1. Improving Patient Safety through Effective Communication
SBAR
Improving Patient Safety through Effective Communication

2. Objectives
Describe factors that contribute to ineffective communication
Identify the components of the SBAR communication model
Utilize SBAR in the expected communication situations

3. 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.

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

5. Communication as a Root Cause
Mode of Communication
Oral %
Written 35%
Electronic 10%
Participants
Among staff 60%
With or among providers 25%
With patient or family 15%

6. 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

7. 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

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

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

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

11. 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?

12. 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

13. 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.

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

15. 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

16. 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?

17. 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?

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

19. 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

20. 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)

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

22. 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?

23. 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.

24. 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

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

26. 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

27. 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

28. 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…

29. 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

30. 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’

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