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SBAR

SBAR. Effective Communication for Patient Safety. SBAR. From 1995 – 2005 JCAHO reviewed over 2537 sentinel events in General Hospitals and Emergency Departments Communication issues identified as being the root cause and the major contributor in these events

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SBAR

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  1. SBAR Effective Communication for Patient Safety

  2. SBAR • From 1995 – 2005 JCAHO reviewed over 2537 sentinel events in General Hospitals and Emergency Departments • Communication issues identified as being the root cause and the major contributor in these events • In 2005 nearly 70% of sentinel events, the root cause was communication.

  3. Why does communication break down? • Different communication styles • High level of activity • Frequent interruptions • No standardization in organizing essential information • Loss of information

  4. What Can Go Wrong? • CONCERN was communicated – BUT: • PROBLEM: was not clearly stated • PROPOSED ACTION: didn’t happen • DECISION: was not reached

  5. Physician-RN Communication • Differences in: • Training and practice • Style of communication • Past experience • Level of empowerment • Tone of voice and level of respect

  6. Physician-RN Communication Styles • Nurses are narrative and descriptive • Physicians are guided to be problem solvers- “just the facts please” • Other complicating factors • Gender, cultural differences • Prior relationships, hierarchy • Perceptions of teamwork depends on point of view

  7. Commnication Handoffs SBAR Is an effective tool for all types of communication handoffs

  8. What is SBAR? • The SBAR model is a simple method to help standardize communication • SBAR allows all parties to have common expectations: • What is going to be communicated • How the communication is structured • Required elements • Focuses on the problem, not the people

  9. Who Uses SBAR? • Nuclear Submarines • Southwest Airlines • Kaiser Permanente • Iowa Health System

  10. TVH Patient Care ServicesInitiative for 2006 • Implement SBAR by 4th quarter, 2006 • Goals: • Clear, concise and thorough communication of pertinent clinical information • Improved patient safety and clinical outcomes

  11. TVH Patient Care ServicesInitiative 2006 • Implementation of SBAR will: • Meet Joint Commission’s requirements for appropriate communication for patient hand-offs • Admissions • Transfers • Shift to shift report • Daily rounds • Improve physician/clinician communication in critical and non-critical patient care situations

  12. TVH Patient Care ServicesInitiative 2006 • Implementing SBAR for patient handoffs • Handoffs include verbal communication • Face-to-face interaction • Opportunity to ask and answer questions • Documentation

  13. TVH Patient Care ServicesInitiative 2006 • Expected outcomes for SBAR use: • Conversation with physicians – in person or phone • Conversations with peers – change of shift • Escalating a concern

  14. SBAR USE • Other uses for the near future: • Discussions with other departments • Shared model of communication throughout the Valley Health system • Assisting patients to learn how to talk with their physicians

  15. SBAR • Situation • Background • Assessment • Recommendation

  16. S – B – A - R • Situation – the problem • Background – brief, related, to the point • Assessment - what you found, what you think • Recommendation – what you want

  17. State: your name and unit I am calling about:: (Patient Name & Room Number) The problem: The reason I am calling ….. SITUATION

  18. State the admission diagnosis and date of admission State the pertinent medical history A Brief Synopsis of the treatment to date BACKGROUND

  19. Assessment • Pertinent objective & subjective information • Most recent vitals • Mental status • Respiratory rate and quality • B/P, pulse rate & quality • Pain • Neuro changes • Skin color • Rhythm changes

  20. RECOMMENDATION • State what you would like to see done: • Transfer the patient? • Change treatment? • Come to see the patient at this time? • Talk to the family and patient about….? • Ask for a consulting physician to see the patient?

  21. RECOMMENDATION • Other suggestions • CXR ABG EKG • CBC Other? • If a change in treatment is ordered, ask: “How often?” • Ask: “If the patient does not improve, when would you want to be called again?”

  22. Example • Situation: • Dr. Jones, I’m calling about Mr. Smith who is short of breath. • Background: • He’s a patient with chronic lung disease and has had increased SOB over the past 4 hours. He is now acutely worse. His oxygen saturation has been 95% on 3L nc until this evening.

  23. Example • Assessment: • He has expiratory wheezes in all lung fields, his oxygen saturation is 85% on oxygen 3L nc and he is very restless • Recommendation: • I think he needs to be transferred to IMC or ICU

  24. SBAR Video • Video

  25. Review of SBAR tools • Tools- SBAR incorporated into: • Shift to shift report • Transfer forms • Computer Documentation screens • Telephone conversation guide

  26. SBAR Tools

  27. Questions?

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