The development and validation of a modified Situation-Background-Assessment-recommendation (SBAR) communication tool for reporting early signs of deterioration in patients

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dc.contributor.advisorKyriacos, Unaen_ZA
dc.contributor.advisorJordan, Sue Een_ZA
dc.contributor.authorBurger, Deboraen_ZA
dc.date.accessioned2016-01-26T10:59:49Z
dc.date.available2016-01-26T10:59:49Z
dc.date.issued2015en_ZA
dc.descriptionIncludes bibliographical referencesen_ZA
dc.description.abstractBackground: Errors in communication are prevalent in healthcare and affect patient safety and cause unnecessary patient deaths. Reporting early signs of physiological or clinical deterioration could improve patient safety and prevent 'failure to rescue' or unexpected intensive care admissions, cardiac arrest or death. The structured Situation-Background-Assessment-Recommendation (SBAR) communication tool enables nurses to provide doctors with pertinent information about a deteriorating patient in a logical order, based on a complete assessment. In addition, nurses have increased confidence in their findings and are better able to initiate a call and to convince a doctor to provide orders promptly or see a patient. Aim: The aim of this sub-study of a randomized controlled trial was to develop and validate a modified SBAR communication tool incorporating components of a local MEWS vital signs observations chart. Methods: The modified SBAR communication tool was developed following a review of available published examples and validated by employing a mixed methods approach: 1) cognitive interviews (n=3 nurses, 2 doctors), 2) determining the index of content validity with nurses (n=5), physicians (n=5) and surgeons (n=8) and 3) inter-rater reliability testing, with calculation of kappa values (n=2 nurses). Results: Cognitive interviews prompted more changes to the modified SBAR communication tool than determined by the content validity index. For cognitive interviews, there were 15/42 (35.71 %) modifications: 11 items were added (26.19 %) and three removed, (7.14 %) resulting in 49 items whereas for content validity index there were 4/49 (8.16%) modifications, 5/49 (10.20%) items removed and one item added (2.04%). Four of 49 items (8.16%) rated as relevant by <70% of nurses and doctors were revised or deleted. No additional modifications were needed following review by surgeons, as all items were rated as relevant by the pre-determined ≥70% of experts. Inter-rater reliability of the SBAR tool was established by two nurses who were mostly in substantial to full agreement on 37/45 items on the modified tool. The exceptions were: 'Calling from' (Cohen's Kappa-0.05) and 'this is a change from' (Cohen's Kappa-0.07), representing agreement below the level of chance. However, the high percentage agreement and nature of the questions suggest that the questions are sound. Percentage agreement amongst participants for these items was 91 % (95% confidence interval (CI): 71 to 99 ) and 86% (95% CI: 65 to 97 ) respectively. Deciding whether a doctor should see the patient now (Cohen's Kappa 0.09) or in the next 30 minutes, achieved fair agreement (Cohen's Kappa 0.20). This reflects a difference in clinical judgement as the decision when to call for assistance depended on the individual nurse's clinical judgement. IRR was not possible to test on 4/45 items, as those items required a response by the person being summoned. Overall, nine of 42 items were removed, 12 were added and 19 substantially modified, leaving 45 items. Conclusion: The modified SBAR communication tool was valid and reliable for use in a local context in conjunction with the Cape Town Modified Early Warning Score (MEWS) vital EWS) vital signs chart.en_ZA
dc.identifier.apacitationBurger, D. (2015). <i>The development and validation of a modified Situation-Background-Assessment-recommendation (SBAR) communication tool for reporting early signs of deterioration in patients</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Division of Nursing and Midwifery. Retrieved from http://hdl.handle.net/11427/16553en_ZA
dc.identifier.chicagocitationBurger, Debora. <i>"The development and validation of a modified Situation-Background-Assessment-recommendation (SBAR) communication tool for reporting early signs of deterioration in patients."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Division of Nursing and Midwifery, 2015. http://hdl.handle.net/11427/16553en_ZA
dc.identifier.citationBurger, D. 2015. The development and validation of a modified Situation-Background-Assessment-recommendation (SBAR) communication tool for reporting early signs of deterioration in patients. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Burger, Debora AB - Background: Errors in communication are prevalent in healthcare and affect patient safety and cause unnecessary patient deaths. Reporting early signs of physiological or clinical deterioration could improve patient safety and prevent 'failure to rescue' or unexpected intensive care admissions, cardiac arrest or death. The structured Situation-Background-Assessment-Recommendation (SBAR) communication tool enables nurses to provide doctors with pertinent information about a deteriorating patient in a logical order, based on a complete assessment. In addition, nurses have increased confidence in their findings and are better able to initiate a call and to convince a doctor to provide orders promptly or see a patient. Aim: The aim of this sub-study of a randomized controlled trial was to develop and validate a modified SBAR communication tool incorporating components of a local MEWS vital signs observations chart. Methods: The modified SBAR communication tool was developed following a review of available published examples and validated by employing a mixed methods approach: 1) cognitive interviews (n=3 nurses, 2 doctors), 2) determining the index of content validity with nurses (n=5), physicians (n=5) and surgeons (n=8) and 3) inter-rater reliability testing, with calculation of kappa values (n=2 nurses). Results: Cognitive interviews prompted more changes to the modified SBAR communication tool than determined by the content validity index. For cognitive interviews, there were 15/42 (35.71 %) modifications: 11 items were added (26.19 %) and three removed, (7.14 %) resulting in 49 items whereas for content validity index there were 4/49 (8.16%) modifications, 5/49 (10.20%) items removed and one item added (2.04%). Four of 49 items (8.16%) rated as relevant by <70% of nurses and doctors were revised or deleted. No additional modifications were needed following review by surgeons, as all items were rated as relevant by the pre-determined ≥70% of experts. Inter-rater reliability of the SBAR tool was established by two nurses who were mostly in substantial to full agreement on 37/45 items on the modified tool. The exceptions were: 'Calling from' (Cohen's Kappa-0.05) and 'this is a change from' (Cohen's Kappa-0.07), representing agreement below the level of chance. However, the high percentage agreement and nature of the questions suggest that the questions are sound. Percentage agreement amongst participants for these items was 91 % (95% confidence interval (CI): 71 to 99 ) and 86% (95% CI: 65 to 97 ) respectively. Deciding whether a doctor should see the patient now (Cohen's Kappa 0.09) or in the next 30 minutes, achieved fair agreement (Cohen's Kappa 0.20). This reflects a difference in clinical judgement as the decision when to call for assistance depended on the individual nurse's clinical judgement. IRR was not possible to test on 4/45 items, as those items required a response by the person being summoned. Overall, nine of 42 items were removed, 12 were added and 19 substantially modified, leaving 45 items. Conclusion: The modified SBAR communication tool was valid and reliable for use in a local context in conjunction with the Cape Town Modified Early Warning Score (MEWS) vital EWS) vital signs chart. DA - 2015 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 T1 - The development and validation of a modified Situation-Background-Assessment-recommendation (SBAR) communication tool for reporting early signs of deterioration in patients TI - The development and validation of a modified Situation-Background-Assessment-recommendation (SBAR) communication tool for reporting early signs of deterioration in patients UR - http://hdl.handle.net/11427/16553 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/16553
dc.identifier.vancouvercitationBurger D. The development and validation of a modified Situation-Background-Assessment-recommendation (SBAR) communication tool for reporting early signs of deterioration in patients. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Division of Nursing and Midwifery, 2015 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/16553en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDivision of Nursing and Midwiferyen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherNursingen_ZA
dc.titleThe development and validation of a modified Situation-Background-Assessment-recommendation (SBAR) communication tool for reporting early signs of deterioration in patientsen_ZA
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMSc (Nursing)en_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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