SBAR Communication Objectives - Home Care Information Network

8/20/2012
SBAR Communication
Communication to Help
Reduce Hospitalization
Objectives
To gain an understanding of SBAR Communication as an
evidence-based tool for communication of patient report
To provide the learner with an understanding of the elements of
SBAR communication for implementation into practice
To provide practical examples for making recommendations
when a change in status is noted.
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8/20/2012
What is SBAR Communication
SBAR is a standardized way of communicating.
Promotes patient safety because it helps individuals
communicate with each other with a shared set of expectations.
Staff and physicians can use SBAR to share patient information in
a concise and structured format.
Improves efficiency, accuracy and patient safety
SBAR stands for:
Situation
Background
Assessment
Recommendation
Why use SBAR Communication
SBAR is a preferred best practice for reporting a patient’s
condition and seeking treatment orders.
SBAR communication was proven 1 to be effective in reducing
hospitalizations when the clinician makes an appropriate
recommendation for care.
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Where is the Disconnect
We all want what’s best for the
patient
The clinician wants to report an
important issue to the physician so
that the patient needs are met…
The physician wants to make sure the
patient receives appropriate care…
So what could possibly
go wrong
Take This Situation, for Example
Ms. Jones is a new patient admitted three days ago following a
hospitalization for heart failure exacerbation. She begins to have
the following symptoms:
• Her weight is 3lbs greater than it was yesterday
• She complains of feeling fatigued
• You note rales in her anterior and posterior lower lung fields.
• She has 2+ pitting edema in her ankles, where previously there was none.
• She has taken the medications in her prefilled medication box that was set
up to help ensure her compliance.
How the nurse reports the situation can effect
how the physician reacts to the situation…
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8/20/2012
Where is the Disconnect
The Nurse’s Report
Dr. Smith, this is Nurse Jackie from AccentCare, calling
about your patient, Ms. Jones .
She was admitted to home health three days ago
following a hospitalization for heart failure exacerbation.
During her assessment today, I noted that she has gained
3 pounds since yesterday and is feeling fatigued. She has
rales in her anterior and posterior lower lung fields and 2+
pitting edema in her ankles, where previously there was
none.
She has taken the medications as prescribed.
What do you want me to do with her
Where is the Disconnect
The Nurse’s Report
The nurse has given a good report of the
patient’s condition.
She feels good that she has identified a change
in condition that indicates a need for physician
intervention.
What is the physician likely to do when
receiving this report
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8/20/2012
Where is the Disconnect
The Physician’s Reaction
Dr. Smith says “Send Ms. Jones to the Emergency
Department at St. Mary’s for evaluation.”
Why did the physician order this
Remember:The physician wants to make sure the patient
receives appropriate care…
What the physician perceived from the nurse’s report was:
“My patient is in trouble and the home health nurse does
not know what to do. I need to ensure that the patient
receives appropriate care.”
What could the nurse have done differently
Recommendation –
The Missing Piece
In the example, the nurse gave a report that
included a summary of the:
• Situation, Background and Assessment of the
patient’s condition, but did not make a
Recommendation.
What recommendations could be made
How might the recommendation effect the
outcome
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8/20/2012
Same Report, with Recommendations
Dr. Smith, this is Nurse Jackie from AccentCare, calling about your patient, Ms. Jones.
She was admitted to home health three days ago following a hospitalization for heart
failure exacerbation.
During her assessment today, I noted she has gained 3 pounds since yesterday and is
feeling fatigued. She has rales in her anterior and posterior lower lung fields and 2+
pitting edema in her ankles, where previously there was none.
She has taken the medications as prescribed.
Would you like to increase her diuretic therapy I can assess her response tomorrow
and collect any labs that you may want. What would you like to order
How might the physician respond differently given this report
Could This Make a Difference
The Physician’s Response
Dr. Smith says “That sounds like a good idea. Lets increase
her HCTZ to 50mg for the next 3 days and please draw a
potassium level on the third day. Keep an eye on her for the
next few days and get me the results. We can decide if that is
a good dose to continue.”
Remember: The physician wants to make sure the patient
receives appropriate care…
So what was the difference this time
What the physician perceived from the nurse’s report was
this:
“My patient is in trouble and the home health nurse has
given a good report and a feasible option on how to help
the patient.”
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8/20/2012
SBAR Works
The evidence in favor of SBAR communication is well documented:
STAR Quality Initiative demonstrated that the use of this in home
health helps reduce avoidable emergent care and
hospitalizations 1
Hospital systems use SBAR as part of their core initiatives for
Patient Safety 2
The Joint Commission endorses use of SBAR in care handoffs and
physician report 3
Prepare Before You Call
The clinician must gather all of the information needed to give the
SBAR report effectively. Prior to calling the physician, follow these
steps:
Have I seen and assessed the patient myself before calling
Has the situation been discussed with a clinical supervisor
Review the chart for appropriate physician to call.
Do I know the report from nurse who worked with the patient
ahead of me
Have available the following when speaking with the physician:
• List of current medications, allergies, and any pertinent labs
• Most recent vital signs
• Reporting vitals/labs: provide the date of previous tests for comparison.
Review the problem and potential recommendations.
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When You Call, Use the SBAR Method
(S) Situation: What is the situation you are calling about
Identify self, agency, patient.
Briefly state the problem, what is it, when it happened or started,
and how severe.
When You Call, Use the SBAR Method
(B) Background: Pertinent background information related to the
situation could include the following:
The patient’s diagnoses
List of current medications, allergies, and labs
Most recent vital signs and previous vital signs for comparison
Other clinical information
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8/20/2012
When You Call, Use the SBAR Method
(A) Assessment: What is the nurse’s assessment of the situation
What could be going on with the patient
The assessment should help form the recommendation you
make.
When You Call, Use the SBAR Method
(R) Recommendation
What is the clinician’s recommendation, or
What does he/she want
Examples:
• Patient needs to be seen in office
• Order change
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8/20/2012
Conclusion
SBAR promotes better communication. In most cases nurses and
physicians communicate in very different ways.
Nurses are taught to report in narrative form, providing all details
known about the patient.
Physicians are taught to communicate using brief “bullet points”
that provide key information to the listener.
Bridging the gap in communication is essential for patient safety.
SBAR is an effective way to communicate among clinicians
References
Burt P., Pabin A. (2006). A quest for quality in home healthcare: a
perspective of work in the 6 and 7SOW into the 8SOW: improving
acute care hospitalization. Home Healthcare Nurse, (3), 167-71
SBAR Technique for Communication: A Situational Briefing
Model retrieved on 8/15/12 from
http://www.ihi.org/knowledge/Pages/Tools/SBARTechniqueforCo
mmunicationASituationalBriefingModel.aspx
Thomas CM, Bertram E, Johnson D. (2009). The SBAR
communication technique: teaching nursing students
professional communication skills. Nurse Educ. 34(4):176-80.
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