Introduction
On this planet, communication is fundamental in a bid to accomplish something. Lack of communication usually puts many issues in disarray as has always been witnessed in the healthcare sector, among many other industries. Consistency in communication is still helpful in encouraging collaboration, thereby reducing or preventing errors (Rayner & Wadhwa, 2020). The continued surge of the problem has resulted in many healthcare providers in the US coming together for the essence of providing coordinated and seamless patient care.
The situation, background, assessment, and recommendation (SBAR) tool is a technique that many in the healthcare sector have considered helpful in solving the handoff communication problems. The technique is effective in bridging the gap witnessed between the healthcare practitioners and staff. The SBAR is a communication briefing model that is effective in the enhancement of handoff communication (Achrekar et al., 2016). The maternal unit of many health care facilities needs improvement in a bid to reduce many medical errors reported. Complications that a mother or child may get during giving birth or carrying a baby as a result of lack of communication may have serious consequences, especially to the child (Sheila, 2013). Hence, there is a need for enhanced facility interventions for maternal practices.
Problem Description
To foster continuity of care and provide safe patient care, a handoff between the health care providers is usually one of the critical factors. The handing off of information has been recognized as a vulnerable area that many health practitioners always fail to do effectively. As such, this shows the importance that effective communication holds when administering treatment. According to the Joint Commission, about 1000 cases of care discontinuity happened in 2018 due to a lack of proper handoff guidelines. In these cases, communication was the fundamental cause of more than 70% of severe medical errors reported (McAllen et al., 2018). Medication errors, delay in discharge from uncertainty in the transfer of patients to critical care, inaccurate patient plans, and repetitive tests, among others, are the consequences of failed communication during the handoff.
The maternity unit of Temple University Hospital has experienced many of these problems. As such, the management of the hospital has sought action that will mitigate the problem (Sankpal et al., 2020). Thus, the project focuses on the implementation of SBAR and evaluation of the SBAR using the clinical evaluation exercise tool (CEX) in the maternity unit to reduce medication errors at the Temple University Hospital. The evaluation will thus be of help to the hospital management as far as reducing errors associated with handoff communication is concerned.
Rationale
Communication competence has been described as “the awareness and appropriate interpretation of the communications patterns in each situation and the aptitude to use the knowledge” (Streeter et al., 2015, p 297) studies have documented that nearly 100,000 lives are lost yearly in the US due to preventable medical errors (Sheila, 2013). Medical errors happening in the maternal unit are often serious yet preventable—the cause of many of these errors is stemming from handoff communication problems (Kaya et al., 2016). Studies have suggested that if healthcare quality is to improve, then communication between the providers of healthcare services must be enhanced (Sheila, 2013). When care is handed-off, when a patient is transferred or when the individuals responsible for patient care change as a result of a schedule change or acuity are some of the instances that always lead to communication breakdown. It is due to these handoff communication problems that the project purposes to implement and evaluate the effectiveness of SBAR using CEX. SBAR is considered one of the ways the handoff communication problems can be solved and thus it helps improve healthcare services.
Specific Aim
The purpose of the evidence-based practice project is to enhance the quality and continuity of patient information that is transferred during the end-of-shift handoff. The study focused on showing how the implementation of SBAR can be effective in solving problems associated with handoff communication. Reduction of medical errors and improvement in the quality of healthcare services provided are the determinants that will help ascertain the effectiveness of the technique using the CEX evaluation tool results.
Significance of the Study
This study is of much significance to the medical world as far as solving handoff communication problems is concerned. Medical errors some of which have led to death while some cause serious complications in individuals have been witnessed across the world (Sheila, 2013). Handoff communication problems have been touted as the major cause of these problems. Thus, by implementing SBAR, the issue of medical errors happening will be immensely reduced and the quality of health services will be improved.
Definitions
Situation, Background, Assessment, Recommendation (SBAR):
- Situation: Getting the context of the situation.
- Background: Getting the background information of the problem.
- Assessment: Critically evaluate the problem.
- Recommendation: Providing possible ways to correct the problem.
- Handoffs: It refers to the transfer and acceptance of responsibility for caring for a patient, and it is achieved through effective communication.
Chapter Summary
All healthcare professionals can recognize the proficiency of communications as a significant factor in patient safety during the handoff. Proper patient care management by health professionals is usually complemented by effective communication. The absence of communication leads to detrimental effects that are risky for individuals. Many of the medical errors associated with the handoff communication problems can be solved. The maternal section of the hospital in many instances usually witnesses many medical errors due to the failure in handoff communication. Through the implementation of the SBAR technique, this problem can be solved and thus save the lives of many individuals, especially infants. SBAR is a technique that has been recommended when it comes to solving the problems associated with handoff communication. Through the use of the CEX tool, the effectiveness of the technique can easily be determined. In the study’s next chapter, existing literature on the SBAR technique, its implementation, communication, and handoff will be discussed.
Literature Review
The literature review will explore and discuss handoff communication within nursing and the health care system. The area of study has readily available pieces of literature that are conclusive. In the years before this study, handoff had become pivotal in addressing patient safety in health care facilities (Klim et al., 2013). A conclusive review will be carried out using the available databases and resources used in conducting the project. The databases include the Cumulative Index of Nursing and Allied (CINAHL), PubMed, Science Direct, Google Scholar, websites, and books. The range of the search date will be between 1998 and 2018, and the reference section of these articles will also be reviewed for the essence of adding more resources. The search terms to be used include handoffs, communication, nurses, patient safety, shift report, and sign-out (Canale, 2018). As such, this chapter presents an overview of patient safety, barriers to good handoff communication, SBAR, handoff communication errors, tools, and handoff communication.
Communication
In nursing, communication is very crucial. In all the nursing interventions such as treatment, rehabilitation, health promotion, prevention, education, and therapy, communication plays a critical role. Poor communication in the healthcare facilities during handover has been identified as the key cause of medical errors (Kourkouta & Papathanasiou, 2014). A 2016 study carried out on ten hospitals found that receivers assessed that 37% of the handovers were unsuccessful, while for the senders, 21% of the handovers were unsuccessful.
Another study exploring how miscommunication among health care providers can affect the safety of the patients indicated that providers are always less likely to verbalize misconduct about the care of co-workers (Norouzinia et al., 2016). More than 1,700 health care providers were surveyed about communication gaps that could impact a patient’s safety (Norouzinia et al., 2016). The study found that approximately 10% of the healthcare providers directly confront their colleagues about their concerns and only one-in-five of the healthcare providers said they have had seen harm come to the patients as a result of handoff failure.
Another study review that was recently carried out to assess the prevalence and characteristics of the handoff incidents in hospitals, found unsatisfying results. The review that focused on handoff incidents that happened over three years, found that 334 handoff incidents such as administering wrong medication and forgetting to give a patient medicine at a specific time occurred within the time frame (Pezzolesi et al., 2016). The main reasons why the handoff incidents happened were as a result of deficient handoff and the absence of any handoff program.
Handoff
Handoff refers to the transfer and acceptance of responsibility for caring for a patient, and it is achieved through effective communication. The handoff process usually occurs in real-time, whereby a caregiver communicates information about the patient to another caregiver to ensure continuity and safety of the patient’s care (The Joint Commission, 2017). As such, the handoff is an essential aspect of patient care and thus the need to improve it.
In a variety of settings, the handoff process is usually key. The number of medical errors that have been witnessed over time as a result of miscommunication has seen several health care institutions conducting a concise handover with essential information (Ma et al., 2016). As such, a study was conducted in four settings to investigate the strategies employed during handoffs. The four settings included a nuclear power plant, NASA, an ambulance dispatch center, and a railroad dispatch center. These four settings were very similar to a healthcare setting where complexity, interconnectivity, resource constraint, and time pressure are the norm (Patterson et al., 2019). Observational data were collected for evidence of 21 handoff strategies. Based on the varied findings, the study concluded how handoffs occurring in high consequence settings could be replicated in the healthcare sector to improve patient safety. Since the study did a similarity examination of the handoffs between the four settings and healthcare, the study failed to explore each strategy’s effectiveness as observed in the different settings and how they could be effective in the healthcare sector.
A study aiming to standardize the process of handoff and thus improve the safety of patients and reduce end-of-shift overtime was conducted within four years. The study did incorporate the use of continuous performance improvement (CPI) methodology (Bereskie et al., 2017). CPI is the methodology that is vital in facilitating the improvement of work methods, improving quality outcomes, standardizing work, and identifying waste. Before the implementation of the standardized handoff worksheet, the researchers observed the handover process. The study observed that the handoff process took 6-42 minutes to be completed (Klee et al., 2012). The handoff worksheet thus had to be redesigned to accommodate the needs of the staff. After the redesigning, the standardized worksheet was implemented and data from the handoff process were collected. Within a week of the implementation, 87% of the staff were following the standardized method with 70% of the staff completing the handoff process within 30 minutes (Klee et al., 2012). The end-shift overtime was reduced and the data collected indicated sustained improvements in safety checks.
Patient Safety: A Burning Issue in the Health Sector
The demand for quality medical services has continued to grow globally, and it has even surpassed the cost associated with them. Deloitte Global has reported that presently 12.6% of the total global domestic product (GDP) is spent on healthcare (Melvey and Slovensky, 2017). The study estimated that the share is expected to rise by 3.6 percent and reach $9.3 by 2020. But even with these massive investments in the healthcare industry, a wide variety of studies have suggested that patient safety has not been addressed adequately (Wojciechowski et al., 2016). As such, it is a hot topic amid all these developments.
The Institute for Safe Medication Practices Canada (ISMPC) advises healthcare facilities to accord the highest priority to patient safety (Hee et al., 2019). Any slight negligence in providing the needed attention can erode consumer trust in healthcare, thereby escalating medical costs, among many other unforeseen circumstances.
The patient’s life may be at risk due to medical errors that may arise from different quotas. Handoff communication is one of the quotas upon which medical error can occur (Abbasi, 2020). Nurses are always charged with the responsibility of providing care to patients (Nadine et al., 2020). As such, it is always logical that as one ends his or her shift, he or she is supposed to brief his colleague on anything concerning the patients to be well conversant with what might be required of him in case anything happens.
The project’s focus will be on implementing SBAR and evaluating its effectiveness through the use of CEX. To the Temple University Hospital, the SBAR technique’s implementation to help will solve handoff is a change that needed consultation before initiation (Horwitz et al., 2013). Several guidelines will be provided on how best to implement the SBAR technique. Growth will be a new thing at Temple University Hospital, especially among the nurses who lacked effective communication skills to enable an effective handoff.
Application of SBAR in Patient Handoffs
SBAR has always demonstrated its effectiveness in improving communication in various settings (Muller et al., 2018). The US Navy developed SBAR to help them with the standardization of critical and urgent communications in nuclear submarines (Jeong & Kim, 2020). Its use in the Navy setting was so significant that it gained a lot of audience in the non-military environment (Nagammal et al., 2016). The implementation of SBAR in the healthcare environment was first done at Kaiser Permanente, Colorado (Allen, 2016). Since then, the technique has become synonymous with communication in the sector. Many organizations have found the technique useful since its format captures crucial information and streamlines communication, useful for all sorts of inter-staff interactions (Achrekar et al., 2016). SBAR serves as a useful tool that standardizes communication, enhances provider empowerment, and promotes patient ownership (Shahid & Thomas, 2018). This wide range of use of SBAR has thus given the technique a lot of prominences not just in the healthcare sector but also in the other sectors such as the transportation sector.
SBAR is the chosen system since it provides an excellent framework for communication. The system serves as an empowerment tool that offers opportunities to ask all questions, ensure the relied information is understood, and formulate a care plan (Kilic et al., 2017). Handoff involves exchanging information and transfer of responsibility and accountability and, by far, a teaching opportunity.
Chapter Summary
In conclusion, the review of literature acknowledges the importance of the handoff process in safeguarding the safety of patients. The literature reveals critical information concerning the benefits of implementing a standardized SBAR tool for the handoff process. Since several studies focus on physician and nurse handoff, much study is still needed on a nurse-to-nurse handoff and how it can be affected using the SBAR technique. As such, the study’s focus on implementing SBAR to help in nurse-to-nurse handoff communication will help add to expand knowledge on the utilization of SBAR. Based on that, chapter three of this study will focus on discussing how the data will be collected. The research design that will be used and the sample study.
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