SBAR A Communication Tool Revised 2008

What is SBAR? Situation, Background, Assessment, Recommendation Thought organizer Framework for communication

Purpose of SBAR Provides a consistent way to share critical information Provides a tool to bridge the difference in communication styles between professionals Provides a clear template of what kind of information is important

Have you ever…. Called a physician and realized you didn’t have all the key information they were asking for? Found yourself talking to a physician and not really being able to organize or communicate your thoughts effectively?

Communication Styles Nurses are trained to “paint the big picture” – are generally very broad and narrative when describing clinical situations Physicians are trained to be problem solvers and learn to be concise – “what do you want me to do?” Different health care workers communicate in different ways – we speak different languages Complicating factors: gender, national culture, hierarchy, prior relationships.

Communication Styles Nurses are also taught that they don’t “diagnose”, which contributes to the broad and narrative communication style. This leaves the doctor impatiently “waiting to find out what they want”

Disorganized Communication Communication Scenario from the CHR

Using SBAR When concerns arise, you need to explain them quickly and well! Situation – punch line 5 – 10 sec Background – context, data, how did we get here? Assessment and Interventions – what’s the problem, what have you tried? Recommendation – what should we do? Refer to handout of tool.

Considerations Have I seen or assessed the client myself before calling? Has the situation been discussed with the Team Leader, or another RN? Do I have the following available at my fingertips: Client’s chart Current meds Recent vitals, allergies, labs etc. Code status

Organized Communication Communication Scenario from the CHR

Example - Situation Dr Brain, this is Nurse Jane calling about Mrs. Smith on 2 East. She is 80 yrs old and had a total hip replacement 2 weeks ago. She was started on an IV for dehydration 3 days ago. √ Her condition has deteriorated – she is complaining of SOB and chest tightness √ She has a Goals of Care Order R1

Background Pertinent History includes congestive heart failure. √ Vital signs – BP 110/60 P 120 RR 28 Sats 90% 3L NP T 38.2 Pain 4/10 √ Chest sounds – Coarse crackles √ Skin – Mottled and Diaphoretic

Assessment √ I’m worried she is in fluid overload or √ I’m not sure what the problem is, but the client is having troubles Could also talk about what you tried so far and if it helped or not. Is the condition getting worse?

Recommendation √ What would you like me to do? or √ The client needs to be seen immediately, what time can I expect you? √ If the client’s condition doesn’t improve, when should I call you back? You might also notify the physician that you are going to be transferring the client to Emergency.

Legal Aspects Tool which provides for consistent communication of critical information Not a legal document (does not replace charting standards) Document communications, assessments etc. in TTR