Communication Using The SBAR Model

Communication Using theSBAR ModelDecember, 2007Sharp HealthCare\\Spefp01\groups1\hr em.ppt12/07

Objectives Definethe elements of the SBAR model Discussthe application of SBAR tool toyour clinical environment Prepareand practice using the SBARmodel prior to calling a physicianSBAR Communication

BackgroundApproximately 98,000 hospitalized patients die as aresult of a medical error in the U.S. each year Communication failure has been found to be theroot cause in nearly 70% of these events Because of this, one of the Joint Commission’s2008 National Patient Safety Goals is to: Improve the effectiveness of communication amongcaregiversSBAR Communication

Sentinel Event Root CausesInadequate Communication is # 1National Data 2005SBAR Communication

Communication Barriers in HealthcareLack of structure and standardization forcommunication The existence of cultural differences in authority,gender, and race Healthcare team members may have differentcommunication styles Many physicians seem to favor “bulleted” summariesor “headlines” Non-physician team members often use detailed,descriptive narrativesSBAR Communication

A Search for a Solution Healthcarehas turned to otherindustries to find an effective solution forthis age-old problem Onesuch solution was found in acommunication model used by the Navyin their submarine division This model is called SBARSBAR Communication

Defining SBAR S– Situation B– Background A– Assessment R– RecommendationSBAR Communication

SBAR Model Provides an effectiveand efficient way tocommunicateOffers a simple way tostandardizecommunication byusing four commonelementsSBAR Communication Mirrors the scientificand nursing process Creates a commonlanguage

SBAR Model Promoted by:The Joint CommissionInstitute For Healthcare Improvement (IHI)Advisory Board CompanyThe World Health Organization (WHO)SBAR Communication

Here’s How It WorksS – SituationWhat is the immediate problem/situation?SBAR Communication

Here’s How It WorksB – BackgroundWhat is the relevant backgroundto the issue/problem?SBAR Communication

Here’s How It WorksA – AssessmentWhat are your conclusionsabout the present situation?SBAR Communication

Here’s How It WorksR – RecommendationWhat can be done to correct the problem?SBAR Communication

R-Recommendation Can Be Most ChallengingBased on your assessment data andknowledge of your patient, offer a“Recommendation” to the physician The Recommendation is one possiblesolution from your vantage point This Recommendation may not be acceptedby the person receiving the message, but is astarting point to discuss solutions SBAR Communication

Clinical SBAR Scenario # 1RN Calling MD Regarding Deteriorating Patient Condition:S–Mr. Lee is hypotensive, confused and his skin ismoist and pale.B–He’s a chronic dialysis patient who is normallyhypertensive.A–He’s being dialyzed now and his B/P is 60/40. He hasreceived 500mL of fluid with no response. We’vestarted a dopamine drip.R–He’s not responding and it looks like he’s going tocode. I need you to come to the bedside and assessthe patient.SBAR Communication

Clinical SBAR Scenario # 2RN Calling MD Regarding Patient’s SOBS–B–A–R–Mr. Smith is short of breath.He’s a 3 day post op colon resectionpatient who has been on room air.I’m concerned because he has laboredbreathing, decreased breath sounds onthe right side, a RR of 36, and O2 Satof 85% on room air.He is on supplemental O2 now. Shouldwe get a stat chest x-ray?SBAR Communication

Clinical SBAR Scenario # 3Physical Therapist communicating with physician about patient’s calf painS–B–A–R–Mrs. Gomez complains of pain in her rightleg every time her Sequential CompressionDevice (SCD) inflates.She is 3 days post op right hip replacementand has not ambulated due to other medicalcomplications.Her right calf is red with mild swelling. I suspecta deep vein thrombosis (DVT).Should we put her on bed rest until you canevaluate her?SBAR Communication

Clinical SBAR Scenario # 4Speech Therapist calling physician about patient’s dysphagiaS–B–A–R–Mr. James is complaining of difficulty swallowingwith vomiting and discomfort following meals.He has a history gastroesophogeal refluxdisease (GERD).I suspect the patient might have a hiatal herniaor other esophageal obstruction.Would you like to order an esophagram and aGI consult to identify/rule out possibleobstruction?SBAR Communication

Additional Resources Ifyou are unable to communicatedirectly with the physician and yourpatient’s condition is unstable, seek outadditional resources such as the RapidResponse Team.SBAR Communication

SBAR Preparation Some preparation is need to communicatewith SBAR Gather relevant information (e.g. chart, labs,MAR, etc.) Formulate your thoughts in a concise manner Practice with a colleagueSBAR Communication

How Can Using the SBAR Format Improve Clarityof Communication with the Physicians I work with? SBARpromotes: Clear, precisecommunication Standardized format fordiscussions partnerships viacollaborativecommunicationSBAR Communication

References Guise, J.M. & Lowe, N.K. (2006). Do youspeakSBAR? Journal of Gynecological and Neonatal Nurses,35, 3, 313-314. Joint Commission on Accreditation of HealthcareOrganizations (2007). National patient safetygoals. http://www.jointcommission.org. Leonard, M., Graham, S., & Bonacum, D. (2004). Thehuman factor: the critical importance of effectiveteamwork and communication in providing safe care.Quality Safe Health Care,13, 185-190.SBAR Communication

References Rodgers, K.L. (2007). Using the SBARcommunication technique to improve nursephysician phone communication: A pilot study.American Academy of Ambulatory Care Nursing:ViewPoint. Retrieved on October 7, 2007 fromwww.aaacn.org. World Health Organization (2007).during patient hand-overs.http://www.jcipatientsafety.org.SBAR CommunicationCommunication

Exit Clickthe Take Test button on the leftside of the screen when you are readyto complete the requirements for thiscourse. Choose the My Records button to viewyour transcript. Select Exit to close the StudentInterface.SBAR Communication

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