Patient Safety Leaders transform handovers at George Eliot

Ward staff and patients at George Eliot Hospital in Nuneaton are reaping the rewards of
investing in training for patient safety improvement.

Ward Senior Sister Louise Jacox was among a cohort of senior nurses and others with a role
in safety improvement who attended the NHS Institute for Innovation and Improvement’s
Patient Safety Leaders (PSL) programme.

The PSL programme is delivered in three modules over six days. It provides practical
guidance on safety improvement tools and techniques. A key part of the programme is to
help delegates identify an area for improvement within their own organisations and support
them as they devise an improvement project to put in place when they return to work.

Louise worked with Alison Cole to introduce a standardised communication tool for use
during nursing handovers on the Bob Jakin Ward for vulnerable adults. Alison works for the
NHS Institute and attended the same PSL programme as Louise.

Historically, handovers on the ward had suffered from a number of shortcomings. They were
taking too long and information given was often inconsistent or incomplete. Healthcare
Support Workers (HCSWs) indicated that handovers were far more detailed than they
required to undertake their role.

This was having a negative impact on morale but, most importantly, on patient safety. It was
noted that patients most commonly tended to have falls early in the morning when
handovers were being conducted.

By changing the way handovers were done, staff time was released to ensure more HCSWs
were on the ward to look after patients during morning handovers.

The approach Louise and Alison used was to modify an existing structured communications
tool – SBAR – for use during handovers.

SBAR stands for Situation, Background, Analysis, Recommendation and was originally
developed by the US military but has subsequently been adapted for use in healthcare.
SBAR is now widely used for handover and escalation scenarios in NHS settings around the
country.

Following the example of a number of healthcare organisations in Australia, they added two
new elements to SBAR to highlight the importance of correctly communicating the patient’s
identity (I) and latest observations (O) – to create the ISOBAR model. Handovers were
streamlined so that HCSW were only present for the parts of handover relevant to their role.
As the following charts demonstrate, the result was significantly reduced handover times,
both for the whole ward team and for HCSWs in particular:
 Total Trained Staff Minutes for Handover - Bob Jakin Ward
(No. trained staff x handover minutes)
Total Minutes Trained Staff
Average Minutes Trained Staff at Handover
LCL Trained Staff Minutes
250

214.51
Trained Staff Handover Minutes

200
PDSA 1
ISOBAR PDSA 2
Handove Separate
150 r HCSW
Handover
123.79
128.00
108.36
100
92.94

50
41.49

Date and Shift

Total HCSW Minutes for Handover - Bob Jakin Ward

(No. HCSW x Handover Minutes)
Total Minutes HCAs Average Minutes HCA at Handover
LCL HCA Minutes UCL HCA Minutes
300
PDSA 1 268.13
Total HCSW Handover Minutes

250 ISOBAR
Handover
200
PDSA 2
160.00 Separate
150
HCSW
Handover
100

50
51.87 22.95
13.64
0 4.33

Date and Shift

Additional benefits include 100% compliance with VTE assessment reporting and no
complaints relating to communication or patient care have been received on the ward since
ISOBAR has been implemented. One relative who had been considering litigation in relation
to a complaint about the ward dropped their complaint after seeing the new system working.
The Care Quality Commission (CQC) also complemented the new system during a recent
audit.

Louise said: “There is no doubt that using ISOBAR has had a positive impact on patients
and ward staff alike. Handover times have been significantly reduced and patient falls seem
to be showing a downward trend.

“The way the whole team was engaged in the process of developing and implementing the
new system and then measuring the results has also been morale boosting and that also
has a positive beneficial knock-on effect for patients who have a better experience when
been looked after by well motivated staff who are working together to make improvements
happen.

“It wasn’t easy getting everyone on board to begin with but now everyone in the team can
see the difference ISOBAR is making and is now right behind it.

“Using the learning gained from the PSL programme and working in tandem with Alison has
been key to making this happen. I would recommend the PSL programme to anyone who
wants to make a practical, positive difference to patient safety in their own trust.”

Alison is now working with the NHS Institute to promote and further develop the PSL
programme and, as a former delegate, is convinced of its value.

“I learnt a huge amount from the PSL programme and, later, when putting the learning into
practice on the ground. The programme does contain theoretical elements but also provides
practical tools and techniques which help staff go away from the programme and apply their
newly gained knowledge when they get back to work.

“George Eliot is one of a number of hospitals who have sent several members of staff
through the PSL programme. That is an excellent way to build the capacity and capability
needed to really make a difference to safety improvement on ward, departmental and
organisational levels.”

Becky Bartholomew is Deputy Director of Nursing for the hospital. She added: “We are
convinced of the value of investing in the PSL programme for key members of staff across
the trust.

“The project on Bob Jakin ward is a very good example of how we are beginning to see the
benefits and reap the rewards of investing in staff training and development of this kind. The
PSL programme is particularly applicable to nursing staff but can also be of benefit to other
staff with a role in safety improvement and I would strongly recommend it.”