CommunicatingCARE incorporating ISBAR and 'Stop and Watch'
1 September 2015 Last updated:
2 September 2015
CommunicatingCARE incorporating ISBAR and 'Stop and Watch'
CommunicatingCARE is an aged care education package incorporating Identify, Situation, Background, Assessment and Recommendation (ISBAR) method and Stop and Watch early warning tools. The package was developed in consultation with local aged care providers, to help staff identify when a resident’s condition changes and allow them to communicate these changes to other health professionals.
To deliver training for aged care providers in the Central Coast Local Health District that helps staff identify changes in a resident’s condition and standardises the communication process.
- Improves communication between general practitioners, Central Coast Local Health District and aged care providers.
- Improves the health outcomes for residents in residential aged care facilities (RACFs) and clients supported by community aged care providers.
- Raises the professional standing of RACFs and community aged care providers in their interactions with general practitioners and NSW Ambulance.
- Reduces avoidable transfers to hospital.
Project dates: September 2014 - June 2015.
Project status: Sustained - the project has been implemented, is sustained in standard business.
The Central Coast NSW Medicare Local (CCNSWML) Aged Care Taskforce was established in late 2012. At the time, a survey was conducted with aged care providers to inform the taskforce on how to improve care for residents in RACFs and what training may be required to achieve these improvements. The survey identified gaps in clinical handover to general practitioners, NSW Ambulance and hospitals. Poor clinical handover can result in a rapid decline in health for residents, often resulting in admission to hospital.
When identifying training needs, it was decided to follow the ISBAR method as all staff are required to have mandatory ISBAR training. This meant that medical, ambulance, general practice and RACF staff would all be using the same process during a clinical handover.
Stop and Watch was trialled by Inner East Melbourne Medicare Local, with seven RACFs. Due to the positive results and feedback, the Taskforce chose to implement these tools into the new model of care.
- Consultations were held with 37 RACFs and 12 home care package providers, on the need for staff training and tools.
- The CommunicatingCARE training package (incorporating ISBAR clinical communication and Stop and Watch tools) was developed by CCNSWML in conjunction with an external ISBAR facilitator, secured through an expression of interest. A registered nurse (RN) was successful, who taught the TAFE Certificate III in Aged Care and facilitated the Adult Community Education (ACE) program with Hunter Medicare Local.
- A ‘train the trainer’ model was used to deliver training sessions in three stages, at times chosen by the RACF:
- Stage One: 2-3 hour session at CCNSWML premises, on the benefits of using ISBAR and Stop and Watch, how to effect change management (e.g. embedding ISBAR in policies, staff key performance indicators and staff meetings) and what the training will cover for educators and other staff
- Stage Two: 4-hour session at CCNSWML premises for RACF clinical educators and trainers
- Stage Three: 2-hour session for RNs and care staff, delivered 3-4 times per day by RACF educator at the RACF or community aged care provider premises. This session was interactive and allowed participants to use ISBAR and Stop and Watch in real-life scenarios. Multiple onsite sessions were provided for larger RACFs.
- Training was designed to provide educators with confidence in training those with a clinical background, as they often had limited experience in this area.
- To access the free CommunicatingCARE training, organisations were required to send a manager to the first session and clinical educator to the second session, so they could continue to deliver the training to staff.
- All managers and educators who completed the training were provided with an ISBAR and Stop and Watch resource pack, including a booklet, lanyard, telephone poster, PowerPoint presentation, usb with digital resources, pre- and post-training evaluation forms.
- CCNSWML developed a tailored onsite training program for RACFs and community aged care providers who could not release staff for training.
- NSW Agency for Clinical Innovation
- Central Coast Local Health District (CCLHD)
- RACFs in CCLHD
- Community aged care providers in CCLHD
- Pre- and post-training evaluations were developed for every session.
- A final evaluation to determine how organisations had implemented ISBAR and Stop and Watch tools was conducted one month after the onsite training.
- To date, 31 organisations have indicated that ISBAR and Stop and Watch is being included in:
- new staff inductions
- standing agenda item for team meetings
- daily work practices.
- Some RACFs have reported that the information from assistants in nursing is more structured using the ISBAR format.
- One RACF has adopted the ISBAR format for their visiting general practitioner communication process.
- One RACF manager contacted CCNSWML to determine if the correct ISBAR form was being used, since they had experienced an inappropriate patient return from the emergency department. This is evidence that ISBAR is being widely accepted as the standard and expected form of communication.
- As part of the final evaluation in June 2015, data on reduced avoidable transfers to hospital for clients in RACFs and those supported by community aged care providers will be gathered and analysed.
Anecdotal evidence to support the success of CommunicatingCARE training
“A Cert III Aged Care staff member couldn’t find a nurse. They kept saying that the resident was very breathless and out of bed – ‘I can’t manage’ – they were really panicking. The RN advised the staff member that they needed to complete the Stop and Watch form. In this way, the RN reinforced the training. By completing the form, the staff member is being held accountable and taking on responsibility, and we also have an official record of the patient’s state of health.”
“We help to change the culture and embed ISBAR into everyday practice by giving public recognition – e.g. at staff meetings – to those who are using it.”
“We have included a space for ISBAR and Stop and Watch information on our duty statements.”
“We discuss completed Stop and Watch forms at the 11.00am and 6.00pm handover.”
“ISBAR makes people plan before they make a phone call.”
- Allow two months lead time to research, tailor and collate training materials and organise the training schedule. This can be condensed to six or eight weeks if you can work on the initiative full-time. This timeframe is based on researching and using materials that are already in existence, not writing them from scratch.
- When providing the onsite training, it was surprising to see the number of RNs and assistants in nursing who had not heard or used a standardised clinical communication tool. It reinforced the need for training.
- Often RACF managers have a RN background and little management training. Therefore, it’s important to include change management in the training session.
- RACFs struggle to release staff to attend training, so we had to be flexible about how we could deliver the training and the session content. We tailored the sessions for RN, assistants in nursing and general service staff.
- Put forward training ideas to RACF staff and RNs to make sure it’s relevant and appropriate.
- CCNSWML representation at aged care forums and events helped build networks, foster credibility, respect and support for the initiative.
- Stage Two educator training sessions were initially five-hours long. Feedback indicated this was too long, so the training was adjusted to suit a four-hour schedule.
- Conduct management and educator training in the morning (8.30 am for 9 am start) on the Medicare Local premises, to minimise risk of losing delegates to workday activities.
- It’s important to tailor the training to accommodate Certificate III Aged Care and Cert III Home and Community Care qualified staff with little clinical experience. For example, some RACFs restricted training for these staff to just coverage of Stop and Watch.
- There is a trend towards training RACF maintenance and ancillary staff to lead a whole of organisation change, as these staff members are in constant contact with residents.
- Plan ahead, by producing a list of training dates that managers can choose from. This way, you can control numbers and stagger the training sessions over a manageable time period.
- To get RACF management on board with the initiative, state at the outset that the training is free and that it will address the standards against which RACFs are audited.
- Have two Medicare Local staff involved in project administration, so that you have a contingency for holidays, illness and peak training periods.
- RACFs can be reluctant to adopt the Medicare Local forms, since they already developed their own.
- It is much easier to implement training in organisations that have a culture of ongoing professional development and where training is incorporated in the employment agreement.
- If the training is deemed to be mandatory, there is likely to be budget available. This budget is often required to pay staff to attend the training in their own time.
- It’s important to continually address ISBAR and Stop and Watch in everything you do, including staff orientation, one-on-one meetings, performance appraisals and staff meetings.
- ISBAR can improve communication between service providers, but it may not change their policies. If the RACFs escalation policy is to call an ambulance, that is likely to remain the policy.
- The Aged Care Emergency Service Program – Hunter Medicare Local/ Hunter New England Health
- INTERACT (Interventions to Reduce Acute Care Transfers) Program – Florida Atlantic University, author of the Stop and Watch tools.
- In Safe Hands - Clinical Excellence Commission, includes Clinical handover and ISBAR
- ISBAR – South AustraliaHealth
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