189 Evaluation of a structured tool for escalating deteriorating patients for multidisciplinary staff in a large London teaching hospital?. (16th November 2020)

• Record Type: Journal Article
• Authors: Seetannah, Daminee; Ludwig, Dalia
• Is Part Of: BMJ leader. Volume 4(2020)Supplement 1
• Page Start: A71
• Page End: A71
• Publication Date: 2020-11-16
• Subjects: Medical personnel -- Periodicals; Leadership -- Periodicals; Medicine -- Practice -- Management -- Periodicals; Health services administration -- Periodicals; 610.68
• DOI: 10.1136/leader-2020-FMLM.189
• Languages: English
• ISSNs: 2398-631X

Abstract

Abstract : The lead sepsis nurse, chief registrar and simulation team in a large London teaching hospital have developed a digital communication tool to improve and standardise the process of escalation and handover of deteriorating patients. The tool is designed for use by the multidisciplinary team (MDT). Poor communication is a frequently cited causative factor leading to adverse clinical events, particularly in relation to escalation and handover of care. UCLH uses ISBARD (Introduction, situation, background, assessment, recommendation and decision) to facilitate and improve how we escalate and handover deteriorating patients. Our trust switched to an electronic health record system last year using the software Epic. Since the introduction of Epic, we have had two serious incidents (SIs) related to miscommunication of escalation of NEWS2 scores. Investigation of these SIs concluded that the process of escalating a rising NEWS2 score could be improved by the use of an ISBARD tool creating a common language to escalate a deteriorating patient. Therefore, we have built a quick and intuitive ISBARD smart text in Epic to use when escalating a deteriorating patient. Teaching sessions are booked for the MDT over the next few months to train staff in the environment where they will use the tool to illustrate its use. We are working with the simulation team to embed the tool in clinical SIM training. We involved the MDT in design and implementation from the outset to optimise staff engagement. If we were starting again we would involve leaders of different staff groups at an earlier stage to help promote the importance and value of the tool. Our project is to streamline staff workload and help identify high risk wards where additional support may be needed. Our tool is designed to aid communication and empower clinicians to escalate their concerns safely and prioritise patient care.