Improving Patient Safety through Effective Communication 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? 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.

Root Causes of Sentinel Events 1995-2002 Communication 65% Orientation/Training 58% Patient Assessments 35% Availability of Information 20% Physical Environment 18%

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%

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

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

Assertion Model Get Attention Express Concern Reach Decision State Problem Propose Action

Strategies for Improved Closed Loop Communication Read Back Critical Language Second Challenge SBAR

SBAR – What is it? Communication tool Originated from the U. S. Navy

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?

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

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.

SBAR for Shift Report Situation: Patient’s name, physician, room number Admitting diagnosis Brief statement of main concern

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

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?

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?

SBAR for Unit Transfers Situation: Patient’s name, physician, background Admitting diagnosis DNR status

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

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)

SBAR for Unit Transfers Recommendation: Patient education needs Skin care needs Behavioral/Psychosocial needs Reassessment needs (pain, falls, etc.) Discharge plan

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?

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.

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

SBAR – Physician Communication Situation: State your name/unit “I am calling you about….” “I have just assessed the patient and I am concerned about…

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

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

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…

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

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’

Summary Remember…in most cases you have already gathered this information Now you are placing that information in an organized, consistent framework