Patient Hand Off Tool Kit Public Information Educational Resource Committee SBAR-Situation...

Patient Hand Off Tool Kit

Public Information Educational Resource Committee

SBAR-Situation Background Assessment Recommendations

http://www.mbemsc.org/

Problem

An estimated 80 percent of serious medical errors involve miscommunication between caregivers when patients are transferred or handed-off.

http://www.centerfortransforminghealthcare.org/assets/4/6/CTH_HOC_Fact_Sheet.pdf


Universal Process across disciplines

SBAR is an evidenced-based communication model developed in the military and is widely used in many industries including aviation and health care to make sure:

the right information gets to the right people in the shortest timeframe

These guidelines outline the priority information that needs to be relayed during patient care handoff to the receiving healthcare provider so that critical information is not missed.



This format emphasizes urgent concerns be brought to the forefront –Patients who meet Point of Entry protocols –should have complaint stated first

Empowers the EMS provider to advocate for the patient


These guidelines are to be used in a flexible way that meets the needs of the situation encountered

Region IV EMS Communication Policy is based on SBAR

Situation: ETA Urgent Concerns/ Point of entry pts Age Sex Chief Complaint:Background: (history of present illness) High Risk medicationsAssessment: General impressions Pertinent findings Vital signs Pain level Recommendations/Recap

Treatment provided Response to treatment and interventions Recap

Massachusetts EMS Region IV Communications Policy

Entry NotesHail Metro-Boston CMED on MED 4

CMED name x 2 Service, call sign, current level of ambulance Reason for request (Priority Level, Medical Control, ALS

entry note, BLS entry note, declaration of disaster, radio test)

Physical Location

•For Example: “Metro-Boston-CMED, Metro-Boston-CMED. This is Bedford A-2 requesting a priority one BLS entry note to the Lahey from Route 62 in Bedford”


Await channel assignment from Metro-Boston CMED (ie “Shift and acknowledge MED 3”)

Once a channel has been assigned, shift to that channel and acknowledge CMED standing by. (ie “Metro-Boston CMED, Bedford A-2 standing by on MED 3”).


Metro-Boston CMED will advise unit that the requested hospital(s) are on-line and for them to proceed with their transmission.

Make the entry note as clear, concise, and short as possible

Rule of thumb, no more than two minutes Immediately request notification of Stroke,

Cardiac, Trauma team, or other specialty services (language, vent required, etc..) if appropriate (following Point of Entry Protocols (POE)

When reporting a patient’s condition, the radio report should include the following - SBAR Format


When provider has completed entry note:

Provider should acknowledge hospital(s)

Inform Metro-Boston CMED you are leaving the assigned MED channel and returning to MED 4

Relinquish the assigned MED channel to CMED on MED 4

Transmit Call sign and time clearing assigned channel

How SBAR works….S State agency name and unit #

Point of Entry* or High Risk pt*-ETA- age and sex of the ptUrgent concerns and immediate needs upfront

B Mechanism of Injuries sustained/LOC/or Onset of illnessInclude complicated medical hx and or High Risk medications

A Vital Signs – and pertinent findings

R Treatment and patient responseRecapRequest any further instructions

Point of Entry- Trauma Adult/Pedi, Stroke, STEMI, SepsisHigh Risk Meds – anticoagulants (Coumadin,Plavix,Aspirin ect)

Let’s practice!

EMS Scenario (Example 1)

You have responded to a home for a report

of elderly female unwitnessed fall.

An 88 year old female is found on the floor, awake-

Family states heard “thud” found pt on floor –report no LOC,

Pt complaining of left hip and shoulder pain.


Left lower extremity is rotated outward, has a positive pedal pulse, warm to the touch-pink in color

Left shoulder without obvious deformity, Color Sensation normal, states-“hurts to move my left arm”

Past Medical History: osteo arthritis CVA, a-fib

Medications: Coumadin, Digoxin


Pt was placed in a cervical collar-log rolled onto back board and pillows to support LLE

Secured on backboard- ice to shoulder

Pt states uncomfortable on the board, but the ice helps

Vital Signs: B/P-172/88 HR-58(irr) Resp-18

SBAR Report…..

(assume you have Hailed CMed - and patched into receiving facility…you have identified your unit #... Proceed

Entry Note (should take no more than 2 minutes-following the region IV

policy)

Situation: ETA – 17 min Urgent Concerns/ Point of entry pts : Elderly

Trauma Age - 88 Sex – female Chief Complaint: Fall with left hip and shoulder

painBackground: (history of present illness-) Unwitnessed fall, Found on floor- left leg and

shoulder pain, family reports no LOC, pt is on Coumadin for A fib and Stroke

Entry Note (should take no more than 2 minutes-following the region IV policy)

Assessment:* General impressions: Elderly conscious female Pertinent findings: Alert- left leg rotated

outward-+ pulses, left shoulder pain-no obvious deformity

Vital signs: B/P-172/88 HR-58(irr) Resp-18 Pain level: Rates pain 5/10 Recommendations/Recap*

Treatment provided - C-spine immobilized, ice to shoulder, immobilized LLE

Response to treatment and interventions – pain improved with immobilization and ice

Recommendations – Will update with any changes-any questions?

Emergency Department Arrival “Hand Off”

Situation: Urgent Concerns/Point of entry pts : Elderly

Trauma Age - 88 Sex - female Chief Complaint: Fall with left hip and shoulder

pain

Background: (history of present illness-detailed history)

Unwitnessed fall, Found on floor- left leg and shoulder pain, family reports no LOC, pt is on Coumadin and Digoxin for A fib and Stroke

States tripped and fell-alert to baseline per family


Assessment:* General impressions: Pleasant elderly

female Pertinent findings: Alert- left leg rotated

outward-left shoulder pain no deformity, warm pink and pulses in both extremities- No c/o neck or back pain-

Vital signs: B/P-172/88 HR-58(irr) Resp-18 Pain level: Rates pain 5/10


Recommendations/Recap:* Treatment provided - C-spine

immobilized, ice to shoulder, immobilized LLE

Response to treatment and interventions – pain improved with immobilization and ice –pt states she in uncomfortable on the backboard

Recap- no changes enroute

SBAR- Interfacility Transfer

Expectations for “Hand Off” from : Acute Care Facility Rehabilitation Facilities

Skilled Nursing Facility or Community Health Center


Situation: Urgent Concerns Age Sex Chief Complaint Background: History of present illness – Include Resuscitation Status (MOLST -

Medical Orders for Life Sustaining Treatment) http://www.molst-ma.org/ Comfort Care DNR

http://www.molst-ma.org/


Assessment: General impressions Pertinent findings Vital signs Pain level Recommendations/Recap: Treatment provided Response to treatment and interventions

Recap

Scenario Example #2 You are called to a Skilled Nursing Facility-

you receive the following report from the staff:

Mr. Jones is an 76 male- transferred 1 week ago from XYZ hospital s/p left knee replacement. For the past few days he has become increasing more fatigued and agitated

He is not eating well and has intermittent fevers


Situation: Urgent Concerns –change on

mental status Age- 76 Sex - male Chief Complaint :fever change in

mental status


Background: History of present illness – 2 weeks s/p left knee replacement-

2 days hx of intermittent fevers- 99.5- 102.3

today lethargic, confused and agitated- generally alert and oriented today-sleeping not eating, agitated


Assessment: General impressions: lethargic, warm

to the touch-combative with stimulation

Pertinent findings-temp 102.3, decreased urine output, tachypnic

Vital signs – HR 102, B/P 112/60, R-28 Temp 102.3

Pain level- 5/10 flank pain


Recommendations/Recap: Treatment provided-acetaminophen

and called EMS Response to treatment and

interventions- no change at this time

Recap – 76 m, altered mental status- confused-agitated, 2 week s/p left knee replacement - fever no response to acetaminophen


EMS transports to closest appropriate emergency department

Let’s practice!

SBAR- Interfacility Transfer Entry Note (should take no more than 2 minutes-following the region IV

policy)

Situation: ETA – 20 min Urgent Concerns/ Point of entry pts :

n/a Age - 76 Sex – male Chief Complaint: fever- change in

mental status


Background: (history of present illness-)

2 weeks s/p left knee replacement – 2 days hx of intermittent fevers-

99.5- 102.3 today lethargic, confused and agitated- generally alert and oriented today-sleeping not eating, agitated


Assessment:* General impressions: Ashen in color-

lethargic, warm to the touch-combative with stimulation-

Pertinent findings: increased agitation with bilateral flank palpation, l knee wound site dry and intact, patient incontinent with foul urine-

Vital signs: HR 102, B/P 112/60, R-28 Temp 102.3

Pain level: 5/10 flank pain


Recommendations/Recap* Treatment provided – 2L Oxygen via nasal cannula ,

position of comfort Response to treatment and interventions – no

changes

Recommendations – Will update with any changes-any questions?

Emergency Department “Hand Off”

Situation: Urgent Concerns/Point of entry pts : Age - 76 Sex - male Chief Complaint: fever- change in

mental status


Background: (history of present illness-)

2 weeks s/p left knee replacement – 2 days hx of intermittent fevers-

99.5- 102.3 today lethargic, confused and agitated- generally alert and oriented today-sleeping not eating, agitated


Assessment:* General impressions: Ashen in color-

lethargic, warm to the touch-combative with stimulation-

Increased agitation with bilateral flank palpation, left knee wound site dry and intact, patient incontinent with foul urine-

Vital signs: HR 102, B/P 112/60, R-28 Temp 102.3

Pain level: 5/10 flank pain


Recommendations/Recap* Treatment provided – 2L Oxygen via nasal cannula ,

position of comfort Response to treatment and interventions – no

changes

Do you have any questions?

Thank you

References:


http://www.mbemsc.org/files/provider_info_items/Entry_NotesApproved_MADPH_OEMS_2_3_10.doc

http://www.psnet.ahrq.gov/resource.aspx?resourceID=4195

Contra Costa EMS




http://www.psnet.ahrq.gov/resource.aspx?resourceID=4195

Patient Hand Off Tool Kit Public Information Educational Resource Committee SBAR-Situation...

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