Evidence-Based Practice Change Process on communication between nurses, physicians, and patients

Evidence-Based Practice Change Process on communication between nurses, physicians, and patients
Week 6 Assignment:  EBP Change Process form
ACE Star Model of Knowledge Transformation
Follow Nurse Daniel as your process mentor in the weekly Illustration section of the lesson.

Name: _____________________

Star Point 1:  Discovery (Identify topic and practice issue)

Identify the topic and the nursing practice issue related to this topic. (This MUST involve a nursing practice issue.)

The quality of communication in interactions between nurses, physicians, and patients has a major influence on patient outcomes. Failures in communication, especially during handoffs are among the common causes of adverse events in healthcare (Galatzan & Carrington, 2018). Poor communication between nurses and providers can occur either intentionally or unintentionally leading to issues in patient safety. For instance, shift report handoffs among nursing teams are dependent on effective communication. Despite this understanding, communication breakdown is common among nurses leading to poor quality outcomes and patient safety events in healthcare.

Briefly describe your rationale for your topic selection. Include the scope of the issue/problem.

Communication breakdown in healthcare is the main cause of adverse patient outcomes, especially in handover situations. Healthcare can be very unpredictable, complicated, and stressful because of the large volumes of patients seeking healthcare services. The unpredictability of patient conditions can cause pressure on nurses and other providers leading to poor communication. Sometimes too much information needs to be communicated to other healthcare providers within a short period. During these situations, failure to provide the right information can translate to poor patient care causing errors in medication and other performed procedures. Poor communication is observed to cause up to more than 60% of all hospital adverse events (Muller et al., 2018). Sometimes poor communication can result in morbidity and mortality during critical events, especially in intensive care units and perioperative units. To overcome these issues, communication strategies that take little time to complete while providing comprehensive information are required.

Star Point 2:  Summary (Evidence to support need for a change)

Describe the practice problem in your own words and formulate your PICOT question.

There are paradoxes in communication during handoffs among nurses and other healthcare teams. Inadequate provision of patient health information during the exchange of shifts among nurses occurs when there no communication protocol. For example, the communication of patient information should be done at the bedside to allow adequate assessment and understanding of the patient’s condition. While sharing patient information, the nurses must address the critical points of the patient including background information, current management, and recommendations for subsequent care. The use of communication tools such as SBAR (situation-background-assessment-recommendation) is recommended by professional organizations to guide handoff reports for nurses and other healthcare providers. The use of such tools can greatly improve the communication process in nursing and help in improving quality and patient safety.

PICOT Question

Among patients in long-term care facilities (P), what is the impact of standardized SBAR communication (I) compared to non-standardized verbal communication (C) on improving patient safety (O)?

List the systematic review chosen from the Cochrane Database of Systematic Reviews from the Chamberlain library. Type the complete APA reference for the systematic review selected.

Müller, M., Jürgens, J., Redaèlli, M., Klingberg, K., Hautz, W. E., & Stock, S. (2018). Impact of the communication and patient hand-off tool SBAR on patient safety: A systematic review. BMJ Open8(8), e022202. https://doi.org/10.1136/bmjopen-2018-022202

List and briefly describe other sources used for data and information. List any other optional scholarly source used as a supplement to the systematic review in APA format.

Galatzan, B. J., & Carrington, J. M. (2018). Exploring the state of the science of the nursing hand-off communication. Computers, Informatics, Nursing : CIN, 36(10), 484–493. https://doi.org/10.1097/CIN.0000000000000461

This research aimed at analyzing the state of science on nurse-to-nurse communication of patient information during handoffs. The synopsis review analyzed articles describing the use of standardized communication tools during nursing handoffs. It was observed that standardized handoff tools increase nurse satisfaction with the structure and consistency of the handoff. The use of electronic health records (EHRs) for handoffs was not adequately addressed in the reviewed articles. Additionally, it was observed that the areas of memory, cognition, and content of the handoff affect the transfer and recall of shared information during handoffs.

Shahid, S., & Thomas, S. (2018). Situation, background, assessment, recommendation (SBAR) communication tool for handoff in health care–A narrative review. Safety in Health4(1), 1-9. https://doi.org/10.1186/s40886-018-0073-1

Sharing patient-specific health care information during handoff requires situational awareness. A narrative review was performed to analyze the use of SBAR communication in healthcare. The research focused on the challenge of communication among healthcare providers, the use of SBAR communication during handoffs, and the comparison of SBAR to other communication tools. The key findings from the review suggest that SBAR is a reliable and validated communication tool that has shown a reduction in medical errors and has improved communication among healthcare providers. When comparing SBAR to other tools, there was no difference in workload, duration, and the amount of information required for handoff. It was observed that the SBAR communication tool paused challenges in its use, especially for patients with complex medical histories and busy units like the ICUs. To conclude, the researchers noted that the SBAR communication tool is a structured communication tool that has shown a reduction in adverse events in a hospital setting.

Institute for Healthcare Improvement. (n.d.). SBAR tool: Situation- Background- Asssessmnet- Recommendation. http://www.ihi.org/_layouts/15/ihi/login/login.aspx?ReturnURL=%2fresources%2fPages%2fTools%2fsbartoolkit.aspx

This source provides information about the recommended SBAR communication tool by the Institute of Healthcare Improvement (IHI). It outlines the practice guidelines for the successful implementation of the SBAR communication strategy for physicians and other healthcare providers. Additionally, a standard SBAR communication tool outlining the four steps and necessary information is presented to guide the communication process in healthcare.

Briefly summarize the main findings (in your own words) from the systematic review and the strength of the evidence.

A systematic review of articles published on SBAR was performed in PUBMED, EMBASE, CINAHL, Cochrane Library, and PsycINFO. Eight studies to improve communication and patient handoffs met the inclusion criteria. Upon completion of the review, moderate evidence for improved communication through SBAR communication was observed. When used to structure communication over the phone, SBAR communication was effective in addressing patient issues between nurses and physicians (Muller et al., 2018). One strength of the systematic review is the inclusion of numerous research articles from an array of the database. The systematic review delivers a comprehensive overview of the available evidence on SBAR communication including statistical analysis to identify the main themes of the subject area. Lastly, the researchers identified the limitations of the study and implications for nursing practice and research.

Outline one or two evidence-based solutions you will consider for the trial project.

The evidence-based solution I will consider for the trial project is the use of the SBAR tool to improve communication among nurses during shift handoffs. The SBAR format provides a structured and standardized process to communicate care during routine management of patients and emergency service delivery. The tool provides an easy method of transferring patient information while addressing the critical aspects of patient care across all healthcare units. From the above evidence, the SBAR tool improved medication reconciliation and promoted the reduction of medical errors leading to improvement of patient safety (Shahid & Thomas, 2018). Additionally, the introduction of the tool in various healthcare organizations has demonstrated a reduction in mortality rates, hospital readmissions, and consequently cost reduction. I believe using the SBAR format will address the communication problem in the facility and improve patient safety.

Star Point 3:  Translation (Action Plan)

Identify care standards, practice guidelines, or protocols that may be in place to support your intervention planning (These may come from your organization or from the other sources listed in your Summary section in Star Point 2).

To foster communication between healthcare providers, the Institute for Healthcare Improvement (IHI) recommends the use of SBAR communication. According to the organization, SBAR is an easy-to-remember, concrete mechanism useful for framing any conversation, especially critical ones, requiring a clinician’s immediate attention and action (IHI, n.d.). The organization has produced a standardized SBAR communication tool and guidelines for communicating with physicians using the SBAR process. For instance, communication using SBAR should be done using direct paging, physician call services, or using phone calls. The IHI recommends that providers should wait no longer than five minutes between attempts to communicate. Secondly, the healthcare provider should communicate following the SBAR process -situation, background, assessment, and recommendation. Documentation of the change in the patient’s condition and physician notification should conclude the communication process.

List your stakeholders (by title and not names; include yourself) and describe their roles and responsibilities in the change process (no more than 5).

Registered Nurses: As the largest members of the healthcare team, nurses are crucial during the implementation of change in any healthcare organization. The RN will participate in education and training for the new change process that will involve SBAR communication. They will then use the SBAR tool to communicate during shift handoffs to ensure quality patient care and achievement of patient safety.

Administration Unit: The hospital administration is responsible for making policies and designing processes to guide quality improvement in healthcare. This team will approve the new change process, provide guidance during the implementation phase and give financial assistance necessary to implement the change in the organization.

Project Manager: I will be the project manager to ensure the implementation of the new change in the organization. My roles will include explaining the purpose of the project to other stakeholders, monitoring the change process, and evaluating outcomes upon completion of the project.

What specifically is your nursing role in the change process? Other nursing roles?

My specific nursing role in the change process will be monitoring the implementation of the project and assessing the outcomes. Through the monitoring process, I will be able to determine whether the new change leads to quality improvement and patient safety. Other nursing roles I will assume include problem solving during the project and decision making upon completion of the change process. I will collaborate with the administration to design policies that will improve communication among nurses in the facility upon successful implementation of the change.

List your stakeholders by position titles (charge nurse, pharmacist, etc.).Why are the members chosen (stakeholders) important to your project?

Charge Nurse: The charge nurse in respectful nursing departments will monitor shift handoffs to ensure the guidelines for SBAR communication are followed.

Nurse Educator: The nurse educator will organize education and training for nurses regarding SBAR communication. The individual will also plan for continuous quality improvement on the communication aspect upon successful implementation of the project.

What type of cost analysis will be needed prior to a trial?  Who needs to be involved with this?

The first aspect of cost analysis will involve the cost of implementing the project to the organization. An analysis of the total expenditure including education, training, purchase of material, and discussion of changes will be made. Secondly, the long-term benefit of the new change to the organization will be done. Costs on reduction of medication errors, length of stay, and readmissions following the new change will be done. To effectively perform the cost-analysis process, the hospital administration and the finance department will be involved. These stakeholders have knowledge and expertise on the cost of the new change in the organization.

Star Point 4:  (Implementation)

Describe the process for gaining permission to plan and begin a trial.  Is there a specific group, committee, or nurse leaders involved?

The first step of gaining permission for the trial will involve presenting my proposal to the hospital administration. To strengthen my approach, I will reach out to the clinical nurse educator to help improve the organizational understanding of the need for the new change. Through the organization’s research unit, I will gather information on the challenge of communication and its impact on patient safety. This information will help the decision-makers in accepting the project.


Describe the plan for educating the staff about the change process trial and how they will be impacted or asked to participate.

The first step in my plan will involve increasing awareness of the need for change in the organization. I will publish reports on the problem of communication and provide materials to staff. The second approach will involve the nurse educator to plan for education and training of nurses on SBAR communication. The IHI SBAR communication strategy will be used to educate staff on the new change and how to effectively use the tool. To engage the staff, I will request the support of the nurse leaders like the charge nurses and the administration unit because their influence will ensure the engagement of staff.

Outline the implementation timeline for the change process (start time/end time, what steps are to occur along the timeline).

The implementation process will take four weeks. Week one of the project will involve seeking permission from the administration, creating awareness of the new change, and communicating the strategy to nurses. Week two will involve the identification of required resources, education, and training of staff on the new change. Week three will involve the actual implementation of SBAR communication across all nursing units in the organization. During week four, a discussion of findings Will be done including a periodic review of the progress. A stakeholder meeting will be held to analyze the effect of the new change and any necessary changes required during the implementation phase.

List the measurable outcomes based on the PICOT.  How will these be measured?

Reduction in medication errors: The implementation of SBAR communication in the facility should translate to reduced medication errors. The EHR system will be used to assess the number of medication errors in respective units.

Improved patient satisfaction: The HCAHPS scores in the aspect of nursing communication should improve upon the effective use of SBAR communication in the facility. The improvement of the scores will be measured by comparing the current with the previous survey scores.

What forms, if any, might be used for recording purposes during the pilot change process. Describe.

To effectively monitor the communication process, the charge nurses will use an SBAR checklist to ascertain all aspects are addressed fully. The forms will be used to evaluate the understanding of the nurses about SBAR communication and whether the IHI guidelines are followed.

What resources are available to staff (include yourself) during the change pilot?

During the change process, I will be available to ensure the strategy is implemented including solving any problems that may arise. I will collaborate with the nurse educator and the charge nurses to provide guidance to staff that might find the process challenging. Secondly, the IHI SBAR communication tool will be available in every department for reference and to remind staff of the required aspects of communication.

Will there be meetings of certain stakeholders throughout the trial?  If so, who and when will they meet?

During the implementation phase, stakeholders will meet at the conference room once weekly to discuss the effectiveness of the new change. The meetings will also serve to identify challenges and recommend possible changes to the new communication model. The weekly meetings will involve the charge nurses, administrator, clinical nurse educator, RN staff representatives, and the project managers.

 Star Point 5: (Evaluation)

How will you report the outcomes of the trial?

The first method of reporting the outcome will be through the hospital administration. The administration will write internal memos to the charge nurses to communicate the findings to other staff members. The second method will involve printed material disseminated through posters and hospital noticeboards. Lastly, the organizational website will be used to communicate the outcomes to staff, patients, and the community.

What would be the next steps for the use of the change process information?

The success of the project will indicate the need for the adoption of the communication strategy in the organization. I will liaise with the hospital administration to propose policies that will ensure the adoption of SBAR communication across all nursing units. If the pilot study does not yield the expected results, the whole change process will be analyzed carefully to identify areas that could be rectified to achieve desirable outcomes. Other evidence-based strategies to improve communication in the organization will be explored and new plans made to implement change.

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