WEEK 1 - XLIST SBAR PDF

## Orientation SBAR Communication Tool ### Alberta Health Services The following Alberta Health Services -staff are acknowledged for their contribution to the development of this orientation learning resource: * Anita Mitzner - Health Professions Strategy & Practice * Leslie Carnegie - Health Pro...

## Orientation SBAR Communication Tool ### Alberta Health Services The following Alberta Health Services -staff are acknowledged for their contribution to the development of this orientation learning resource: * Anita Mitzner - Health Professions Strategy & Practice * Leslie Carnegie - Health Professions Strategy & Practice * Debbie Bailer - Health Professions Strategy & Practice * Deanna Janes - Health Professions Strategy & Practice * Jane Thompson - Health Professions Strategy & Practice © Alberta Health Services, 2010. All rights reserved. This information is to be used only by Alberta Health Services staff and persons acting on behalf of Alberta Health Services for guiding actions and decisions taken on behalf of Alberta Health Services. No part of this information may be reproduced, modified or redistributed for any purposes other than those noted above without the prior written permission of Health Professions Strategy & Practice, Alberta Health Services. ### Introduction This learning resource should be completed by all health professionals. Once you have read this learning resource, complete the exercises within. If you have any questions, please contact the educator or designate in your area. Upon completion of the learning module, you will be able to: 1. explain SBAR. 2. describe the advantages of using SBAR. 3. develop a communication plan using SBAR. ### Communication Safe, effective clinical care depends on reliable, flawless communication between caregivers. Miscommunication is frequently identified as being a major contributor in sentinel or critical events. Patient care concerns or safety issues can occur as a result of communication breakdown. Reasons why communication breaks down may include: * different communication styles * high level of activity * frequent interruptions * complex healthcare environment * stress * no standardization in organizing essential information Using a standardized form of communication: * helps healthcare providers speak the same language * allows all users to have common expectations * provides predictable structure for what is going to be communicated * promotes critical thinking ### What is SBAR? SBAR is a situational briefing model that provides a framework for communication between members of the healthcare team. This communication tool is designed to standardize the delivery of information shared between healthcare providers, regardless of the situation and who is having the conversation. It also provides an opportunity to propose an action and reach a decision in a collaborative manner. ### SBAR Communication Tool The components of SBAR are below. | Component | Description | |---|---| | **S** Situation | What is my major concern? | | **B** Background | What are the pertinent facts? | | **A** Assessment | What do I think is the problem? | | **R** Recommendation | What do I recommend that we do? | ### Advantages of Using SBAR * Improves communication resulting in improved safety for patients * Provides a consistent way of communicating among health team members * Succinct and to the point format * Communicates the problem clearly * Ensures completeness of information and reduces the likelihood of missed data * Promotes critical thinking - organizes relevant information * Enhances teamwork among healthcare providers * Provides an opportunity to propose an action and reach a decision in a collaborative manner * Improves nurse/physician relationship * Improves healthcare professional satisfaction * Improves overall quality of care ### Some situations to consider using SBAR include: * Shift to shift report in the patients' rooms * Reporting on patients in multidisciplinary rounds * Communication between departments * Communication across sites * Communication to physician ### Always prepare your information before calling the physician or other health care provider: * Assess the patient yourself * Review medical record * Know the admission diagnosis and any significant medical history * Medications * Vital signs * Allergies * Lab results * IV fluids * Read most recent progress notes and assessment by physician, nurses and other healthcare professionals from the previous shift * Ensure that e-record, eMAR, etc. are readily available ### Learning Activity #1 Instructions: Unscramble the word in parentheses to fill in the blanks. 1. SBAR is a ______ tool. (numactionimoc) 2. SBAR provides a ______ structure. (paledritecb) 3. SBAR is designed to ______ the delivery of information. (daresizatnd) 4. Decisions can be made ______ (livelylabratoco) 5. SBAR promotes ______ thinking. (catcilir) 6. SBAR enhances ______ (twomaker) 7. Before calling a physician, you must be well ______ (darepepr) **Note:** The answers can be found in Appendix A. ### SBAR Communication Tool Before calling a physician or approaching a health professional with patient concerns, you need to gather information and think about your approach to communication. Using a tool such as SBAR can help you organize and communicate this information. | **S** Situation | **B** Background | **A** Assessment | **R** Recommendation | |---|---|---|---| | (State in 5 - 10 seconds) Indicate your name, title, role. State: <br> * who you are concerned about <br> * the problem <br> I am concerned about... | Pertinent history. Events leading up to the current condition. Consider the following clinical information: <br> * diagnosis, procedure performed <br> * medications, allergies, IV fluids, lab results <br> * assessment findings, recent vital signs <br> * mental status <br> * oxygenation | What is your assessment of the situation? <br> * What do you believe the problem is? <br> * I'm not sure what the problem is but the patient is deteriorating. <br> * I'm concerned. Something is wrong. | What do you need from the physician or health professional? | ### Remember to document the change in condition and who was notified. SBAR utilizes critical language: * I am calling about a problem. * I am concerned about... * I need you to come and see this patient... * I think this patient requires... ### Remember you must be well prepared when calling the physician. You must have confidence in your assessments and communicate exactly what you have assessed or observed. #### Examples Let's look at some examples. For the situations identified, how would you communicate using SBAR? #### Paul Todd Paul Todd a resident in a Continuing Care facility has had persistent pain to his right lower leg for the last 3 days. On exam, you find the right leg to be slightly edematous compared to the left. The calf is warm to touch and he has some erythema to the posterior aspect. Pain is experienced on dorsiflexion. Pedal pulses are equal bilaterally. The right calf circumference is 3.5 cm larger than the left calf. Paul's vital signs are normal and he has no complaints of SOB or chest pain. His last analgesic, acetaminophen 650 mg given at 1420 was not effective for pain management. He rates his pain as 7/10. He has no known allergies. You advise bed rest and inform Paul his physician will be contacted. **SBAR for Paul Todd:** | **S** Situation | **B** Background | **A** Assessment | **R** Recommendation | |---|---|---|---| | I am calling about Paul Todd. The main problem is edema, warmth and redness to his right lower leg. He has no known allergies. | His vital signs are stable. He has a positive Homan's sign and rates his pain at 7/10. His posterior right calf is red, warm and edematous, skin is intact. He was given acetaminophen at 1420 which was ineffective for pain. | I think the problem is a possible DVT in his right leg. | I think Paul needs to be seen today. Are there any diagnostic tests you wish to order? | #### Emma Miller Emma Miller, 81 years old, was admitted yesterday with atrial fibrillation. She appears cold, clammy, tachypneic but shallow, and is less responsive than when you checked one hour ago. Vital signs include BP 130/78, pulse is 120 irregular. Her SpO2 on room air is 86%. She and her physician have discussed that she will have all medical treatment excluding chest compressions. She is on a Cardizem drip but started on Cardizem orally today. She has also been started on Coumadin. Emma has allergies to Morphine and Codeine. Her medical history includes TIA, hypertension, left hip fracture with surgical repair last year. You call for a respiratory therapist and begin to place her on a non-rebreather mask. **Using SBAR, write down what you would communicate to the respiratory therapist** **SBAR for Emma Miller:** | **S** Situation | **B** Background | **A** Assessment | **R** Recommendation | |---|---|---|---| | Emma has become unresponsive and her breathing is shallow. Her SpO2 is 86% so I am putting her on a non-rebreather mask. She is to have all medical treatment with the exception of chest compressions. | Emma is in atrial fibrillation with a rate of 130. She was on IV Cardizem and started this orally today. She was also started on Coumadin today. Emma was fine an hour ago. She has become less responsive. Her BP is dropping. She has a history of TIA and hypertension. Emma is cold and clammy and her breathing is ineffective. | I am concerned that she is deteriorating and in respiratory distress. | Can you come and assess her right away? | ### Learning Activity #2 Instructions: Read each situation below. Write out the conversation you would be having with the appropriate health professional. #### Mark Adams You are an LPN and have been assigned to 77 year old Mark Adams. When making rounds you find Mark shouting "get out of here, leave me alone." You enter and change his incontinent product. He now appears calmer. You note that his urine is dark in colour, smells foul and you see a trace of blood. Upon reviewing his chart you see he is prone to urinary tract infections and his fluid intake has not been documented for days. He has a bowel movement every 3 days. Using SBAR, what would you report to the charge nurse? **SBAR for Mark Adams:** | **S** Situation | **B** Background | **A** Assessment | **R** Recommendation | |---|---|---|---| | Mr. Adams is uncooperative and combative. He has foul smelling urine. | No intake has been recorded. He is incontinent for foul smelling urine and a trace of blood was seen when he was last changed. He has a history of urinary tract infections. | I think the problem is a possible urinary tract infection. | I am going to give him fluids to drink and record his intake and output. Did you want me to try to get urine for urinalysis and C&S? | #### Rita Haines Julie, a physiotherapist has been treating Miss Rita Haines a patient on Unit 89 admitted 10 days ago. Miss Haines has pain in her right foot and is unable to transfer independently or climb stairs. Due to unmanaged pain, she has been able to attend only 2 out of 10 joint treatment sessions. She is confused and is at risk for aspiration. Miss Haines is to be discharged home today. Julie contacts the physician. **SBAR for Rita Haines:** | **S** Situation | **B** Background | **A** Assessment | **R** Recommendation | |---|---|---|---| | I am calling about Miss Haines on Unit 89. The main problem is her right foot pain. She is unable to transfer independently or climb stairs as she has unmanaged pain. She has only attended 2/10 physio treatments.| Miss Haines is confused. She has been in hospital for 10 days with no pain improvement and is scheduled for discharge today. | I am unable to accurately assess or treat her due to her unmanageable pain. | Physio should be discontinued until some level of pain control is achieved. She may benefit from a pain management program. I would recommend that she not be discharged today. | **Note:** The answers can be found in Appendix A. Other acronyms have also been used. They include: * SBARD (Situation, Background, Assessment, Recommendation, Documentation) * ISBAR (Identity, Situation, Background, Assessment, Recommendation) * CHAT (Current Situation, History, Assessment, Treatment) * SHARED (Situation, History, Assessment, Recommendations, Evaluate, Document) Check with your educator or manager as to the acronym used in your area. ### Learning Activity # 3 Instructions: Choose the one correct answer in parentheses for each statement. 1. Using SBAR, your belief of what the problem is belongs in (situation, **assessment**) 2. The patient's medications may be included in (**background**, assessment) 3. The situation should be stated in about **(10**, 15, 20) seconds. 4. You need to **(document)** changes in your patient's condition. 5. SBAR is (**empowering**, limiting) to the health professional. 6. Tools such as SBAR present information in (**predictable**) order. 7. Another acronym for SBAR is (**CHAT**, TALK) **Note:** The answers can be found in Appendix A. ### References * Becket, C.D.; Kipnis, G. (2009). Collaborative Communication: Integrating SBAR to Improve Quality/Patient Safety Outcome. *Journal for Healthcare Quality*. 31(5): 19-28. * Hiag, K. Sutton, S. & Whittington, J. (2006). SBAR a shared mental mode for improving communication between clinicians. retrieved from www.ihi.org * Joint Commission on Accreditation of Healthcare Organizations (2008). Website available at www.jointcommission.org * Munro, M. (2006). SBAR: A Structured Human Factors Communication Technique. *HealthBeat*. www.asse.org * Pope, B. B.; Rodzen, L; Spross, G. (2008). Raising the SBAR: How Better Communication Improves Patient Outcomes. *Nursing 2008*. 38(3) 41-43. * Reeser, J. (2010). SBAR Communication Tool. www.bellaonline.com/articles/art8230.asp * Rogers, K. (2007). Using the SBAR communication technique to improve nurse-physician phone communication: A pilot study. retrieved from ProQuest database * Safer Healthcare (2010). SBAR: A Communication Strategy for Today’s Healthcare Professional. www.SaferHealthcare.com * Velji, K; Baker G.R. (2007). SBAR: A Shared Structure for Team Communication. Toronto: Toronto Rehabilitation Institute. * Velji, K; Baker G.R.; Fancott, C.; Andreol, A.; Boaro, N.; Tardif, G., Aimone, E. Sinclair, L. (2008). Effectiveness of an Adopted SBAR Communication Tool for a Rehabilitation Setting. *Healthcare Quarterly*. 11: 72-79. ### Appendix A Answer Keys #### Learning Activity #1 1. communication 2. predictable 3. standardize 4. collaboratively 5. critical 6. teamwork 7. prepared #### Learning Activity #2 **SBAR Mark Adams:** | **S** Situation | **B** Background | **A** Assessment | **R** Recommendation | |---|---|---|---| | Mr. Adams is uncooperative and combative. He has foul smelling urine. | No intake has been recorded. He is incontinent for foul smelling urine and a trace of blood was seen when he was last changed. He has a history of urinary tract infections. | I think the problem is a possible urinary tract infection. | I am going to give him fluids to drink and record his intake and output. Did you want me to try to get urine for urinalysis and C&S? | **SBAR Miss Haines:** | **S** Situation | **B** Background | **A** Assessment | **R** Recommendation | |---|---|---|---| | I am calling about Miss Haines on Unit 89. The main problem is her right foot pain. She is unable to transfer independently or climb stairs as she has unmanaged pain. She has only attended 2/10 physio treatments.| Miss Haines is confused. She has been in hospital for 10 days with no pain improvement and is scheduled for discharge today. | I am unable to accurately assess or treat her due to her unmanageable pain. | Physio should be discontinued until some level of pain control is achieved. She may benefit from a pain management program. I would recommend that she not be discharged today. | #### Learning Activity #3 1. **assessment** 2. **background** 3. **10** 4. **document** 5. **empowering** 6. **predictable** 7. **CHAT**