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SBAR. SBAR : Made Easy. Clinician Module. 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. Home Care Challenges.

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Sbar

SBAR

SBAR: Made Easy

Clinician Module


Objectives

  • 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


Home care challenges

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)


Sbar

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


Healthcare and submarines

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


Sbar ihi connection

  • Institute for Healthcare Improvement

    • Focus on improving health care

  • Modified the Navy’s SBAR

    • R – Recommendation rather than Resolution

SBAR: IHI Connection


Sbar home care connection

Condenses messages

Promotes critical thinking

Interdisciplinary communication

Physician communication

SBAR: Home Care Connection


S b a r stands for

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


Sbar preparation

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


Communicating with physicians

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


Sbar technique

(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


Sbar technique1

(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


Sbar technique2

(A)Assessment:

  • What are the clinician’s?

  • What is the analysis ?

  • Is this problem severe or life threatening?

SBAR Technique


Sbar technique3

(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


Sbar activity 1

SBAR

Interdisciplinary

Communication

Example

SBAR: Activity #1


Sbar

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.


Sbar

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.


Sbar

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.


Sbar

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.


Sbar

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.”


Sbar in action less than 20 seconds

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.”


How to use sbar at dhch

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


From the physician

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

From the physician…


Sbar activity 2

SBAR Physician

Communication sample

The following example demonstrates using SBAR to communicate issues, problems or opportunities for improvement to physicians

SBAR: Activity #2


Sbar

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


Sbar

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.


Sbar

SBAR Physician Communication

Assessment

ASSESSMENT

What do you think the problem is?

Example: She has elevated blood pressure and pulse.


Sbar

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.


How to use the sbar form with physicians

  • Script for phone call to physician’s office

  • Fax

  • Hand deliver

How to Use the SBAR Form with Physicians


Ach connection

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


Sbar

QUIZ


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