AFTER-HOURS CALL GROUP TRAINING MODULES

Steps to Using the Call Group:

Each call group has one phone number that connects to a live dispatch service. The dispatch service then patches the call directly through to the physician on call. When using the dispatch service, be sure to complete the steps below.

1. Fill out the SBAR and gather any additional documentation as needed
2. Call your region-specific phone number
3. Dispatch connects you to physician OR takes a number for a call back

Tips & Guidelines:

• While your care home may accommodate individuals in assisted living in addition to long-term care residents, this call group only covers those specifically in designated long-term care beds.
• Dispatch will ask for your name, the care home’s name, the resident’s MRP, and the reason for call.
• Most calls are directly patched through, and the overall average call length is ~5 minutes. In the unlikely event you have called and not received a response within a timely manner, please give the dispatch center a call back to ensure there hasn’t been a breakdown in communication.
• The LTCI collects, collates, and monitors data provided to the dispatch center to ensure consistent quality of calls and service provided. 

Resources

LTCI's BPE Tools for 24/7 Availability & Onsite Attendance, Including:

• After-Hours SBAR forms
• After-Hours Coverage Guide
• After-Hours Facility Staff Reminder
• After-Hours Posters

We welcome your feedback! If you have any questions or concerns, please contact the LTCI team at (778)265-3137 or [email protected]

The LTCI has developed an urgent communication tool for long-term care called the SBAR (Situation, Background, Assessment, Recommendation) form. Completing the SBAR is required before initiating a call to one of the LTCI After-Hours Call Groups. In this module, we’ll review what the SBAR is used for, when to use it, and what to do with it after your call is completed.

*Disclaimer: the scope of this module and video relates to the call group specifically and is meant to be a supplemental guide for care homes and nurses. Each care home has specific policies and practice guidelines in place that must be considered. Therefore, these videos are not directive – please speak with your leadership team regarding specific policies, expectations, and support systems.*

SBAR Overview:

1. Nurse Communication Section: refers to the resident and care home section at the top of the SBAR and includes the Situation, Background, Assessment, and Recommendation sections. Think of this section like a notepad. Putting your thoughts onto paper in a clear and consistent manner using the SBAR can aid in your decision-making.
2. Physician Communication Section: used for taking note of the physician’s response and orders. After you have discussed the situation, make note of the on-call physician’s response and orders if any are given. Orders must be read-back to confirm accuracy and reduce the risk of errors. These steps will decrease communication mishaps and increase resident safety.
3. The final component of the SBAR is follow-up. Physician orders, if received, should be transcribed into the resident’s chart using your care home’s doctors’ order form or computerized order entry process. The resident chart orders are to be sent to the pharmacy, not the SBAR form. Document the call, the physician’s response, and your actions in the resident’s progress notes.

Final Steps:

When you have completed the call:

• Transcribe and process orders as per your facilities order process (do not send SBAR to pharmacy)
• Fax the SBAR form to the Resident’s MRP
• Fax the SBAR form to the on-call Physician for their records, numbers are on the back of the SBAR
• Place SBAR in the resident’s chart

Tips & Guidelines:

• When an SBAR form is filled out prior to calling the after-hours call group, succinct and useful resident assessment information can be passed from the nurse to the physician on call.
• Review the chart for relevant medical history and recent progress notes, assess the resident, then complete the SBAR.
• Please write in blue or black ink for readability, as the form will need to be faxed back to the after-hours physician for confirmation, as well as to the resident’s MRP
• If for some reason the on-call physician’s fax number doesn’t work, and you’ve double checked the fax number and put a ‘1’ in front of the number, check the LTCI website to ensure you have the most recent version of the form. If the number still matches, let your leadership team know so that they can contact the LTCI for assistance.
• As the appropriate location for filing a completed SBAR can vary amongst different care homes, ensure you check with your care home leadership if you are unsure of where these are stored.
• Please do not recycle the form, as this is important for the continuity of care for all residents

Resources

1. LTCI's After-Hours SBAR Forms
2. Concern-Specific SBAR Forms:
   - Urinary Tract Infection SBAR
   - Behavioural and Psychological Symptoms SBAR

We welcome your feedback! If you have any questions or concerns, please contact the LTCI team at (778)265-3137 or [email protected]

Topics covered include:

• non-pharmacological interventions
• questions to consider prior to calling the physician
• Choosing Wisely Canada’s Guideline Seven Tests & Treatments to Reconsider in LTC
• resources available on LTCI’s website
• preparation for contacting the After-Hours Call Group about an agitated resident

Resources

1. P.I.E.C.E.S. Toolkit & Resources
   a) Toolkit
   b) PIECES 3-Question Template
   c) PIECES Team Mobilization
   d) Putting It All Together: RAI-MDS and PIECES Integration
2. Behaviour & Psychological Symptoms SBAR
3. Learning Series: Dementia Behaviour Complications (January 2022)
4. Choosing Wisely Canada: Seven Tests & Treatments to Reconsider in LTC (March 2022)

We welcome your feedback! If you have any questions or concerns, please contact the LTCI team at (778)265-3137 or [email protected]

Topics covered include:

• natural and unnatural deaths in LTC
• what to do when considering a call to the Coroner
• pronouncement of death in LTC
• Pronouncement of Death in LTC & MRP Death Notification Form
• BC Coroners Working with the Coroner FAQ
• preparation for contacting the After-Hours Call Group regarding a resident death

Resources

1. Pronouncement of Death in LTC & MRP Death Notification Form
2. BC Coroners: Working with the Coroner FAQ
3. Medical Certification of Death: Tips & Reminders for Physicians
4. Funeral Homes Search

We welcome your feedback! If you have any questions or concerns, please contact the LTCI team at (778)265-3137 or [email protected]

Topics Covered Include:

• common reasons for calls regarding diabetes
• questions & nursing interventions to consider prior to calling the physician
• Island Health’s Clinical Order Sets: Diabetes Management & LTC Nurse Protocol Hypoglycemia
• preparation for contacting the After-Hours Call Group regarding diabetes

Resources

1. Island Health Clinical Order Set: Diabetes Management & LTC Nurse Protocol Hypoglycemia
2. Island Health Clinical Order Set: LTC Nurse Protocol Hypoglycemia

We welcome your feedback! If you have any questions or concerns, please contact the LTCI team at (778)265-3137 or [email protected]

Topics Covered Include:

• rationale for calling a physician prior to an ED transfer
• questions to consider and assessment preparation prior to calling the physician
• LTCI ED transfer resources
• Emergency Department Transfers: Physician/NP and Nurse Communication
• Choosing Wisely Canada: Seven Tests & Treatments to Reconsider in LTC

Resources

1. Emergency Department Transfers: Physician & Nurse Communication
2. Choosing Wisely Canada: Seven Tests & Treatments to Reconsider in LTC (March 2022)

We welcome your feedback! If you have any questions or concerns, please contact the LTCI team at (778)265-3137 or [email protected]

Topics Covered Include:

• nursing interventions to consider prior to calling the physician
• focused assessment
• preparation for contacting the After-Hours Call Group regarding abnormal lab values

Resources

*Refer to your care home’s Nursing Procedures and Lab Manual for more information about lab tests, as well as your responsibilities for communicating abnormal and critical lab results to physicians.

1. Understanding lab tests
2. Heart & Stroke Canada’s resource on anticoagulants

We welcome your feedback! If you have any questions or concerns, please contact the LTCI team at (778)265-3137 or [email protected]

Topics Covered Include:

• tips, tools, and resources related to palliative management
• nursing interventions to consider prior to calling the physician
• Island Health’s Clinical Order Set LTC End of Life
• preparation for contacting the After-Hours Call Group

Resources

1. Island Health Clinical Order Set LTC End of Life
2. BC Interprofessional Palliative Symptom Management Guidelines
3. The Dementia Trajectory Toolkit by Dr. Trevor Janz
4. LTCI Learning Series:
   1. The Dementia Trajectory by Dr. Trevor Janz (May 9, 2019)
   2. Management of Late-Stage Dementia & Parkinson’s – Parkinson’s Disease in the Residential Care Setting & Managing Advanced Dementia and Frailty, by Dr. Alexandre Henri-Bhargava & Dr. Ted Rosenberg

We welcome your feedback! If you have any questions or concerns, please contact the LTCI team at (778)265-3137 or [email protected]

Topics Covered Include:

• tips, tools, and resources related to pain management
• nursing interventions to consider prior to calling the physician
• pain assessment
• preparation for contacting the After-Hours Call Group

Resources

1. LTCI Learning Series:
   a) Pain in Long-term Care, by Dr. Romayne Gallagher (March 15, 2021)
   b) Pain Management in Long-term Care - Pain in Residential Care in the Age of the Opioid Crisis, by Dr. Romayne Gallagher (June 25, 2019)
   c) Treating Pain in Long-term Care - Pain Management Cases & Managing Chronic Pain in the Age of Opiate Aversion, by Dr. Romayne Gallagher & Dr. Ted Rosenberg (May 16, 2018)
2. Pain Foundations for Primary Care Providers
3. RNAO Pain Assessment & Management Resources

We welcome your feedback! If you have any questions or concerns, please contact the LTCI team at (778)265-3137 or [email protected]

Topics Covered Include:

• questions to consider prior to calling the physician
• resources related to respiratory issues on the LTCI website
• preparation for contacting the After-Hours Call Group

Resources

1. LTCI Learning Series: Respiratory Tract Infections in Long-term Care (2016) Dr. Karsten Hammond

We welcome your feedback! If you have any questions or concerns, please contact the LTCI team at (778)265-3137 or [email protected]

Topics Covered Include:

• skin and wound assessments
• questions & nursing interventions to consider prior to calling the physician
• laceration repair kits
• resources related to skin and wound-related concerns on the LTCI website
• preparation for contacting the After-Hours Call Group

Resources

1. Laceration Repair Suture Kit Info
2. LTCI Wound Care Resources
3. LTCI Learning Series
   a) Wounds in Long-term Care, by Shelly Barnes & Erin Ballard (March 2022)
   b) Wounds in Long-term Care, by Shelly Barnes (July 2021)
   c) Management of Infections in Residential Care, by Dr. Wayne Ghesquiere, Dr. Eric Partlow, and Dr. Divya Virmani (March 2018)

We welcome your feedback! If you have any questions or concerns, please contact the LTCI team at (778)265-3137 or [email protected]

Topics Covered Include:

• questions & nursing interventions to consider prior to calling the physician
• non-pharmacological nursing interventions
• Urinary Tract Infection SBAR
• resources related to urinary concerns on the LTCI website
• preparation for contacting the After-Hours Call Group

Resources

1. Urinary Tract Infection SBAR
2. Island Health’s Care of the Resident with a Suspected Urinary Tract Infection in Long-term Care 
3. Diagnosis and Management of Urinary Tract Infection in Long-term Care Facilities: Clinical Practice Guideline (2015)
4. LTCI Learning Series
   a) Asymptomatic Bacteriuria & UTIs in Residential Care, by Colleen Mayhew (2017)
   b) Urinary Tract Infections, by Dr. Karen McClean (2015)

We welcome your feedback! If you have any questions or concerns, please contact the LTCI team at (778)265-3137 or [email protected]