Embedding SBAR into Care homes - KSS AHSN · Embedding SBAR into Care homes Dr Iain Wilkinson Dr Natalie Broomhead Surrey and Sussex Healthcare NHS Trust . SBAR Education through

SETS Course

‘SETS’ Embedding SBAR into Care

homes

Dr Iain Wilkinson

Dr Natalie Broomhead

Surrey and Sussex Healthcare NHS Trust

SBAR

Education through

Technology and

Simulation

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

SBAR

• Situation

• Background

• Assessment

• Recommendation

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

course

Simulation

Training Podcasts.

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

The e-learning module

SBAR

• Situation

• Background

• Assessment

• Recommendation

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

Video 1

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

VIDEO 2

Course materials

• Work book

• Pad of SBAR forms

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

Word Cloud

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

Podcast example

SETS Course

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