaking up for fear of
blame or having an opinion being dismissed
• Nurses, doctors and other clinicians have all
been taught to communicate in different ways
@SAFE_QI
Improving communication takes two forms
Improving the
mechanisms for
communicating
Improving the
message being
communicated
@SAFE_QI
How do we get everyone to leave with the same message?
The Message
@SAFE_QI
I
S
B
A
R The I-SBAR team
@SAFE_QI
Key driver
• Communication remains the foundation of
patient safety.
• Numerous reviews of SI indicated poor levels
of communication in the handover of patient
details contributed to the incident
• Improved communication = improved care
@SAFE_QI
Aims
• Patients, and families are safe in the hospital
• Patients have timely and equitable access to
services
• Improve the cost and efficiency of care
delivery
@SAFE_QI
What is I-SBAR?
• Communication framework- avoid failures in
communication
• Originating from the nuclear submarine service
• Used extensively in medicine
• Safety focused
• Sets expectations
• Teamwork
• Acute clinical situations
@SAFE_QI
I – S – B – A – R
• Identify – yourself and the patient
• Situation – what is the problem
•Background –information to contextualise the problem
•Assessment – your clinical assessment and prediction
•Recommendation – what you think should happen
@SAFE_QI
Key tasks
• Adapt the SBAR
tool for your
environment
• Test the tool in
the ward
environment
@SAFE_QI
I – S – B – A – R – D
• Identify
• Situation
•Background
•Assessment
•Recommendation
•Decision
@SAFE_QI
Nurses
Consultant
Admin Porter
Doctors
Patient
Communicating with who?
@SAFE_QI
Key tasks
• Develop an education package to train staff in
the use of I-SBAR
• Test the education package
• Implement I-SBAR for nurses and doctors
@SAFE_QI
Objectives
• Implement I-SBAR
• Spread I-SBAR across the team
• Spread I-SBAR across the organisation
• Refine I-SBAR training
• Establish I-SBAR as the tool of
communication
@SAFE_QI
Process measures
• % of staff trained in I-SBAR
• % always using I-SBAR for critical
communication
• % always including all essential elements in
their report
• % where physician always agrees with
recommendation

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Editor's Notes

  • #6: Group discussion – was the open dialogue?