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SBAR

SBAR. Improving Patient Safety through Effective Communication. Objectives. Describe factors that contribute to ineffective communication Identify the components of the SBAR communication model Utilize SBAR in the expected communication situations. Why should we be communicating effectively?.

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SBAR

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  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

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