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Patient safety leaders transform handovers at George Eliot

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Ward staff and patients at George Eliot Hospital in Nuneaton are reaping the rewards of investing in training for patient safety improvement.

Ward Senior Sister Louise Jacox was among a cohort of senior nurses and others with a role in safety improvement who attended the NHS Institute for Innovation and Improvement’s Patient Safety Leaders (PSL) programme.

The PSL programme is delivered in three modules over six days.  It provides practical guidance on safety improvement tools and techniques.  A key part of the programme is to help delegates identify an area for improvement within their own organisations and support them as they devise an improvement project to put in place when they return to work.

Louise worked with Alison Cole to introduce a standardised communication tool for use during nursing handovers on the Bob Jakin Ward for vulnerable adults.  Alison works for the NHS Institute and attended the same PSL programme as Louise.

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Historically, handovers on the ward had suffered from a number of shortcomings.  They were taking too long and information given was often inconsistent or incomplete.  Healthcare Support Workers (HCSWs) indicated that handovers were far more detailed than they required to undertake their role.

This was having a negative impact on morale but, most importantly, on patient safety.  It was noted that patients most commonly tended to have falls early in the morning when handovers were being conducted.

By changing the way handovers were done, staff time was released to ensure more HCSWs were on the ward to look after patients during morning handovers.

The approach Louise and Alison used was to modify an existing structured communications tool – SBAR – for use during handovers.

SBAR stands for Situation, Background, Analysis, Recommendation and was originally developed by the US military but has subsequently been adapted for use in healthcare.  SBAR is now widely used for handover and escalation scenarios in NHS settings around the country.

Following the example of a number of healthcare organisations in Australia, they added two new elements to SBAR to highlight the importance of correctly communicating  the patient’s identity (I) and latest observations (O) – to create the ISOBAR model.  Handovers were streamlined so that HCSW were only present for the parts of handover relevant to their role.  As the following charts demonstrate, the result was significantly reduced handover times, both for the whole ward team and for HCSWs in particular:

Additional benefits include 100% compliance with VTE assessment reporting and no complaints relating to communication or patient care have been received on the ward since ISOBAR has been implemented.  One relative who had been considering litigation in relation to a complaint about the ward dropped their complaint after seeing the new system working.  The Care Quality Commission (CQC) also complemented the new system during a recent audit.

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Louise said:  “There is no doubt that using ISOBAR has had a positive impact on patients and ward staff alike.  Handover times have been significantly reduced and patient falls seem to be showing a downward trend.

“The way the whole team was engaged in the process of developing and implementing the new system and then measuring the results has also been morale boosting and that also has a positive beneficial knock-on effect for patients who have a better experience when been looked after by well motivated staff who are working together to make improvements happen.

“It wasn’t easy getting everyone on board to begin with but now everyone in the team can see the difference ISOBAR is making and is now right behind it. 

“Using the learning gained from the PSL programme and working in tandem with Alison has been key to making this happen. I would recommend the PSL programme to anyone who wants to make a practical, positive difference to patient safety in their own trust.”

Alison is now working with the NHS Institute to promote and further develop the PSL programme and, as a former delegate, is convinced of its value.

“I learnt a huge amount from the PSL programme and, later, when putting the learning into practice on the ground.  The programme does contain theoretical elements but also provides practical tools and techniques which help staff go away from the programme and apply their newly gained knowledge when they get back to work.

“George Eliot is one of a number of hospitals who have sent several members of staff through the PSL programme.  That is an excellent way to build the capacity and capability needed to really make a difference to safety improvement on ward, departmental and organisational levels.”

Becky Bartholomew is Deputy Director of Nursing for the hospital.  She added:  “We are convinced of the value of investing in the PSL programme for key members of staff across the trust. 

“The project on Bob Jakin ward is a very good example of how we are beginning to see the benefits and reap the rewards of investing in staff training and development of this kind.  The PSL programme is particularly applicable to nursing staff but can also be of benefit to other staff with a role in safety improvement and I would strongly recommend it.”

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