SBAR
ndationA CommunicationHandbookfor All Staff ]
dationA CommunicationHandbookfor All Staff
SAMPLESBAR: Situation, Background, Assessment, Recommendation—A Communi cation Handbook for All Staff is published by HCPro, Inc.Copyright 2006 HCPro, Inc.All rights reserved. Printed in the United States of America.ISBN-13: 978-1-57839-813-3ISBN-10: 1-57839-813-4No part of this publication may be reproduced in any form or by anymeans without prior written consent of HCPro, Inc., or the CopyrightClearance Center (978/750-8400). Please notify us immediately if you havereceived an unauthorized copy.HCPro provides information resources to the healthcare industry.HCPro, Inc. is not affiliated in any way with The Joint Commission, whichowns the JCAHO and Joint Commission trademarks.Molly Hall, Executive EditorJohn Novack, Group PublisherJean St. Pierre, Director of OperationsMike Mirabello, Senior Graphic ArtistShane Katz, Cover DesignerAdvice given is general. Readers should consult professional counsel withspecific legal, ethical, or clinical questions.Arrangements can be made for quantity discounts.For more information, contact:HCPro, Inc.P.O. Box 1168Marblehead, MA 01945Telephone: 800/650-6787 or 781/639-1872Fax: 781/639-2982E-mail: customerservice@hcpro.comVisit HCPro at its World Wide Web sites:www.hcmarketplace.com and www.hcpro.comRev. 02/200721110
SAMPLESBAR: Situation, Background, Assessment, RecommendationContentsIntroduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Where communication fails . . . . . . . . . . . . . . . . . . . . . . . 2SBAR communication: Who? . . . . . . . . . . . . . . . . . . . . . . 3What is SBAR? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Situation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4SBAR script: Situation . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5SBAR script: Background . . . . . . . . . . . . . . . . . . . . . . . . . 6Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7SBAR script: Assessment . . . . . . . . . . . . . . . . . . . . . . . . . 8Recommendation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8SBAR script: Recommendation . . . . . . . . . . . . . . . . . . . . . 9“Critical” words . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Sample SBAR card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12SBAR in action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Using SBAR during patient hand-offs . . . . . . . . . . . . . . . . . . 14Using SBAR during RN to MD communication . . . . . . . . . . . 15Tips for calling a physician . . . . . . . . . . . . . . . . . . . . . . 16Using SBAR with emergency response teams . . . . . . . . . . . . 16Using SBAR when resolving a complaint . . . . . . . . . . . . . . . 17SBAR practice and discussion . . . . . . . . . . . . . . . . . . . . 18Certificate of completion . . . . . . . . . . . . . . . . . . . . . . 203
SAMPLE
SAMPLESBAR: Situation, Background,Assessment, RecommendationIntroductionHospitals are centers of communication. Patients whocome into your facility will be treated by any numberof healthcare professionals. Each person who workswith a patient must provide accurate and updated information to other caregivers. After a while, all of theinformation about a patient’s condition can becomeconfusing and scattered.Whether you’re a nurse, dietician, maintenance worker,or surgeon, your ability to communicate informationeffectively and efficiently greatly affects patient safety.In fact, data shows that most medical errors occur as aresult of communication breakdowns.1
SAMPLESBAR: Situation, Background, Assessment, RecommendationWherecommunication fails: 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 beforecommunication is cut offSBAR (pronounced s-bar) is a communication tool thatcan improve the way you communicate.SBAR stands for Situation Background Assessment RecommendationSBAR helps you outline the most important points of asituation and remove irrelevant information. Regardlessof your job or role, this simple technique will help youorganize information and present it in a way that provides important facts in a quick, coherent way.2
SAMPLESBAR: Situation, Background, Assessment, RecommendationSBARcommunication:Who?4 Nurse to physician4 Physician to physician4 Resident to attending4 Nurse to nurse4 Pharmacy to physician/nurse4 Nurse to technician4 Bed control to nurse4 Administrator to physician4 Office/dietary/housekeeping staff to patientThis training handbook will explain each step of SBAR,provide examples of when SBAR might be used, and offeropportunities for you to practice your SBAR skills.What is SBAR?SBAR was developed by the United States Navy for submariners, who often work in stressful, time-critical environments. Sound familiar? Hospitals are often stressfulplaces with significant time constraints, especially in anemergency.3
SAMPLESBAR: Situation, Background, Assessment, RecommendationEach component of SBAR—situation, background, assessment, recommendation—provides a format for which topresent information in a specific, organized way.SituationThe first step of the SBAR tool is stating the situation.In other words, what is the problem?The situation should include: Your name and unit Patient’s name, physician, room number Brief statement of your concernsSBAR Script: SituationI am calling about.The patient’s code status is.The problem I am calling about is.4
SAMPLESBAR: Situation, Background, Assessment, RecommendationSBAR Script: Situation (cont.)I have just assessed the patient personally: Vital signs are: Blood pressure / ,pulse , and temperature .I am concerned about the patient’s– blood pressure because it is over 200 or less than 100– pulse because it is over 140 or less than 50– respiration because it is less than five or over 40– temperature because it is less than 96 or over 104BackgroundThe second step of SBAR is background. Provide a briefhistory on the patient or situation, making sure the information is pertinent to the situation at hand.The background may include: Admission diagnosis and date of admission Pertinent medical history Brief synopsis of the treatment to date Clinical assessment (neuro, resp, cardio, GI/GU/bowl,integ, wound) Recent interventions given and effectiveness5
SAMPLESBAR: Situation, Background, Assessment, Recommendation Abnormal lab or imaging tests, telemetry Status of IV Gait/fall precautions Diet Living situation; discharge plan Vaccines, allergiesSBARAssessmentscript:BackgroundThe patient’s mental status isq alert and oriented to person, place, and timeq confused and cooperative or noncooperativeq agitated or combativeq lethargic but conversant and able to swallowq stuporous, not talking clearly, and possibly unableto swallowq comatose, eyes closed, and not responding tostimulation6
SAMPLESBAR: Situation, Background, Assessment, RecommendationSBARscript:Background (cont.)The skin isq warm and dryq diaphoreticq mottledq paleq extremities are coldq extremities are warmThe patient is not or is on oxygen.q The patient has been on (l./min.) or (%)oxygen for minutes (hours)q The oximeter reads %q The oximeter does not detect a good pulse andis giving erratic readingsThe third part of the SBAR tool is making an assessment:The assessment should include: Vital signs Oxygen status Any changes from prior assessments7
SAMPLESBAR: Situation, Background, Assessment, RecommendationSBARscript:AssessmentI think the problem is.q The problem seems to be cardiac/infection/neurologic/respiratory .q I am not sure what the problem is, but the patientis deteriorating.q The patient seems to be unstable and may getworse. We need to do something.RecommendationThe final SBAR step is recommendation. Give a recommendation (or a response) based on the situation, background, and assessment of the case. In other words,what do you think needs to be done?The recommendation should include: Anything that needs to be attended to immediately Details on what the patient’s physician has been told Anything that has been left undone8
SAMPLESBAR: Situation, Background, Assessment, Recommendation Information on anything that could not be finishedduring your shift/time with the patientFor many people, the recommendation step of SBAR isthe most intimidating. You may feel unqualified to makea recommendation or worry that the recommendationyou make is incorrect.It’s natural to worry about making a recommendation—especially if you are new or inexperienced. But, rememberyou are not making the final decision. The purposeof the recommendation stage is to outline your thoughts.It’s up to the physician or responsible party to decidehow to act. Saying something as simple as, “I need you tocheck on the patient now,” is a proper recommendation.SBARscript:RecommendationI suggest or request that you.q transfer the patient to critical careq come to see the patient at this timeq talk to the patient or family about code status9
SAMPLESBAR: Situation, Background, Assessment, RecommendationSBARscript:Recommendation (cont.)q ask the on-call family practice resident to see thepatient nowq ask for a consultant to see the patient nowAre any tests needed?Do you need any tests done (e.g., CXR, ABG, EKG, CBC,or BMP)?Others?If a change in treatment is ordered, askq how often do you want vital signs?q how long do you expect this problem will last?q if the patient does not get better, when would youwant us to call10
SAMPLESBAR: Situation, Background, Assessment, RecommendationCritical languageIt is important that your recommendation be taken seriously—regardless of who is receiving it. The use of“critical” language can increase the intensity of your message. Critical language uses words that convey a senseof urgency.“This patient needs medication now.”“I need you to check on the patient immediately.”“Critical”words: Now At once Must Instantly/this instant Need Acute Immediately Imperative Critical Vital Priority Crucial Important Urgent Quickly Essential RequiresTo help you remember the SBAR steps, you may want tocarry a card like the one on the next two pages.11
SAMPLESBAR: Situation, Background, Assessment, RecommendationSample SBARcardSBAR report about a critical situationSSituationBBackground patient name and location I am calling about . code status The patient’s code status is .The problem I am calling about is .I have just assessed the patient personally: Vital signs are: Blood pressure / , pulse , respiration ,and temperature . I am concerned about the patient’s– blood pressure because it is over 200 or less than 100 or 30 mmHg below usual– pulse because it is over 140 or less than 50– respiration because it is less than five or over 40– temperature because it is less than 96 or over 104The patient’s mental status is alert and oriented to person, place, and time confused and cooperative or noncooperative agitated or combative lethargic but conversant and able to swallow stuporous, not talking clearly, and possibly unable to swallow comatose, eyes closed, and not responding to stimulationThe skin is warm and dry diaphoretic mottled pale extremities are cold extremities are warmThe patient is not or is on oxygen. The patient has been on (l./min.) or (%) oxygen for minutes (hours) The oximeter reads % The oximeter does not detect a good pulse and is giving erratic readings12
SAMPLESBAR: Situation, Background, Assessment, RecommendationSample SBARAAssessmentRRecommendationcard say what you think is the problem I think the problem is . The problem seems to be cardiac/infection/neurologic/respiratory . I am not sure what the problem is, but the patient is deteriorating. The patient seems to be unstable and may get worse. We need todo something. say what you would like to see done I suggest or request that you .transfer the patient to critical carecome to see the patient at this timetalk to the patient or family about code statusask the on-call family practice resident to see the patient nowask for a consultant to see the patient nowAre any tests needed?Do you need any tests done (e.g., CXR, ABG, EKG, CBC, or BMP)?Others?If a change in treatment is ordered, ask how often do you want vital signs? how long do you expect this problem will last? if the patient does not get better, when would you want us to call again?13
SAMPLESBAR: Situation, Background, Assessment, RecommendationSBAR in actionSBAR is a useful technique for all types of communication—not just emergencies. However, when you arenervous, hurried, or under stress, your potential forcommunication errors is heightened. At these times,SBAR can be a life-saving communication tool.When SBAR is a “must”: During a patient hand-off During RN to MD communication When calling a emergency response team(e.g. RRT, MRT) When resolving a consumer (patient or family) issueLet’s take a closer look at SBAR in these situations.Using SBAR during patient hand-offsSBAR is especially useful in hand-off situations wherethe care of a patient is transferred between shifts, floors,or staff members. The Joint Commission on the Accredi tation of Healthcare Organizations has made patienthand-offs a National Patient Safety Goal. Part of thegoal requires that patient hand-offs provide time for caregivers to ask and answer questions. With SBAR, you may14
SAMPLESBAR: Situation, Background, Assessment, Recommendationbe able to answer most questions even before they areasked.Using SBAR during RN to MD communicationWhen nurses need to communicate with physicians,especially if the physician is off duty, there is the potential for miscommunication. Nurses are trained to be narrative and descriptive. Physicians, however, want to getstraight to the “meat” of the issue: What specifically iswrong and what do you want me to do?SBAR gives you the chance to organize your thoughtsand prioritize information before talking to a physician.And it helps a physician get the facts she needs in aclear and concise way.Before talking to a physician, ask yourself (you mayeven want to write down your answers!): Why I am calling this physician? What’s happening to the patient that makes this callimportant? What information is relevant to the situation? What might it mean? What would I do if I had to make the decision?15
SAMPLESBAR: Situation, Background, Assessment, RecommendationTipsfor calling a physicianBefore calling the physician:q Assess the patientq Review the chart for the appropriate physicianto callq Know the admitting diagnosisq Read the most recent progress notes and theassessment from the nurse of the prior shift.Have available when speaking to the physician:q Chart, allergies, meds, IV fluids, labs/resultsUsing SBAR with emergency response teamsYou may work in a facility that has an emergencyre sponse team (often called a rapid response team). Thisis a specific team designated to respond to patientsin trouble.Depending on your hospital’s specific policy, you mayneed to activate this emergency team at some point. SBARwill help you present key information needed to help a16
SAMPLESBAR: Situation, Background, Assessment, Recommendationpatient whose condition is deteriorating. The team needscritical information about the patient to assess the situation.Using SBAR when resolving a complaintDealing with a dissatisfied patient or family membercan be a stressful situation. SBAR can help you organizeyour response to the complaint and explain the situationin a clear and concise manner. However, don’t becomeso locked into the four steps of SBAR that you becomerobotic. Remember that you want to remain caring andcompassionate while resolving the complaint.SummaryLike any new technique, the best way to master SBARis to practice it. Use it in phone calls, e-mails, memos, orany other time you have to communicate. Once you getthe hang of it, you’ll find that communicating in criticalsituations will become easier and take less time. Clear,effective communication will saves lives and makes all ofour jobs easier.17
SAMPLESBAR: Situation, Background, Assessment, RecommendationSBARpractice and discussionUse the following scenarios to practice your SBAR technique. Think about how you would communicate in thesesituations. Discuss your ideas with your manager andother staff members.Scenario oneA patient arrived in your outpatient clinic today for anevaluation and is seemingly intoxicated. She has missedthe last two appointments. She has a history of paranoidschizophrenia and is on medication. She also has a history of rheumatic heart disease and atrial fibrillation. Sheis scheduled for mitral valve replacement and cardiologyclinic has referred the patient to you. The clinic is extremelybusy today. What are you concerned about? How should the clinic handle this situation? Who do you need to call and how will you organize your thoughts before calling?18
SAMPLESBAR: Situation, Background, Assessment, RecommendationSBARpractice and discussion(cont.)Scenario twoYou are taking care of a 72-year-old female for the firsttime tonight. You’ve been told at shift report that the patientis doing well but has had a rough day with lots of family and visitors. She has not had much chance to rest. At2:30 a.m., you enter the patient’s room to take vitals. Sheis arousable but her heart rate is 42. Her blood pressureis 98/40, and her pulse rate is regular. She was admitted three days ago in rapid atrial fibrillation, diuresed, andplaced on a beta blocker. She is also on digoxin 0.25mg p.o.q. AM. Her last potassium 2 days ago was 3.8.The patient is scheduled to undergo a colonoscopy aroundnoon, since she was noted to have heme and stools. She isNPO and has taken her bowel prep.19
of completionRob StuartSenior Vice President/Chief Operating OfficerSBAR: Situation, Background, Assessment, Recommendation—A Communication Handbook for All Staffhas read and successfully passed the final exam ofThis is to certify thatSAMPLECertificate
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2 SAMPLE SBAR: Situation, Background, Assessment, Recommendation SBAR (pronounced s-bar) is a communication tool that can improve the way you communicate. SBAR stands for Situation Background Assessment
tools like critical language, psychological safety, and effective leadership are central to providing safe care. The SBAR technique provides a framework for communication between members of the healthcare team about a patient’s condition. SBAR is an easy-to-remember, concrete mechanism useful for framing any conversation, especially critical .
SBAR Pocket Card template o Print these cards on heavier paper and laminate for each staff member when introducing the SBAR concept. Include this pocket card in your orientation . I am calling about patient na
appropriate Cerner power forms or in SurgiNet . SBAR PROCESS-ALGORITHM Created July 2012 by Quality & Practice Council Approved July 2012 by Evidence Based Practice Board SBAR Process For Admission s /Transfer s Sending RN Report called and documented on patient transfer powerform .
Recommendation of an issue ( Adapted SBAR Tool). In order to develop better ways to improve effective teamwork and communication, and protect patients and families from inadvertent harm, the Toronto Rehabilitation Institute (Toronto Rehab) conducted two research studies that adapted, implemented and evaluated the SBAR
SBAR Communication R-Recommendation Can Be Most Challenging Based on your assessment data and knowledge of your patient, offer a “Recommendation” to the physician The Recommendation is one possible solution from your vantage point This Recommendation may not be accepted by the person receiving the message, but is a
Mar 06, 2020 · Pharmacy Date SBAR Communication Prepared: March 4, 2020 Reviewer: Dr. Lauren Lyles-Stolz, Executive Director Link to Action Plan: Action Information Follow-up Report only Situation: (Briefly describe the current situat
added into the chart 39 Key Recommendations for Other Agencies zStaff who are comfortable using the SBAR will recommend it to others- Staff not as comfortable will not change overnight – keep checking with staff about using the tools zInvolve staff in the decision making process and developing the tool specific to your agency 40
224 Communicating in the 21st Century Essay writing ‘The essay is a form of refined torture. Discuss.’ You almost certainly will never encounter such an essay topic, but you might think it.
