Embedding SBAR into Care homes - KSS AHSN · Embedding SBAR into Care homes Dr Iain Wilkinson Dr...
Transcript of Embedding SBAR into Care homes - KSS AHSN · Embedding SBAR into Care homes Dr Iain Wilkinson Dr...
SETS Course
‘SETS’ Embedding SBAR into Care
homes
Dr Iain Wilkinson
Dr Natalie Broomhead
Surrey and Sussex Healthcare NHS Trust
Funding
• Funding from TEL funding stream of HEKSS
• Funding call to ‘reduce admissions to hospital from care homes’
• Feeding into the educational delivery already undertaken by Sussex Community Trust
– Trying to embed the use of SBAR communication into the care homes in northern-west sussex
S • Ever increasing number of older people coming to hospital
B • A program to reduce admissions to hospital was set up by
HEKSS – aiming to use Technology Enhanced Learning to do this
A • Sometimes the ‘wrong’ information gets to the ‘right’ person
leading to potentially avoidable admission to hospital
R • Setting up a 3 part TEL course to teach SBAR communication
skills
E-learning (pre-learning)
• Introducing the ideas of SBAR and the course principle
Simulation (learning)
• Short scenarios using SBAR, practical re-enforcement of the e-learning
Podcast (post learning)
• Reinforcing learning over the year
Educational rationale
• Simulation underutilised in care home staff
• Little research into its effectiveness1 in this group but rapidly emerging evidence base in other areas of healthcare
• Feedback given using evidenced based tool2
• Drawing on idea of a flipped classroom with the pre-learning an important part
Mobile Simulation Lab
• Laptop with attached webcam
• HDMI transmitter / receiver
• Portable flat screen TV
Simulation scenarios
• Needed to feel ‘real’
• To address common conditions in care homes
• Be applicable to all levels of staff
• Involvement of community geriatrician and community trust imperative
• Scenarios written and reviewed by faculty
• Feedback on specific scenarios by the first 25 participants
Scenarios
• Falls (hip fracture)
• Delirium
• Stroke and advanced care plans
• Dementia and behaviour that challenges
Scenario
• Each scenario ends with a piece of SBAR communication
– To GP
– To CPN
– To relatives
– In preparation for paramedic / ambulance call
– To staff nurse / manager
1. Does the introduction of SBAR into routine use within care home influence the numbers of patients
referred to hospital?
• Evaluation in progress
– Comparing admissions to SaSH from care homes involved in the training and those not
• compared pre and post training periods
2. Using simulation can you enhance the expertise and empower staff to ensure the ‘right’ thing happens for
their patient?
• Qualitative study with University of Surrey dept. of Higher Education
• Series of semi-structured interviews with participants who have completed all three parts of training
3. Does simulation ‘work’ better in a real life
work environment vs a simulation ‘lab’?
• Difficult to actually study
• Uptake on sessions in the simulation lab very poor – 3 sessions had to be cancelled due to low numbers
• Greater number of sessions taking place in care homes themselves – able to compare the outcomes from these and the other venues?
4. Do care home staff feel TEL is of benefit?
• Questionnaires post training
• Electronic questionnaires following all the training – exploring the impact of each section
• Interest in the use of podcasts as a learning medium for care home staff
Initial quantitative work
• N = 200 staff trained so far
0
2
4
6
8
10
12
14
16
18
20
No Yes
Simulation training previously? (first 25)
0
1
2
3
4
5
6
0 50 100 150 200
Sco
re
Participant
Overall session score (0-5)
Data presented on first 171 pl
Which part of the simulation day is
most useful? • Thematic analysis
– Great value in the discussion – enjoyed by most
– Participation in the simulation – although some reticence / fear about this people recognise the benefits
– DNAR / ACP discussion particularly leads to valued discussion
– Idea of no right / wrong in simulation
Knowledge of SBAR and its potential uses
Pre test (mean – 1-4) Post Test (mean score 1-4)
P
2.08 3.53 P<0.0001
So…
• Simulation as a training tool seems to be accepted by staff in care homes
• Staff enjoyed the discussions following the simulation as much as the practical simulation itself
Podcasts
• Recording • At the simulation sessions
• Following using ‘case-studies’ and real life examples (all anonymous!)
• Production • Professional media
company
• Will sound like a 10 minute radio programs (think radio 4…)
• Use • Reinforcing learning
that has occurred
• Wider training
• Marketing for the course
• Dissemination • Via itunes / stitcher /
radio apps etc.
• Directly to users via email / website
Conclusions
• SETS course is now up and running
• Few problems along the way!
• All numbers required now trained – few sessions still to go
• Indepth analysis to come
• Next year…
1. Smith S, Barry D. The Use of High-Fidelity Simulation to Teach Home Care Nursing Western Journal of Nursing Research 2011 35(3) 297–312
2. Kolbe et al. TeamGAINS: a tool for structured debriefings for simulation-based team trainings BMJ Qual Saf 2013;22:541-553
3. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Medical Teacher, Vol. 27, No. 1, 2005, pp. 10–28