SBAR: A How To Guide!

What is SBAR Originally developed in the military Adapted to aviation to combat communication barriers inherent in the work environment, which were causing life threatening crashes. Adopted by healthcare after the realisation that there are fundamental similarities between healthcare and aviation/military environments Both are high risk, high stress, time sensitive environments, where wrong decisions can be life threatening.

What is SBAR? SBAR is a structured communication tool intended to add predictability and consistency to critical points of information transfer. SBAR helps to reduce the influence of individual communication styles on clarity of information being relayed.

What is SBAR A way to get everyone ‘in the same movie’ before proceeding, as to increase chances of best possible patient care. A hybrid of physician and nursing communication styles.

Situation: what is going on Background: brief hx, relevant context What is SBAR? Situation: what is going on Background: brief hx, relevant context Assessment: what I think, conclusions Recommendation: What I need, in what time frame

When should SBAR be used? Ideally SBAR should be used every time that patient information needs to be relayed from one clinician to another. The most critical points are: Physician contact Patient handoff Patient transfer Team briefings Rounds

Through a case: step by step 85 y.o. POD#3 hip repair[i] Hx CHF, HTN, DM Was doing well, eating, working with PT Now SOB, respirations look laboured RR26, O2 sat 93% BP 130/65 Lungs with crackles ½ up, I/O +1500 past 24 hours No chest pain [i] IHI, SBAR: Application and critical success factors, Participant WebEX training, Wittington J, Nagamine

Traditional Model Of Communication “I’m calling about Mr. Smith, he’s SOB” Play 20 questions, then come up with a plan that may or may not be mutually acceptable[i] [i]IHI, SBAR: Application and critical success factors, Participant webEX training, Wittington J, Nagamine

Using SBAR Model of Communication RN : “I don’t like what I’m seeing”[i] Problem solve Organise data/information Communicate and collaborate [i]IHI, SBAR: Application and critical success factors, Participant webEX training, Wittington J, Nagamine

Thought process of RN[i] B A – I don’t like what I see. What am I seeing? R [i]IHI, SBAR: Application and critical success factors, Participant webEX training, Wittington J, Nagamine

Thought Process of RN S B – RR is 26, O2 sat is 93%, BP is 130/60 lungs have crackels ½ up, I/O +1500/24hr A – Fluid overload? R IHI, SBAR: Application and critical success factors, Participant webEX training, Wittington J, Nagamine

SBAR format Situation: I’m calling about Mr. Smith; he says he’s SOB and his breathing looks laboured to me. Background: He’s POD#3 from hip replacement and has hx of HTN, and CHF. He’s been doing well until today – he was eating, working with PT. Now his RR is 26, O2 sat 93%. Lungs have crackles half way up, I/O +1.5L IHI, SBAR: Application and critical success factors, Participant webEX training, Wittington J, Nagamine

SBAR Format Asssessment: I think he might be in fluid overload. Recommendation: I’d like to Hep lock his IV and get an MD to evaluate him as soon as possible. IHI, SBAR: Application and critical success factors, Participant webEX training, Wittington J, Nagamine

SBAR Process Some do this naturally For others it takes practice Gut Feeling or Vague Notion Problem-Solve and package Articulate IHI, SBAR: Application and critical success factors, Participant webEX training, Wittington J, Nagamine

Who should be using SBAR Nurses Doctors Residents Interns OT PT Dieticians

How will this help me? By employing SBAR when communicating regarding a patient, you will ensure that pertinent information is conveyed in a clear manner, the first time around. Time efficient. Helps to raise level of patient care. Increases stability of interactions with co-workers.

A Win-Win Expectation or an Assessment and Recommendation accomplishes the following Sends the message that “I value your assessment”, promotes mutual respect Gives psychological safety to the junior person to help the with assertion, sharing of ideas Reduces ambiguity, guesswork, variability for both sender and receiver. IHI, SBAR: Application and critical success factors, Participant webEX training, Wittington J, Nagamine

Now practice Scenario 1

Scenario 2

QUIZ!!! Where did SBAR originate? Why did SBAR originate? What does SBAR stand for? Why is SHR implementing SBAR use? How can SBAR improve clinical communication? Who should be using SBAR?

Go Forth and SBAR!!! You’ll be happy you did!