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Interactive Handover What should I be worried about ? Quality Measurement in ICU Feasibility study & knowledge translation Wrae Hill & Lenora Marcellus BC-PSQC Quality Forum 2015

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Context : 80 % of serious adverse events related to poor communication We know surprisingly little about something we do all the time

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Problems: Critical incidents associated with handovers No standard for handover processes No expectation of interaction Nursing shift change overlap not funded Common Hill, W. (2012) Time for a Change in Change of Shift Report QI study conducted across Interior Health and presented at the 2012 BC Quality Forum Rare

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How do experts communicate ? Hill, W (2010) Cognitive Human Factors in ICU Techniques clinicians report that they use to develop their anticipation, intuition and foresight at change of shift report (CoSR). CJRT 46.4 ICU Receivers ask anticipatory questions : What are you worried about ? What should I be worried about ? Expert Physicians/ Nurses/Respiratory Therapists ask anticipatory questions and learn ; Interdependence Brevity vs. Relevance for receiver How to perceive each others subtle signals. Shared mental model of evolving risk to get On the same page Hollnagel 2010 - Resilience Engineering

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HISTORY ANTICIPATE WHAT MIGHT OCCUR WHAT SHOULD I WATCH OUT FOR ??

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Hill, W., Marcellus, L. Et al (2014) Interactive Handover - What should I be worried about? Quality Measurement in ICU Measures : Interactive Handover Quality Score (IHQS) Pre : Post CoSR 69 RNs, 32 RRTs 15 Charge RN 2 ICU settings

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High PreHigh Post Improved Post IDRAW Low Pre IDRAW Modest improvement

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Interactive Handover (4:22) https://www.youtube.com/watch?v=GSHcub4K-uk Interactive Handover KT / Implementation Handover Quality Feasibility Study: 1.Measurable by direct observation using IHQS 2.Where it is low, it may be improved using IDRAW, (Increased quality in less time) 3.Structured interaction : quality / less time ? Next Steps : Research Safe Communication Curriculum + Sim Labs (UBC/UBC-O/UVIC/BCIT) http://www.cw.bc.ca/onlinecourses/development/ubc/sph2014/http://www.cw.bc.ca/onlinecourses/development/ubc/sph2014/. Implementation: Effective Verbal Communication CPGs (2 pgs ea) Verbal Handovers ID / Relevant concise story/ Active receiver Urgent Communication (SBAR) appropriate assertion / Clear request iLearn videos Peer to Peer - Social Contagion Physicians & Nurses co-create their videos to model behaviours

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AVIATION SAFETY Standard phraseology 15 sec Verbal burst @ transitions Active receiver Type/ Identity/speed/ Direction/ Altitude/ ETA HEALTHCARE COMMUNICATION SAFETY Standard phraseology (IDRAW ?) Short Verbal burst @ transitions 1.Identity (Pt & MRP) 2.Relevant concise story 3.Active Receiver (What should I be worried about ?) Implement by peer-peer spread Role model (Hospitalists/ Nurse Educators/ TLNs) Teach in orientation/ CME & Simulations Contact: Wrae Hill MSc RRT FCSRT wrae.v.hill@interiorhealth.ca / Lenora Marcellus PhD RN lenoram@uvic.cawrae.v.hill@interiorhealth.calenoram@uvic.ca

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1.Alvarado,K., (2006) Transfer of Accountability: Transforming Shift Handover to Enhance Patient Safety, Healthcare Quarterly, 9(Sp) 2006: 75-79Alvarado,K., Healthcare Quarterly, 9(Sp) 2006: 75-79 2.Berger,J. (2013) Contagious: Why Things Catch On (Simon & Schuster) 3.Foster, S. & Manser, T. (2012a). Effects of patient handover characteristics on subsequent care: A systematic review and implications for future research. Academic Medicine, 87 (8), 1105-1124. 4.Frankel, R.M. (2012) Context, culture and (non-verbal) communication affect handover quality BMJ. BMJ Qual Saf 21:i121i127 5.Handoff of Care 2012 Frequently Asked Questions - Virginia Health System http://www.healthsystem.virginia.edu/internet/e-learning/handoff_faq.pdfhttp://www.healthsystem.virginia.edu/internet/e-learning/handoff_faq.pdf 6.Hill W., Nyce,J. (2010a) Human Factors in Clinical Shift Handover Communication (Review) Canadian Journal of Respiratory Therapy 46.1 Spring 7.Hill,W. (2010b) Cognitive Human Factors in ICU Techniques clinicians report that they use to develop their anticipation, intuition and foresight at change of shift report (CoSR) Canadian Journal of Respiratory Therapy 46.4 Winter 8.Hill (2012c) - Handover Communication - Direct observation of Change of Shift Report (CoSR) Assessment of current state on 26 units at 11 hospitals in Interior Health Interior Health Patient Safety Report 2011, Poster BC Quality Forum 2012 9.Hilligoss B, Moffatt-Bruce, S.D. (2014) The limits of checklists; Handoff and Narrative thinking, Downloaded from qualitysafety.bmj.com on April 12, 2014 10.Hollnagel, E. (2010). Exploring resilience: What is it? Why is it important for healthcare? How resilience can point to critically needed solutions in healthcare. Beyond High Reliability: Improving Patient Safety Through Organizational Resilience. June 3-4, Vancouver, Canada. 11.Horwitz, L,I,.Moin,T.,Krumholz,H..,Wang,L.,Bradley,E.H. 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