Kirsty Wood

Thanks for your feedback, we have started to go paperless as a trust over the last year. We do have electronic observations and more recently careflow connect. It is currently being used for ward handovers and team referrals as the first stage. I am led to believe escalation referrals will be introduced at some point but not aware of our trusts timeline. The wards will need to complete the referral using SBAR format electronically. We will be able to edit what specific information we are looking for to reflect the current deteriorating patient SBAR tool.

Hi Shabnum, Common models used for critical reflection in healthcare are Driscoll's model (what, so what, now what) or STARS technique ( situation, task, action, result, self-reflection). Hope this is helpful 🙂

I have attached a copy of the collated results from the survey I conducted within my trust at the end of last year. The results were surprising to us, given our experience. The response was pretty unanimous that staff knew what SBAR was and why it would be used, they mostly all reported using the tool and stated that they would not change the tool. As a team, we could only put the lack of SBAR referrals down to staff education and encourage them to use it more. So I proceeded with the relaunch by revamping the old SBAR form into a pre-printed sticker that could be directly applied in the clinical notes. The relaunch was advertised on the lead up through various forms of social media and hospital communications. I held an SBAR education stand in a communal staff area, which allowed me to engage and inform staff about SBAR and the upcoming changes. Also providing cake, obtaining staff pledges and playing SBAR games with prizes! (have attached photos with consent from participants) The next stage was the roll out of the SBAR sticker, which took form in personally visiting each ward area using tea trolley teaching for engagement and added bonus of staff well-being. We provided drinks and treats for all staff, which they gratefully received whilst I spoke to them about the new sticker. (again photo attached) We initially saw an increase in use, as you normally do with any new change. And so, to ensure the level of engagement a few weeks later ran a SBAR easter prize competition. We continued to include SBAR teaching in any of our resuscitation and deteriorating patient course. We were asked for specific SBAR teaching to targeted staff groups. We provide SBAR superstar certificates for any staff member that provides an SBAR referral with extra attention if they use an SBAR sticker in the notes. With permission, they have a photo and which gets put on the hospital staff social media. The plan was for me audit the use of the stickers, however due to COVID this has not been feasible. General verbal feedback from the wards has been very positive. The challenge now will be to ensure a good level of interest and engagement. SBAR survey results.pdf

I would be interested to know, if overnight, patients who score 0-2 on NEWS which has not changed with no concerns since the last set of observations, what your trust policy is on observation frequency? Does your trust require observations to be carried out 4 hourly minimum regardless of patients NEWS score and stability? Or if there are no concerns and the patient is clinically stable with consecutive NEWS 0-2 that they do not have observations taken overnight? Looking forward to hearing what other trust practices are.

Hi @Rob Tomlinson, yes the 'Dragons Den' is just for staff at Kettering General for funding in order to implement new idea/ innovation for the trust. I'm not sure what there rules are with potential out of trust applicants, but I'm happy to provide the contact email to you if you wanted to enquire further?

@Alex Entwisle Thank you for sharing your essay and your experiences, I am glad that you have been able to implement this within your department. @Viranga I am more than happy to share the survey question and findings. I will be looking at collating the project into an article, i am currently in the stages of implementing SBAR stickers and am hoping to evaluate the effectiveness of them and whether the addition training and resources have made an impact. I will be measuring the outcomes through a repeat survey and through our critical care outreach database, looking at whether there has been a direct increase in the use of stickers and SBAR handovers received.

We are looking into introducing a new device to deliver CPAP at ward level into our trust. Currently we use NIPPY machines which can deliver some PEEP when in a selected mode, however the downfall to this is, it can only produce an oxygen concentration of around 50%. Often, the patient groups that require this intervention are on high oxygen requirements and so particularly in the early stages would benefit from a device that could deliver both. I have previously worked with Pulmodyne 02-Max trio which allows up to 90% oxygen and PEEP up to 7.5cmH20. Majority of patients responded very well to this treatment. I wondered whether any other trusts/ team have any other experiences/ devices that they may use and recommend? @Danielle Haupt@Claire Cox@Emma Richardson@Mandy Odell@PatientSafetyLearning Team@Patient Safety Learning@Patient safety Hub@CCOT_Southend

I agree Claire, it becomes extremely difficult to screen those patients that have high NEWS but are stable with a plan and those that may not fit into certain categories that are at great risk of deterioration. Part of the reason, I think, is because of the high quantity of patients that score NEWS throughout the day, and nursing staff feel they need to alert CCOT for majority of them, not because they are worried necessarily but because it says in the policy and they are worried that if they don't they will be held responsible. In turn, we are conditioning the nursing population to move away from using nursing intuition and losing the confidence to make clinical decisions. In some ways, they are relying on electronic systems to tell them what to do with their patients instead of their nursing experience and knowledge kicking in. We are receiving more and more referrals where staff members don't really know why they are referring, just that the 'policy says so'. And we are seeing less conversations where staff are aware of their patients scoring, have assessed the patient themselves, had a medic review them and are happy that there is a plan in place. Whether this is the new generation of nurses we are seeing, or due to the transition to electronic systems/ devices, the fear of litigation or the lack of time for nursing staff to care for their sick patients. We provide training about the CCOT and all aspects deteriorating patients varying from nursing students, medical students and all grades which should off set some of the difficulties. Despite this, the route of the problem is still unknown and so I do not have any magical solutions. Sorry. Would love to find out if anyone else is having similar experiences and/or if anyone has any suggestions to help?

Great blog, fascinating content. Looking forward to reading more.

Our Call 4 Concern leaflet is in the very early draft stages, will post when finalised.

Thanks for your response @Danielle Haupt The survey, through surveymonkey, has gone out to staff members direct to their emails and on our shared facebook page for the trust. Fingers crossed I get a decent amount of responses. It is an interesting though putting it on twitter and finding out what the wider audience think, at this point I would need to gather data from my trust in particular, but after that could be an interesting option.

@Danielle Haupt Great idea to put in your newsletter! @Sam We are just setting up our own newsletter and would love to put about the hub in there. Would you be able to provide us with some text too?

Thanks @Claire Cox, I've posted a new topic in the 'how to engage for patient safety' forum, hope this okay?

Morning all, As a Critical Care Outreach nurse of many years, one of my greatest bugbears is SBAR handover, or there lack of! Within my trust, there is an SBAR proforma attached to the NEWS2 chart, which appears to be fit for purpose currently. (We are still on paper obs charts, moving to e-obs by the end of the year) SBAR is taught and embedding in all our teaching and training, the candidates at the time of the courses are all able to giver perfect SBAR handovers in simulation but as soon as they walk out the door all of that seems to disappear. It is all too often we receive poor handovers for referrals, the lack of information and clarity means that we cannot prioritise patients effectively. I am currently looking at the nuts and bolts of why this is and what we need to do to address the issues. I have started by sending a survey out to all registered nursing staff so that we can get feedback from those who should be using it. Hopefully, from the responses this may mean we can formulate a plan to improve this. Does anyone else have the same issues/ concerns in you line of work? Has anyone got anything that they do in their trust that works?