href="#fb3_img_img_e55bc146-2843-5612-920e-54c244b99a7d.png" alt="Photograph of the registered nurse catches up on safety news by reading the PMU newsletterr."/>FIGURE 4.5 Registered nurse catches up on safety news by reading the PMU newsletterr.
Source: Kary Blaschak.
I PASS THE BATON
Communication also includes the transfer of information during transitions of care, for example across units or sites of care, during shift changes, and during hospital discharge. These communication handoffs provide an opportunity to ask questions, clarify information, and confirm understanding. The tool I PASS the BATON can be used effectively in handoffs. The I PASS the BATON acronym for remembering the key components of the handoff is presented in Figure 4.6
Source: Patti Ludwig‐Beymer.
SBAR
SBAR is another helpful tool for handoffs. The acronym SBAR stands for Situation, Background, Assessment and Recommendation. Kaiser Permanente originally adapted a United States Navy tool to enhance collaboration between nurses and physicians (Institute for Health Care Improvement, 2018c). Situation refers to a concise statement of the immediate problem. Background is a brief summary of pertinent information related to the situation. Assessment refers to analysis and consideration of action options. Recommendation addresses the actions requested.
Case Study 4.3
Jean uses SBAR as a nurse in labor and delivery. When caring for Mrs. Jones, she calls the obstetrician to report, “Here's the situation. I have some concerns about Mrs. Jones' baby related to the fetal heart rate. For the past two hours the baby has had a rising baseline from 135 to 170. Now, the strip has minimal variability with no elicited fetal heart rate accelerations using vibroacoustic stimulation and position change. I need you to come and visualize this strip and assess the situation. When can I expect you?”
1 What critical information does Jean communicate with the physician?
2 How does this clear communication enhance patient safety?
3 How do you suppose the physician responded to Jean's telephone call?
Nursing and Interprofessional Teams
Health care delivery requires strong and supportive health care teams, where members monitor team function, share the workload, and support each other. TeamSTEPPS (AHRQ, 2013a, 2013b) provides team strategies and tools to enhance performance and patient safety. CRM, described earlier in this chapter, was adopted into health care from aviation to promote and reinforce the team behaviors of cooperation, coordination, and sharing regardless of formal position. It's been used to improve patient care in obstetrics, the operating room, the emergency department, and other settings (Kreiser, 2012).
To enhance patient safety and quality, many hospitals have implemented rapid response teams. These interprofessional teams are activated by a staff nurse or other clinician when a patient's condition deteriorates unexpectedly. A rapid response brings clinical experts quickly to the patient's bedside and can be implemented in a cost‐effective manner (Mitchell, Schatz, & Francis, 2014). In recognition of patient‐centered care, some facilities permit a rapid response team to be activated by patients and family members (Gerdik, Vallish, Miles, Godwin, Wludyka, & Panni, 2010).
Evidence from the Literature
Source: Adapted from Leach, L.S. & Mayo, A.M. (2013). Rapid response teams: Qualitative analysis of their effectiveness. American Journal of Critical Care, 22(3), 198–210.
Discussion: The article describes the effectiveness of rapid response teams in a large teaching hospital using grounded theory methodology. Researchers found that effective team performance included the concepts of organizational culture, team structure, expertise, communication, and teamwork. Because of inconsistency in membership, team members had little opportunity to develop relationships or team skills.
Implications for Practice
Implications for Practice. Communication between team members and managing a crisis are critical aspects of an effective response team. Team training is needed to enhance the performance of teams that work together infrequently and experience time pressure to perform.
High team performance is facilitated when nurses and other staff members are expected to and comfortable with providing both positive and constructive feedback to team members. Positive feedback is essential for reinforcing safe behavior. Clinicians perform many safe actions every day and should be recognized for that. Constructive feedback is needed to discourage and change unsafe behaviors. People tend to avoid constructive feedback because they are uncomfortable providing it. However, a simple reminder is often all that is needed to correct behavior. Constructive feedback should always be met with a thank you, and a change in behavior.
Cross Monitoring
Cross‐monitoring is a tool to assist in error reduction in teams and allows team members to monitor unusual situations or hazards, identify safety slips or lapses, and provide impromptu consultation and feedback. For example, many HROs use two‐person patient identification when administering narcotics via a patient‐controlled administration system. If the pump were set incorrectly, the patient could receive an inappropriate dose, have a respiratory arrest, and potentially die. The two‐person process is an essential safety step and reinforces teamwork when providing care.
Mutual Support
Providing mutual support to team members is the ability to anticipate team members' needs and provide assistance as needed through accurate knowledge about their workloads and responsibilities. Team members are expected to advocate for the patient. Feedback should be timely, respectful, specific, and directed toward quality improvement.
Evidence‐Based Practice
In this competency, nurses integrate best current evidence with clinical expertise and patient/family preferences and values to deliver optimal health care. Direct care nurses develop an individualized plan of care for each patient based on the evidence, patient values, and their clinical expertise. Nurse leaders design the work environment and organizational systems to support evidence‐based practice and facilitate the integration of new evidence into standards of practice. They also translate knowledge into practice and generate new knowledge for nursing practice. Providing care based on the evidence is essential for an HRO and plays a key role in fostering both staff and patient safety. Evidence‐based practice is discussed in greater detail in Chapter 10.
Quality Improvement (QI)
