SBAR

1. SBAR Improving Patient Safety through Effective Communication

2. Objectives • Describe factors that contribute to ineffective communication • Identify the components of the SBAR communication model • Utilize SBAR in the expected communication situations

3. Why should we be communicating effectively? • The overwhelming majority of untoward events involve communication failure • Per JCAHO – Communication breakdowns remain the primary root cause of more than 60% of the 2,034 sentinel events analyzed.

4. Root Causes of Sentinel Events 1995-2002 • Communication 65% • Orientation/Training 58% • Patient Assessments 35% • Availability of Information 20% • Physical Environment 18%

5. Communication as a Root Cause • Mode of Communication • Oral 55% • Written 35% • Electronic 10% • Participants • Among staff 60% • With or among providers 25% • With patient or family 15%

6. Other Contributing Factors • Nurses are narrative and descriptive • Physicians want “just the facts”- what specifically is wrong and what do you want me to do? • Gender issues • Cultural issues • Hierarchy • Prior relationships

7. Where Communication Fails • Lack of Closed Loop Communication: • Failure to get attention • Failure to communicate level of concern • Failure to communicate real problem • Failure to communicate desired action • Failure to reach decision together before communication cut-off

8. Assertion Model Get Attention Express Concern Reach Decision State Problem Propose Action

9. Strategies for Improved Closed Loop Communication • Read Back • Critical Language • Second Challenge • SBAR

10. SBAR – What is it? • Communication tool • Originated from the U. S. Navy

11. SBAR – What does it stand for? • Situation- What is happening now, chief complaint, acute change? • Background– What factors led up to this event, pertinent history? • Assessment - What do you see, clinical assessment? • Recommendation- What do you want done? What action do you propose?

12. SBAR – Why use it? • Provides standard communication tool – makes communication less random and person dependent • Ensures completeness of information • Places every clinical person on the same communication level • Creates a safe, respectful, organized communication

13. SBAR – When can it be used? • All ‘hand off’ communications: • Shift to Shift report • Transfers between units/departments • Calling physicians with patient problems • Each situation uses the same structure with modifications to content in each section of the acronym.

14. SBAR for Shift Report • Situation: • Patient’s name, physician, room number • Admitting diagnosis • Brief statement of main concern

15. SBAR for Shift Report • Background: • Brief history of hospital course • Vital signs • Clinical assessment (include only abnormal) • Abnormal lab, imaging tests, telemetry • Status of IV • Gait/fall precautions • Diet • Discharge plan

16. SBAR for Shift Report • Assessment: • Let incoming nurse know what you think is going on • Do you have concerns? If so, what are they? • Is there a problem that could be life threatening? • Did you start anything that could not be finished on this shift?

17. SBAR for Shift Report • Recommendation: • What would you like the incoming nurse to attend to? • What have the physicians been told? Not yet told? • Has anything been left undone?

18. SBAR for Unit Transfers • Situation: • Patient’s name, physician, background • Admitting diagnosis • DNR status

19. SBAR for Unit Transfers • Background: • Brief history of hospital course • Priorities/plan of care/pt. problem list • Reason for transfer (if applicable) • Medical interventions (chest tube, drains, lines, etc.) • Gait/fall precautions • Isolation precautions

20. SBAR for Unit Transfers • Assessment: • Patient assessment data • Critical, pertinent diagnostic results • Vital signs • Medication changes • Respiratory status • Mental status • Restraint status • Pain management • Diabetes management (if applicable)

21. SBAR for Unit Transfers • Recommendation: • Patient education needs • Skin care needs • Behavioral/Psychosocial needs • Reassessment needs (pain, falls, etc.) • Discharge plan

22. SBAR – Nursing Unit to Procedure Area • Situation: • Reason for Test/Procedure • Active DNR status • Background: • Latex/Contrast Dye allergies • Implanted Metallic Devices (pacemakers, ortho implants, etc. • IV status • Anticoagulation therapy • Diabetes management • Isolation precautions • Mobility status – able to lie flat?

23. SBAR – Nursing Unit to Procedure Area • Assessment: • Patient assessment data • Mental status • Respiratory issues • Recommendation: • Special patient needs (pain, sitter, restraints, etc.) • Diabetic needs (next scheduled BGM, insulin, etc.

24. SBAR – Return from Procedure Area to Nursing Unit • Situation: • Procedure – type, entry site, dressing • Background: • Unstable vital signs and unusual events during procedure, change in pt. condition • Medications received during procedure • Assessment: • Current vital signs/patient assessment data • New dressing and IV sites • Recommendation: • Post procedure orders

25. SBAR – Physician Communication • Situation: • State your name/unit • “I am calling you about….” • “I have just assessed the patient and I am concerned about…

26. SBAR – Physician Communication • Background • State the admission diagnosis and date of admission • State the pertinent medical history • Provide a brief synopsis of the treatment/procedures to date • Provide name of admitting/consulting physicians • DNR status

27. SBAR – Physician Communication • Assessment • Vital signs • Assessments of the following systems: • Neuro, Musculoskeletal, Respiratory, C-V, GI/GU, Skin • Pertinent diagnostic test results • Wound (drainage?) • Change from prior assessments *IDENTIFY problems, concern, or decline in condition

28. SBAR – Physician Communication • Recommendations • What would you like to see done? • Transfer the patient • Come to see the patient at this time • Have a House Officer/Resident see the patient • Change the treatment • Order lab or other diagnostic test • Other suggestions…

29. Resistance…. • We don’t need this • I already know how to do this • We don’t have a problem • It’s just more work to do • It’s too ‘soft and fluffy’ • Cultural issues – won’t speak up • Doesn’t feel safe

30. Benefits of Using SBAR • Clear way to communicate • Reduces ambiguity, guesswork, variability for both sender and receiver • Saves time for patients, physicians and staff • Avoids staff /physician frustration • Everyone is on the same ‘wavelength’

31. Summary • Remember…in most cases you have already gathered this information • Now you are placing that information in an organized, consistent framework