Here are some other ways the survey participants ensure that clinical nurses have the most current knowledge of symptom management, pharmacology and evidence-based practice guidelines:

• Web sites with current information
• Online articles
• Offering tuition reimbursement
• Non-required reading
• Annual needs survey to determine educational needs
• Self-directed studies
• Case conferences
• Ongoing best practices education
• Teleconferences
• Updates from QIO
• Nursing journals

The feature tool of this BPIP was SBAR—39 percent of survey participants were already using SBAR and another 37 percent are anticipating implementing SBAR. Here are some successes or barriers that participating HHAs have experienced with SBAR:

Attempted to utilize the SBAR format in a written form to fax to a physician. We are redesigning the tool to allow for multiple scenarios.

We get quicker response to requests and physicians appreciate the extra effort to provide essential background and offer prudent solutions to patient complaints. It takes a load off the doctors.

The SBAR has helped decrease our ER trips, which in turn has reduced our ACH rate.

Faxing of SBAR forms is beginning to be successful.

Of course at first the staff was very defensive about yet another piece of paper to fill out, but once they completed it, they felt it was an excellent tool to have and use.

Successes:  Favorable response when speaking directly with physician or PA

Barrier:  Inability to speak with physician resulting in VM messages answered by office staff.

Physicians are very receptive to the use of SBAR. In the last 6 months, our hospital as a whole has required that all physician interaction per phone be done in SBAR format.

We have only found successes, physicians have informed us that it’s easy to speak with the staff, they present facts clearly and they state they know patients get concise information from the staff. This enhances their (physician’s) comfort with prescribing treatment changes and knowing the patient will be monitored and they will be kept informed of changes.

This package could not have come at a more perfect time. We just completed educating our entire staff, including clerical and billing, on the SBAR as part of our Organizational Culture Plan of Action to improve communication. The package will help reinforce what we have taught. We are going to survey staff and physicians on the use of the SBAR and get their feedback on how to improve it.

Both our HH & hospice staff have been educated on SBAR, now our preferred method of communication, within the past six months. This came about as a result of our combined HH & hospice "Organizational Culture Team." Our lowest domain was "Communication" and we chose SBAR as our improvement model.