88 - The Process of Enhancing Communication in Multi-Organ Transplants: Creating a New SBAR

Description: Description of Team:

A team consisting of Registered Nurses (RNs), Charge nurses and Nursing Leadership collaborated to create and implement a multi-organ transplant SBAR (Situation, Background, Assessment, Recommendation) hand-off tool to enhance communication between multiple services, minimize miscounts, ensure compliance with information handoff protocols throughout the surgery, and effectively monitor surgery progression to ensure patient safety.

Preparation and Planning:

Being a large academic center that perform a high volume transplants a year. As well as recent advances in medical science and cutting-edge technology have significantly increased the number of multi-organ transplant procedures for patients with multi-organ failure. Current SBAR structure in the operating room has gaps that fail to address the specifics of complex and highly regulated cases involving multiple organ transplants and multidisciplinary teams.

A meeting was to be conducted to debrief with the transplant nursing teams regarding unstructured communication between teams in the room that have attributed to prior errors. This was to Identify flaws and find areas of improvement in the current handoff. A survey was created to gather comprehensive feedback from all relevant stakeholders in these cases.

Assessment

Analyze the results of the survey to identify key feedback and areas for improvement.

Implementation:

Create a multi-organ specific SBAR form based on the feedback received, ensuring it addresses the identified gaps and enhances communication and compliance during surgeries.

Roll out the new SBAR form by conducting in-services, team huddles, and individual coaching sessions. Ensure all team members are thoroughly trained on the new SBAR form and its usage.

Outcome:

The pre-implementation survey was sent out to Operating room nurses yielding 77% of nurses felt the current SBAR does not support the communication needs during a multi-organ transplant. 93% of RN's felt a separate structured multi-organ specific SBAR would lead to improvements in continuity of care amongst multidisciplinary teams during the duration of the procedure. An overall lack of communication amongst all team members including nurse to nurse hand off and physician and transplant coordinator to all RNs is an area requiring improvement.

As per the results of the survey, an enlarged dedicated area on the new SBAR was created for instrumentation and soft goods that are intentionally retained or on/off the sterile field at time of organ team change and as well as a dedicated area for important times that must be tracked for each specific organ on the SBAR form.

Implications for Perioperative Nursing:

Given the highly regulated and complex nature of multi-organ transplants, the implementation of a structured handoff process that meticulously tracks crucial elements throughout the extended procedure has markedly enhanced team communication, improved the effectiveness of managing the complexities of these cases, and bolstered patient safety. This approach aims to reduce surgical miscounts and generally improve handoff communication between multiple nursing teams.