SBAR

1. SBAR SBAR: Made Easy Clinician Module

2. Recognize the need for a structured communication process • Define SBAR • Describe how improving communication will support reducing avoidable acute care hospitalizations • Apply SBAR technique into daily practice Objectives

3. Home Care Challenges • Changes in payment system • Burdensome paperwork/data collection • Higher acuity level • Communication methods beyond face to face (e.g. phone, fax, email)

4. US Navy Nuclear Submarine THE NEED: The ability to communicate clearly, effectively and efficiently in just seconds Communication Model S = Situation B = Background A= Assessment R = Resolution IHI, 2006

5. Healthcare and submarines How are submarines & healthcare operations alike? • Exist in “harms’ way” • Require timely action to avert disaster • 24X7 operations • Lots of turnover and cultural diversity • Deal with fear, fatigue, interruptions, distractions • At the root of their adverse outcomes unclear, in concise, or inaccurate information

6. Institute for Healthcare Improvement • Focus on improving health care • Modified the Navy’s SBAR • R – Recommendation rather than Resolution SBAR: IHI Connection

7. Condenses messages Promotes critical thinking Interdisciplinary communication Physician communication SBAR: Home Care Connection

8. S-B-A-R Stands for … S = Situation What is going on with the patient B = Background What is the clinical background information that is pertinent to the situation A = Assessment What I think—conclusions R = Recommendation • What is needed and in what time frame

9. Ensure all pertinent patient information is available before you contact the physician • Name • Medical record number • Age • Diagnosis • Medication list • Allergies • Vital signs • Lab results • Advance Directive SBAR: Preparation

11. Communicating with Physicians • 40 patients a day • need to cue the physician to who we are and who the patient is • may only see our patients every couple months or less

12. (S) Situation:What is the situation you are reporting? • Identify self, agency, patient, patient location • What is going on with the patient. A concise statement of the problem • 10-15 SECONDS only SBAR Technique

13. (B) Background: Clinical background information that is pertinent to the situation • The admitting diagnosis and date of admission • List of current medications, allergies, IV fluids, etc. • Most recent vital signs • Lab results: provide the date and time test was done and results of previous tests for comparison • Advance Directive SBAR Technique

14. (A)Assessment: • What are the clinician’s? • What is the analysis ? • Is this problem severe or life threatening? SBAR Technique

15. (R) Recommendation: • What action/recommendation is needed to correct the problem? • What solution can you offer the physician? • What do you need from the physician to improve the patient’s condition? SBAR Technique

16. SBAR Interdisciplinary Communication Example SBAR: Activity #1

17. SBAR Interdisciplinary Communication demonstrates using SBAR to communicate issues, problems or opportunities for improvement to coworkers or supervisors. SITUATION – State what is happening at the present time that has warranted the SBAR communication. Example: Hi, Kathy, this is Brian. I am calling to report that my patient, Mrs. L., has an elevated blood pressure this morning and admits to feeling very anxious.

18. SBAR Interdisciplinary Communication Background BACKGROUND – Explain circumstances leading up to this situation. Put the situation into context for the reader/listener. Example: Mrs. L’s blood pressure is 188/92 (R) which is up from 126/80, 186/90 (L). Her pulse has increased from 64 bpm (regular rate and rhythm) to 98 bpm (regular rate and rhythm). There are no other abnormal symptoms are present during my assessment. The patient has verbalized that she is somewhat nervous and jumpy but denies any unusual activity or stress. She also has a history of panic attacks.

19. SBAR Interdisciplinary Communication Background BACKGROUND – Explain circumstances leading up to this situation. Put the situation into context for the reader/listener. Example: Mrs. L’s blood pressure is 188/92 (R) which is up from 126/80, 186/90 (L). Her pulse has increased from 64 bpm (regular rate and rhythm) to 98 bpm (regular rate and rhythm). There are no other abnormal symptomsare present during my assessment. The patient has verbalized that she is somewhat nervous and jumpy but denies any unusual activity or stress. She also has a history of panic attacks.

20. BACKGROUND– Explain circumstances leading up to this situation. Put the situation into context for the reader/listener. Example: Mrs. L’s blood pressure is 188/92 (R) up from 126/80, 186/90 (L). Her pulse has increased from 64 bpm (regular rate and rhythm) to 98 bpm (regular rate and rhythm). No other abnormal symptomatology evident during my assessment. The patient has verbalized that she is somewhat nervous and jumpy but denies any unusual activity or stress. She also has a history of panic attacks. . RECOMMENDATION – What would you do to correct the problem? Example: I would like you to notify the physician of these findings and ask if we can have a social worker referral for an evaluation to r/o psychosocial issues that may be causing Mrs. L’s suspected panic attacks. I would also like you to visit the patient in the a.m. to assess her vital signs. I will plan to call the physician tomorrow with our findings to see if he would like to schedule Mrs. L for an office visit. SBAR Interdisciplinary Communication Assessment . Assessment State what is happening at the present time that has warranted the SBAR communication. Example: “ Kathy, I think Mrs. L is anxious and might be having a panic attack. She states this is similar to ones she has had before.

21. SBAR Interdisciplinary Communication Recommendation Recommendation What would you do to correct the problem? Example: “I would like to notify the physician of these findings and ask if we can have a social worker referral for an evaluation to r/o psychosocial issues that may be causing Mrs. L’s suspected panic attacks. I would also like to visit the patient in the a.m. to assess her vital signs. I will plan to call the physician tomorrow with our findings to see if he would like to schedule Mrs. L for an office visit.”

22. SBAR inaction -less than 20 seconds S-Hi, Kathy, this is Brian. I am calling to report that my patient, Mrs. L., has an elevated blood pressure this morning and admits to feeling very anxious. B-Mrs. L’s blood pressure is 188/92 (R) which is up from 126/80, 186/90 (L). Her pulse has increased from 64 bpm (regular rate and rhythm) to 98 bpm (regular rate and rhythm). There are no other abnormal symptoms are present during my assessment. The patient has verbalized that she is somewhat nervous and jumpy but denies any unusual activity or stress. She also has a history of panic attacks. A-Kathy, I think Mrs. L is anxious and might be having a panic attack. She states this is similar to ones she has had before. R-“I would like to notify the physician of these findings and ask if we can have a social worker referral for an evaluation to r/o psychosocial issues that may be causing Mrs. L’s suspected panic attacks. I would also like to visit the patient in the a.m. to assess her vital signs. I will plan to call the physician tomorrow with our findings to see if he would like to schedule Mrs. L for an office visit.”

23. Interdisciplinary Communication: Voice mail/face to face Hand offs Report to managers and peers Message to office staff to forward to physician During case conferences How to Use SBARat DHCH

24. “How the nurse communicates patient information will depend on whether I listen to the nurse or not.” From the physician…

25. SBAR Physician Communication sample The following example demonstrates using SBAR to communicate issues, problems or opportunities for improvement to physicians SBAR: Activity #2

26. SBAR Physician Communication Situation . SITUATION – State what is happening at the present time that has warranted the SBAR communication. Example: This is Carol from Duke Home Care. We are seeing Mrs. L for pressure ulcer treatment. I am calling to report, Mrs. L, has an elevated blood pressure this morning. She also told me that she feels very anxious

27. SBAR Physician Communication Background BACKGROUND – Explain circumstances leading up to this situation. Put the situation into context for the reader/listener Example: Duke Home Health has been seeing Mrs. L for three weeks for care of a pressure ulcer. This is the first time her blood pressure has been elevated. Today her blood pressure is 188/92 (R); up from 126/80; 186/90 (L). Her pulse has increased from 64 bpm (regular rate and rhythm) to 98 bpm (regular rate and rhythm). No other abnormal symptoms evident during my assessment. The patient has verbalized that she is nervous and jumpy but denies any unusual activity or stress. She also stated that she has a history of panic attacks.

28. SBAR Physician Communication Assessment ASSESSMENT What do you think the problem is? Example: She has elevated blood pressure and pulse.

29. SBAR Interdisciplinary Communication Recommendation RECOMMENDATION – What would you do to correct the problem? Example: I can draw electrolytes and enzymes this morning and call you will the results. I am also requesting to have an order for a social worker to visit to r/o psychosocial issues. I will revisit Mrs. L tomorrow and contact you with our findings.

30. Script for phone call to physician’s office • Fax • Hand deliver How to Use the SBAR Form with Physicians

32. ACH Connection Improving Physician Communications with SBAR  Physician understanding of patient problem Physician trust with clinician Opportunity for early, appropriate intervention that may  reduce avoidable ACH

33. QUIZ