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Alex Entwisle

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    This is my essay I did for my last year of my foundation degree course (apologies for spelling and grammer mistakes) 

     

    The positives and the negatives of using the SBAR tool

    Introduction 

    Within this essay I am going to look at how the positive and the negative of using the SBAR tool

    within the Emergency Department . The findings from this essay which will all be evidenced based I

    will be concluding my essay with how it can I can improve my communication skills within my work

    place.

     

    According to Martin and Ciuzynski (2015), a large number of patients die every year in hospital and

    healthcare environments as a result of poor documentation and communication between different

    medical specialists. Industry standards and systems, help such as SBAR tool to improve the

    communication. SBAR definition is situation, background, assessment, and recommendation (SBAR)

    communication tool. If this is done well then, all our patients will be safer and the medical doctors

    and nursing safer will be happier.  

     

    Sackett et al (1996) informs you that Evidenced based practice (EBP) is “the integration of clinical

    expertise, patient values, and the best research evidence into the decision-making process for patient

    care”. If you have these three then you can start to explore the evidenced based practice.

     

    Williams (2017) WRITES that it is proof put together nursing practices with respect to basic

    reasoning and demonstrated results. Likewise called EBP, it supplements what medically trained staff

    realised in a learning environment and what they read in nursing journals. It additionally causes them

    assess the most recent research and innovation and decide how to apply it in a genuine world, and

    within the areas in which you work in.

     

    To address the implied question in this essay I intend to use medical journals. By researching I intend

    to find out what impact the SBAR tool has had on clinical communication. I intend to look at various

    journals which I will find by using the specific medical search engines: CINAHL, MEDLINE,

    PUBMED.  I will make sure that all the information that I will look at will be that most up to date and

    relevant to my work with an Emergency Department and a medical unit

     

    Within the Emergency Department staff  need make sure that all interactions and clinical decision

    about our patients care  are fully recorded in writing and this is done by using the SBAR tool which

    every member of staff, who is qualified to make and follow up clinical decision must update. Within

    my role as Assistant Practitioner I am able to make full use of the SBAR tool when I hand over any of

    my patients to another team.  

     

    ACT Academy (2018) define that the SBAR is a communication tool and is a simple to use and ,

    organise patients notes, that will enable better communication between clinical staff. O'Shaughnessy,

    (2015) informs us that the SBAR was initially created by the United States Military for

    correspondence on atomic submarines, however in 1990s it has been utilised in a wide range of

    medical services settings, especially identifying with improving patient safety. 

     

    Novak (2012) states that there are various advantages to executing bedside handovers utilising a clear

    communication tool, such as the SBAR tool. Novak (2012) also states that there has been finical

    saving which originate from serious incidents, for example, falls and prescription mistakes, which can

    happened during ward moves and ward handover. During these various handovers, this can become

    side tracked by staff “catching up” about other than clinical issues. The SBAR tool is structure so this

    should not happen if the handover is conducted well.

     

    Bickhoff (2015) argues that the essential disadvantage to bedside handovers is the issue of keeping up

    data protection inside an open setting. while different investigations found that patients were stressed

    over the sharing of personal  details, This was more pronounced in Emergency Departments, where

    patients in the room had a higher percentage of hearing other patients personal . In my department we

    have stopped bedside handover, because we had complaints from patients on exactly this matter. So as

    a team we came up with a compromise, we have the first part in a private room where we discuss the

    patient’s details, and then we would walk around only going through the drug charts and observation

    sheets. As this new form of ward round takes place, the new nursing staff can introduce themselves to

    the patients.

     

    In an article by Eberhardt (2014) carried out study which looked into the benchmark information

    included what number of handovers was archived what's more, what frames of mind the nursing staff

    had about current handover methods. The group gathered standard information through looking at

    audits and patient record when patients moved from one department to another like from an

    emergency department to another ward during a 1-month time span. They found that the area,

    substance, and event of the documentation were conflicting. A clinical note, about the patient was in

    fluctuating styles, was composed archiving a patient handover 32% of the time. A comment of a

    during the patient handover to the observational sheet (the NEWS chart within the NHS) within the

    patient's medical record 42% of the time. SBAR arrangement was not utilised by any stretch of the

    imagination, nor was there any sign of a nurse to nurse handover. They disseminated surveys with

    respect to current practices and culture toward patient handovers to all medical-surgical or theatre

    nursing staff and the reaction rate was 28% and 31%, separately. Whereas 81% of the medical-

    surgical carefully  knew of trusts approach to give handover report in SBAR design, 93% demonstrate

    that they offered report to an  nursing staff under 25% of the time, and 86% expressed that handover

    was in SBAR design under 25% of the time. The results from the theatre nursing staff surveys

    certified these discoveries. 

     

     Lee et al (2016) performed a qualitative study finding recognised four fundamental subjects that

    explains the utility of SBAR as an interprofessional specialised instrument across over clinical and

    non-clinical setting. Firstly, is the common language between staff and their departments, for example

    different specialities have different shortened words they use, this should not be happening we should

    all be talking the same language within health care. Secondly the effective association of information

    to distinguish quick issues. Thirdly they found the help of collective group-based communication like

    a handover should  including shared basic leadership and compromise. Then lastly was Flexibility,

    allowing use in various configurations, for example, face to face handovers , group presentation,

    email correspondence and attaching the relevant documents. The way the team learnt from this study

    is by involving the multi-disciplinary in activities that looked at the highlighted problems which they

    thought they could improve on from the study which they performed. The one thing they found out

    that the SBAR tool helped the staff who were not clinically trained to improve on their

    communication skills  as well and how this helped them improve in their roles.  Since the SBAR

    specialised communication tool becoming  well known across the NHS, incorporating  it into Doctors

    and Nurses training. In my Foundation Degree course, we have had the SBAR tool/framework taught

    to us twice within a our first year. 

     

    Martin, Ciuzynski (2015) performed a study within a Children's Emergency Department. The

    information was gathered from 32 nurse and 2 nurse practitioners who used a structure

    communication tool and pre questionnaires were taken  and one on the use of the SBAR tool. The

    study results showed 83% of patient experiences incorporated a joint assessment. A group handover

    using the SBAR was directed 86%of the time. All trained nursing staff that has deemed competent to

    handover verbalised patient's treatment designs in 89%of cases and 97%of cases, respectively.

    Improved collaboration, communication, and nursing fulfilment scores were shown by those staff who

    used the SBAR. I feel this represents my experiences, as I am someone who hands over to other

    teams/ colleagues from wards. When I have completed my handover, I document in the notes that the

    patient handover was completed and ward staff happy with verbal handover. 

     

    Kesten (2011) tells us that the undertaking assembles the proof toward improving communication

    between medical staff which includes Nurses and doctors, which may eventually improve patient’s

    results. Future research directed in an interdisciplinary setting utilising training for all clinical staff.

    Teaching all staff within the hospital environment mainly clinical staff, as the uses of the SBAR tool,

    this will help staff to improve their own communication at work and also at home.

     

    Muller et al (2018) tells us that studies could be completed better. They end their article by outline,

    numerous authors guarantee that SBAR improves patient’s outcomes. There is some proof of the

    forcefulness of SBAR execution on patient result; however this proof is restricted to specific  

    conditions, for example, communication via telephone. Particularly high calibre studies are not

    focusing on the shortcomings of the SBAR tool. Future studies are expected to further show the

    advantage of SBAR as far as patient wellbeing what's more, continues raising the familiarity with

    communication mistakes. SBAR may be a versatile tool that is reasonable for some human services

    settings, specifically when clear and concise communication is required.

     

    Eberhardt (2014) lastly informs us  that patient’s handover stays one of the most significant parts of

    patients care. Compelling and productive communication is intrinsic to any handover for ideal and

    safe patient care. Utilising evidenced  based practice, our association distinguished an issue and

    executed an answer that built up reliable and contemporary communication  methodology. The SBAR

    as a transfer tool  institutionalised the patient handover technique and expanded nursing adherence

    and fulfilment with the new practice/documentation. We trust that the SBAR tool as a transfer

    documentation proceeds to advance and improve communication  throughout the hospital setting.

     

    It has been difficult to find any negative of  the use of the SBAR  tool. I think this is because it does

    benefit the patient and staff. Like Muller et al (2018)  inform us that , the real impact of SBAR on

    patient result is unclear. The wide selection of SBAR (or some other communication procedure)

    without demonstrating the advantage may incomprehensibly limit enhancements on the grounds that

    an issue probably illuminated will be less tended to. In this manner, the motivation behind this

    efficient survey is to abridge the accessible proof for and assess the effect of the usage of SBAR in

    clinical settings on patient wellbeing as estimated by the frequency of unfriendly occasions. The lack

    of negative data show us that on the whole the SBAR works well within a clinical setting.  I think this

    is because it can be used in any setting within a hospital, but continued studies and training must be

    used.

     

     

    Conclusion  

    Currently there is no mandatory study day within my trust which all staff should go on to enhance

    their collective knowledge of the SBAR tool. If there were, staff would most likely be better at using

    the SBAR tool. I intend to feedback to my practice educator ti find out if we could include this into

    documentation for all new starters into the Department

     

    My experience from bedside handover is that it can take longer as relatives can keep asking

    questions which could be answered at the end of the handover. Another problem is that patients

    can hear other patients details and this is difficult as sometimes we have patients with very

    confidential problems. It was agreed that patients with sensitive problems would be discussed

    in a private room and then bedside handover for introducing the new team to the patients and going

    through the documentation.  This was a problem within two areas in the Emergency Department,

    the clinical decision unit and the main emergency department. In the main Emergency Department

    we have the main hand over in the Staff Room then go out to the main department to get handover

    from the relevant nurses who full the SBAR tool with the way our documentation is laid out.

     

    In my department we use many different handover for example over the phone, transfers to wards,

    ambulance handovers, bedside handovers in our short stay ward and shift handover times. As a

    department we knew that we had to improve after we had incidents regarding handovers. In 2017 we

    introduced the SBAR tool into our safety booklet in the department and have reduced some

    incidents as well. We even do this within our department when we take the patients to our Clinical

    Decision Unit. Within my role as assistant practitioner, I am qualified to do all of these types of

    handovers. 

     

    We as a department although we used the SBAR tool when handing over we found out that if there

    was incident then there was no proof on what was said during that handover. In our Emergency

    Department within our nursing documentation there is a SBAR form we must fill out when going to

    the ward. Our Matron said this will help him if he has to follow up because it is all will be on the

    SBAR form.  

     

    We also use a red SBAR form if we are communicating to other department over the phone when

    we have a concern about a patient. This helps us as Nurses to make sure we have all the relevant

    information to tell the other person at the end of the phone.  I like this from because it has any

    recommendations or when the doctor might come and review the patient.

     

    This form and any other SBAR forms should always be kept within the medical notes, this is if there

    is a concerns we call look back at the information.  I would not say that we are the perfect with the

    SBAR tool, over the last year I think in the Emergency Department have improved at using the SBAR

    tool when we have to talk to doctors or other colleagues on the phone about patients. We could get

    better when it comes to the writing of the SBAR forms. At the end of the day this is to ensure patient

    safety

     

    The last point is that Dunsford (2009) point’s out, that is  preventable medical mistakes keep on

    happening at disturbing rates, and communication failure  are at the because of a significant number

    of these episodes. Embracing an organized specialised framework, for example, SBAR can help

    medical staff communicate in a clear and concise manner. The strategy can be actualised on any scale,

    from individual to trust wide, and encourages the understanding of interdisciplinary language, that

    will enable all staff across the trust to improve the understanding and communication, which will lead

    to improving patient security and safety . This is why NHS England and staff must keep using the

    SBAR tool as so far the evidence shows it does work.

     

     

     

    Reference list 

    ACT Academy (2018) SBAR communication tool – situation, background, assessment, recommendation https://improvement.nhs.uk/documents/2162/sbar-communication-tool.pdf. [online] accessed 20/06/19 

    Bickhoff. L. (2015) Bedside handovers: All it’s cracked up to be?http://www.definingnursing.com/handover/. [online] accessed 20/06/19 

    Dunsford. J. (2009) Structured Communication: Improving Patient Safety with SBAR. https://onlinelibrary-wiley-com.ezproxy.brighton.ac.uk/doi/10.1111/j.1751-486X.2009.01456.x. [online] accessed 09/07/2019 

     Eberhardt. S. Nursing (2014) Improve handoff communication with SBAR. https://www.nursingcenter.com/wkhlrp/Handlers/articleContent.pdf?key=pdf_00152193-201411000-00006. [Online] Accessed 09/07/19 

    Lee, S.Y, Hao,Y. C,Lien. W,Shiong. (2016)SBAR: towards a common interprofessional team-based communication tool. https://onlinelibrary-wiley-com.ezproxy.brighton.ac.uk/doi/full/10.1111/medu.13171. [online] accessed 09/07/2019 

     Kesten, K. (2011). Role-play using the SBAR technique to improve observed communication skills in senior nursing staff. https://search-proquest-com.ezproxy.brighton.ac.uk/docview/846979798/fulltextPDF/955FBFC6F8664EF0PQ/1?accountid=9727. [online] accessed 16/07/19 

    Martin, H. S Ciurzynski (2015) Situation, background, assessment and recommendation- Guided huddle improve communication and teamwork in the emergency department. https://www-sciencedirect-com.ezproxy.brighton.ac.uk/science/article/pii/S0099176715002287. [Online] Accessed 09/07/2019 

    Muller,M. J, Jürgen. M, Redaell. K, Klingberg. W, Hautz. S, Stock. (2018)Impact of the communication and patient hand-off tool SBAR on patient safety: a systematic review.https://bmjopen.bmj.com/content/bmjopen/8/8/e022202.full.pdf. [Online] Accessed 18/07/19

    Novak.k, R Fairchild. (2012)Bedside reporting and SBAR: Improving patient communication and satisfaction.https://www-sciencedirect com.ezproxy.brighton.ac.uk/science/article/pii/S0882596312002692#bb0025.[online] accessed 20/06/19.  

    O'Shaughnessy, G (2015). SBAR (Situation-Background-Assessment-Recommendation) An effective and efficient way to communicate important information http://www.giftoflifeinstitute.org/sbar-situation-background-assessment-recommendation/. [Online] accessed 16/07/19 

    Sackett, D.L., Rosenburg, W.M.C., Muir Gray, J.A., Haynes, R.B. and Richardson,W.S. (1996) Evidence-based Medicine, what it is and what it isn’t, British Medical Journal, 312: 71–2. Accessed 16/07/19 

    Williams. E (2017). What is evidenced based practice in nursing. https://careertrend.com/about-6618780-evidence-based-practice-nursing-.html.[online] accessed 20/06/19  

     

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