Kitney Patricia, Tam Raymond, Bennett Paul, Buttigieg Dianne, Bramley David, Wang Wei
ORNAC J. 2017 Mar;35(1):13-18.
A structured approach to communication between health care professionals contains introduction/identification; situation; background; assessment and request/recommendation (ISBAR). ISBAR was introduced into the post anaesthetic care unit (PACU) of a large Victorian health service in 2013. The aim of this study was to measure the effect of an education program on ISBAR compliance.
A pre/post-test design using a 14-item audit tool was used to measure compliance to ISBAR before and after an education intervention in two acute hospitals in Melbourne, Victoria. The intervention consisted of one 30-minute education session to anaesthetists, and two 30-minute education sessions to PACU nurses, combined with visual cues using ISBAR wall posters.
In Hospital A, significant improvement from pre- to post-audit was found in the items of cardiovascular assessment and actions (Fisher's exact test p < .05) and (X² (1) = 4.06, p < .05), respiratory assessment (X² (1) = 12.85, p < .01), analgesia assessment and responsibility + referral (X² (1) = 4.44, p < .05. For Hospital B significant improvement was found in communication difficulties (X² (2)= 13.55, p-< .01) and significant decreased performance was found in respiratory assessment (X² (1) = 8.98, p < .01) and responsibility + referral (X² (1) = 13.26, p < .01).
The results from this study cohort suggest an augmented education program may produce mixed results for ISBAR compliance. More than education and visual tools may be required to improve PACU ISBAR compliance.
医护人员之间结构化的沟通方法包括介绍/识别、情况、背景、评估以及请求/建议(ISBAR)。2013年,ISBAR被引入维多利亚州一家大型医疗服务机构的麻醉后护理单元(PACU)。本研究旨在衡量一项教育计划对ISBAR合规性的影响。
采用前后测试设计,使用一个包含14个项目的审核工具,在维多利亚州墨尔本的两家急症医院对教育干预前后的ISBAR合规情况进行测量。干预措施包括为麻醉师安排一次30分钟的教育课程,为PACU护士安排两次30分钟的教育课程,并结合使用ISBAR墙贴作为视觉提示。
在A医院,审核前后在心血管评估及措施项目(费舍尔精确检验p<0.05)以及(X²(1)=4.06,p<0.05)、呼吸评估(X²(1)=12.85,p<0.01)、镇痛评估及责任+转诊(X²(1)=4.44,p<0.05)方面有显著改善。在B医院,沟通困难方面有显著改善(X²(2)=13.55,p<0.01),而呼吸评估(X²(1)=8.98,p<0.01)和责任+转诊(X²(1)=13.26,p<0.01)方面的表现显著下降。
该研究队列的结果表明,强化教育计划对ISBAR合规性可能产生不同的结果。可能需要不止教育和视觉工具来提高PACU的ISBAR合规性。