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Announcing the latest competition winner...

In January 2011, the 1000 Lives Plus Student Chapter launched their second essay competition which asked students to: "Complete an SBAR report on a patient safety incident you are aware of within your own clinical speciality."

Lauren Wareing, a fourth year medical student from Cardiff University achieved the first prize of £250 with the following entry:

Clear Communication Can Save Lives
From a young age, the ability to convey information effectively provides a way of ensuring that our needs are met successfully.  As a fourth year medical student, there have been many obstacles along the road to becoming a doctor that have required utilising comprehensive communication skills.  A doctor is only one element of a huge multi-disciplinary team.  Effective communication between team members is vital to eliminate confusion, ensuring the smooth and, most importantly, the safe running of patient care.
My current placement is within a Mental Health team based over two sites; a small 22 bedded inpatient unit and a community outpatient department, situated approximately 15 minutes apart.  A patient receiving treatment from the Mental Health Services may have been transferred to their care from a vast cohort of health professionals; including psychiatrists, social workers, clinical and forensic psychologists, and community psychiatric nurses, just for starters.
The SBAR is an excellent tool to implement within this healthcare setting.  Consisting of four established patient-centred questions, regarding Situation, Background, Assessment and Recommendation, the SBAR creates a standardised approach giving direction to the patient’s care plan. 
For a Mental Health team good communication is imperative as continuity of care is important not only during shift handovers between teams,, but also when a patient is discharged out into the community as the patient’s maintained recovery then becomes the responsibility of the community team.  All members of both teams must be familiar with the patient’s recommended treatment and where they are along their path to recovery.
Along with an in-depth past medical history, assessment of risk is a crucial aspect of patient care within Psychiatry; be that the risk of the patient to themselves or the risk of the patient to others.  Due to the dynamic nature of psychiatric disorders; implementation of the SBAR tool would enable essential information regarding a patient’s ever-changing level of risk to be conveyed successfully.  This would be reflected in the level of monitoring that the patient receives.
To demonstrate how implementation of the SBAR would improve the quality of communication between different members of the Mental Health team, an example of a scenario that occurred on the ward a few days ago is provided below:
SBAR Report


The patient appears extremely distressed.  He is making increasing demands, becoming agitated and verbally aggressive as he does not feel that his demands are being met in a suitable time period. He has begun banging on the nurse station window and the verbal aggression has escalated, despite attempts to diffuse the situation.


The patient has a diagnosis of Schizophrenia, which he has suffered from for 10 years. The patient is well-known by the Mental Health team.  The patient has been well for the past few years, and as part of his care plan has gradually been reducing the dose of his anti-psychotic medication.
 Over the past couple of weeks, he has refused to take any medication at all, despite encouragement from his community nurse.  He suffers from delusions regarding a family living in the surrounding area that has no connections to him whatsoever.  He has been known to stalk the family in the past; although he has made no violent attempts towards any of the family members.  Over the past week the family have reported to the police that he has been frequenting their premises.
He has a past history of violence towards staff members, reportedly attempting to attack a nurse during a previous admission.
The patient was eventually brought into hospital having been sectioned under the Mental Health Act 2007 and given medication.


The patient is extremely distressed and agitated due to severe persecutory delusions.  Due to the severity of the patient’s illness there is a lack of reasoning behind his actions.


In order to address the situation further diffusion techniques should be implemented to prevent crisis. If there is a perceived loss of control of the situation, and physical aggression is displayed, the patient should be sedated using an intramuscular injection of diazepam.  Sedation will protect the patient from causing physical injury to himself or others, and eliminate further distress on the patient’s part.
As shown by the SBAR assessment above, situations can escalate quickly and having recommendations in place for suspected eventualities is extremely beneficial as they may improve patient safety by providing protection to both the patient through continuity of care and to the staff.



Previous Essay Competitions

In October 2010, the 1000 Lives Plus Student Chapter launched their first essay competition on the topic: "As a student, have you made a small change in healthcare that made a big impression?"

The winning entry was received by Lauren Jones, a 2nd year Occupational Therapy student from Cardiff University: 

Small change in healthcare
As a 2nd year Occupational Therapy student, I was keen to start my third placement in adult re-ablement. Based in the community, the majority of my patients were elderly people who required assistance settling back to independent living after discharge from hospital.
Each patient is given their own personal file to keep at their home that contains all their medical information which is then regularly updated upon each visit from an Occupational Therapist, carer, social worker or other healthcare profession.
These notes aid multi-professional communication throughout the different teams as it is clear to see the patient assessments that had been carried out by other members of the team.
The file records the progress of the patient and identifies any particular needs they might have. Information regarding the patient’s treatment is always easily accessible which means the process is kept patient-centred.
It also meant we did not have to rely on asking the patient to remember the treatment they were receiving, or waste time telephoning different people to clarify the patient’s situation. 
Early on in my placement, I noticed that the Occupational Therapists would write their notes in those files at the patient’s house only to then return to the office where they would then write out all the notes again. I felt that this duplication of effort was a huge waste of time, whilst constraining the Occupational Therapists from completing other necessary tasks.
My suggestion was that the Occupational Therapists take carbon paper with them to each patient home visit to make carbon copies of the notes that they write.  Although a very simple suggestion, it was one that had not been thought of before.  It took a while for colleagues to remember to keep a supply of carbon paper with them but soon the team started regularly using this method.
This method meant that it was far easier to return to the office and file a copy of what had been written, rather than trying to remember the whole process and trying to relay information again in a professional way. Consequently, the team agreed that it saved a few hours a week of note writing, which allowed the Occupational Therapists to be allocated more time to other tasks for the benefit of the patients.
Each member of the team has to complete a time sheet which states how many hours a day have been dedicated to certain activities and tasks. It was visibly demonstrated that the amount of time spent on note writing had been significantly reduced much to the relief of the Occupational Therapist manager.  
In this current technological age hand-writing notes seems to be a rather laborious task. I believe that the best way to cut down even more time and increase consistency would be through the implementation of electronic / computerized notes that all teams could access. 
Until that day, however, my team are happy with this cost-effective manageable practice that ensures more time with the patients, and less time with the pens!


Last updated: 08/09/2011