The last top tip for safer surgery I have for you is handovers. A lack of information is identified as one of the commonest causes of patient safety incidents. In this session, we learn how to use handover frameworks to ensure that correct information is delivered in a concise, precise, and timely manner.

So why should we standardise communication? Why should we use handover frameworks? Well, in 1974, disaster was narrowly averted when an incident involving a Boeing 747 occurred on approach to Nairobi, Nairobi Airport in Kenya.

Clearance was given for the plane to descend 7500 ft. That's 7500 ft. However, both pilots believed they had 5000 ft.

Which is 5000 ft and set their altitude alert accordingly. However, that altitude was 327 ft below the airport height. Fortunately, the aircraft broke through the the clouds.

And realised what was happening, and that they were too close to the ground and entered a, a climb. They came within 70 ft of hitting the ground. To avoid this type of confusion, most jurisdictions now require altitudes to include the words 100 or 1000 as appropriate.

So 7500 should be spoken as 7500 ft. And although the report indicated the clearance were given in accordance with international procedures, had the Controller used the now standard method of saying altitudes, the event likely would not have occurred. The event points out reoccurring problems.

Pilots have difficulty interpreting messages with several zeros in them. And I'm sure when I mention this, you can think of ways that we would apply this to the veterinary setting. You can probably recount instances where drug dosages or amounts have been misheard or misunderstood.

So, we know that within healthcare, there's been various campaigns which have been used to standardise protocols for treatment and communicating these these clearly. The high fives project, the high fives project was launched in 2007 to examine the concept of standardisation in clinical processes by implementing targeted patient safety improvement practises. The name high fives derives from the project's original intent to significantly reduce the frequency of 5 challenging patient safety problems in 5 countries over 5 years.

A key objective was to, to develop and assess standard operating protocols in a range of healthcare systems and cultures and to provide evidence of the benefits of standardising in healthcare as one of the means to affect safe and excellence in performance. The 100 lives A 100,000 lives campaign set a goal of saving 100,000 lives through improvement in safety and effectiveness of of healthcare. Their goals were to deploy rapid response teams at the first sight of patient decline, deliver reliable evidence-based care for acute myocardial infarction, to prevent deaths from heart attack, to prevent adverse drug events by implementing traumatic medicine reconciliation, prevent central line infections by implementing a series of interdependent scientifically grounded steps called the central line bundle.

And to prevent surgical site infections by reliably delivering the correct periopererative antibiotics at the perfect time. And to prevent ventilator association, no, no pneumonia by implementing a series of interdependent. Scientifically grounded, including steps including the ventilator bundle.

When reliably implemented, these interventions will greatly reduce mobility and morbidity in in the healthcare setting. We also know that this went on to be the 5 Million Lis campaign. Which included preventing pressure ulcers, reducing MRSA, preventing harm from high risk communications, reduced surgical complications, reliable care for heart failure, and communication initiatives.

So we know that by learning from a range of safety critical in industries, including aviation and healthcare, communication structures have been identified which are applicable and practical for veterinary practise. These include, The patient safety briefings, handovers, closed loop communication, feedback and debriefing, and emergency communication. We need to remember that we can only remember 7 things at a time, to ensure that both verbal and written methods are used.

And we also need to remember that written communication is the least way of transferring information, whilst the most rich way of information transfer occurs during face to face communication. The first tool that we'll talk about is handovers. So SBA situation background assessment and request was first developed by the military, specifically for nuclear submarines to use in situations which were stressful or time pressured.

It was then used in the aviation industry, which adopted a similar method before it was put into use in healthcare. SR is not only recommended for useful verbal communication, but also, also for written communication and entries into clinical notes. A request to provide an SBA update or handover ensures that the correct information is delivered in a concise, precise, and timely manner.

Within healthcare we recognise it's important to be able to identify our patient and ourselves and therefore, SBA became ISBA, beginning with identity before moving on to situation, background, assessment and request a recommendation. It's important to understand the aims of the SBA. I bar.

We need to be concise. What do the, what do the people need to know and how can we best paint that mental picture? We need to be consistent in our approach.

We need to make it easier for ourselves by using a structure like ISBA, and therefore reducing anxiety and increasing medical mental capacity. We need to make sure that what we're talking about is relevant, that it's not just information that they can read from the clinical notes. And we want to make sure that we're inclusive.

We want to encourage members of the team to ask questions and use closed loop communication to ensure feedback. We also want to make sure that it's standardised, that the structure that we used is standardised. And then we break messages into chunks that our brains can use and work more efficiently with.

The single barrier, biggest problem or barrier that we know exists to communication is the illusion that it's taken place. And that's why we're going to talk about closed loop communication. Closed loop communication is a highly effective tool which originated in the military, and it's based on verbal feedback to ensure the proper team understanding of a meaningful message.

It's a 3 step process. Where the transmitter communicates a message to the intended receiver, utilising their name where possible. The receiver accepts a message with acknowledgment of receipt via verbal confirmation seeking clarification if required, and then the original transmitter verifies that the message has been received and correctly interpreted, therefore losing closing the loop.

Within veterinary teams, this is particularly useful during surgery or emergency resuscitation attempts. Or when we're passing on emergency drugs or sutures. So as you can understand, handovers are really fundamental for for.

Our patient safety in practise. And lack of information is identified as one of the common causes of patient safety incidents. In this session, we learned how to use handover frameworks to ensure that correct information is delivered in a concise, precise and timely manner.

If you'd like any more information about VetTE, please contact me at Helen at VettE. I hope you've enjoyed this bite-size series and to see you again soon. Thank you for your time.