Amanda, Davies

Assignment: From the article, deduce the following:  Implementation, Evaluation, Implementation Barriers, and  Questions to Think About, using the exemplar as a guide.

1) Implementation Through: The Transtheoretical Model: Stages of Change 

· Precontemplation

· Discuss report issues with charge nurses and harvest nurses, asking them for ideas.

· Contemplation

· Charge and harvest nurses sit with knowledge of the problem. Offer them research on SBAR.

· Present plan to stake holders. Invite CNO, directors, harvest nurses and PCTs.

· Preparation

· Supply staff with SBAR templates, offer in-services on SBAR communication education, and educate on SBAR during pre-shift meetings.

· Action

· Implement SBAR template during hand-off report.

· Maintenance

· Continue buy-in from harvest nurses and other staff by asking them to help personalize the form for the unit

· Set performance goals related to hand-off associated errors.

· Highlight problems related to hand-off report during pre-shift report and how SBAR could circumvent those.

Evaluation
Desired Outcome	Actual Outcome	Maintain Goals and Desired Outcomes
· Lower amount of time giving report by < 45 minutes · Implement standardized SBAR throughout the unit, structuring the process  · Nurses will be able to demonstrate standardized process of hand-off report · Statistical significance in decreasing the rate of communication errors that leads to errors in patient care	· Amount of time giving report has decreased by using a standardized process (Stewart & Hand, 2017)  · Standardized process of giving report increased efficiency of verbal communication (Stewart & Hand, 2017)  · Decrease in the rate of callbacks for information clarification (Robins & Dai, 2017) · Use of the SBAR tool during handoffs in a quasi-experimental study decreased the proportion of incident reports related to misunderstanding, misinterpretation, or omission of information from 31% to 11% (Stewart & Hand, 2017	· Provide continuous education throughout clinical experience on usage of the standardized process of giving report (Stewart & Hand, 2017)  · Standardized process for reporting reduces hierarchical barriers (various career stages) increases confidence of the users, decreases length of report time and accuracy of exchanged information. (Stewart & Hand, 2017)

3) Implementation Barriers

· Medical personnel have personal bias on giving report (Ghosh et al., 2018) 

· Different nurses have different approaches to how they perform report (Ghosh et al., 2018)

· Some staff are unreceptive to change (Robins & Dai, 2017) and it is difficult to [enforce a change in practice for long time staff (Eberhardt, 2014) 

4) Questions to Think About

· Why is SBAR preferred to personalized hand off reporting?

· What limitations do you think SBAR represents when giving report?

· Is it more beneficial to use a single standard SBAR tool or to personalize the tool to match specific units? Why?