Improving JMO clinical handover at all shift changes - ARCHI

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Key elements for implementation1. A communication frameworkto facilitate clinical handoverat JMO shift change (ISBAR)The ISBAR framework represents a standardised approachto communication which can be used in any situation.ISBAR is based on ‘SBAR’ a system which was developedby the US Navy for use in nuclear submarines.ISBAR stands for Introduction, Situation, Background,Assessment and Recommendation. 7A communication framework increases the consistencyin the delivery of information. As yet, there is no evidenceproving that one mnemonic is the gold standard. ISBAR isrecommended because:What, and how much, clinicalinformation should I hand over?Appendix D has a summary to provide guidance on theclinical information that should be considered whenhanding over specific patient types:• Medical• Surgical• Paediatric• Psychiatry• Obstetrics and Gynaecology• Emergency Department.Sufficient clinical information must be handed over toensure transfer of responsibility and accountability forpatient care.• It is well recognised in the current Safe ClinicalHandover implementation plans of a number ofHealth Services• It aligns with Between the Flags and DETECT training• It is portable, memorable and easy to use• It helps you to organise what you’re going to say• It is a generic communication framework that isapplicable to both clinical and non-clinical settings• Consistency of practice will benefit Junior MedicalOfficers who often move between facilities andHealth Services.Patients who are less stable or have changingmanagement plans may require a detailed handover,while others who are relatively stable and with feweroutstanding tests or actions can be summarisedmore quickly.Senior clinician supervision at clinical handover isimportant to help JMOs decide which patients, how muchand which clinical information needs to be handed over.(See page 11 for further assistance.)See Appendix D for more detail on the clinical informationyou should be considering at handover.ISBAR templates are available to download:http://www.archi.net.au/e-library/safety/clinical/nsw-handover6 NSW Health Improving JMO clinical handover – Implementation Toolkit
Hand over relevant clinical informationin the ISBAR framework…IIdentificationIdentify yourself, the patient and who youare talking to.“I am (name and role), from (ward/facility) andI’m calling regarding (multiple patient identifiers,such as; name, age, gender, Ward/bed, MedicalRecord Number)”S SituationState the patient’s diagnosis/reason foradmission and the current problem.“The situation is that I have a patient (age/gender), who is (diagnosis/deteriorating/stable).My concerns are (clear and succinct concerns). Thecurrent presenting symptoms are (clear, currentand relevant symptoms and observations).”B BackgroundWhat is the clinical background or context?By way of background (Give pertinent informationwhich may include: Date of admission / presentingsymptoms / medication / previous recent vital signs/ test results / status changes)A AssessmentWhat do you think the problem(s) is?(Don’t forget to have the current vital signsand a key problem list ready!)“My assessment on the basis of the above is thatthe patient is….. they are at risk of….. andin need of….”R recommendationWhat are you asking the person to do?“My recommendation is that this patient needs(what test/action) by (who) within (timeframe)”Repeat to confirm what you have heard.Eg “I understand that I am to…. and you will…”2. Senior leadership:deciding who and what tohand over at shift changeAt the end of handover, the JMO receiving handovershould have a clear understanding of:• sick, deteriorating and unstable patients• outstanding actions, procedures, tests or resultsto be reviewed• other important factors that will impact work onthe following shift.JMOs are at the beginning of their careers and aredeveloping their clinical experience and knowledge base.The leadership and supervision by senior clinicians isessential to help JMOs provide effective clinical handover.Senior clinicians are defined as:• Registrars• Career Medical Officers• Consultants• Staff Specialists• Visiting Medical Officers• Senior Nurses.Senior clinicians have experience that can help JMOsdeliver the most important key messages for effectivetransfer of patient care in a complete yet concise manner.The leadership roles required from senior clinicians include:• oversee and implement handover processes• attend and lead handover at JMO shift changes• understand the signs and symptoms of deterioration• recognise clinical risks and convey these conceptsto JMOs• prioritise which patients and what information ishanded over• Involve JMOs in clear prioritisation of patients andallocation of tasks.Some examples of how senior leadership for JMOhandover can be demonstrated include:NSW Health Improving JMO clinical handover – Implementation Toolkit 7
Page 2 and 3: NSW DEPARTMENT OF HEALTH73 Miller S
Page 4 and 5: ContentsAt a glance................
Page 10 and 11: • Senior Medical Officers involvi
Page 12 and 13: 3.1 Handover happensClinical handov
Page 15 and 16: AppendicesAppendix AA clear case fo
Page 17 and 18: The implementation of structured an
Page 19 and 20: Appendix DClinical information to c
Page 21 and 22: Most of the fundamental information
Page 23 and 24: The framework below is a framework
Page 25 and 26: Existing guides:IMPLeMeNTATION TOOL
Page 27 and 28: CD and Video supportJMO clinical ha
Page 29 and 30: Useful referencesThe JMO clinical h
Page 31 and 32: The Acute Care Taskforce tested all
Page 33 and 34: This document can also be downloade

Improving JMO clinical handover at all shift changes - ARCHI

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