SBAR: A communication formula for patient safety
Effective communication can mean the difference between life and death. For example, air traffic controllers and pilots need to clearly understand what each other is saying. The lives of people not involved in the exchange depend on it. There's no room for misunderstanding in the crowded skies. Medication errors, treatment delays, or even inappropriate physician orders are just a few of the consequences that can result from communication that's misunderstood. And again, people's lives hang in the balance.
In 2003, the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) developed a set of National Patient Safety Goals that includes the goal of improving "the effectiveness of communication among caregivers." A sentinel event is "an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof." In the 2007 Joint Commission's Annual Report on Quality and Safety, the commission identified inadequate communication between care providers or between care providers and patients/families as a consistent root cause of sentinel events. Clearly, attention needs to be given to the way we communicate.
In these times of staffing shortages and higher acuity patients, we are constantly forced to do more with less. Quite often, time is the resource we seem to need the most. Time management, setting priorities, and honing our organizational skills are all essential abilities that enable us to provide optimal care and promote positive patient outcomes. Yet we waste time and increase the chance of patient harm when our communication is disorganized and unclear. There is, though, an effective technique that can be used to clarify and streamline information exchanges. It's called SBAR, and it stands for Situation, Background, Assessment, and Recommendation.
SBAR was first used in the Navy and later was used by staff at Kaiser Permanente in Colorado after Michael Leonard, MD, and co-workers Doug Bonacum and Suzanne Graham, PhD, RN, adapted SBAR for use in healthcare. Although the focus is primarily nurse/physician communication, SBAR can be used for communication in other areas as well. For instance, if a nurse needs to coordinate several tests that are to be done, it may be necessary to speak with a staff member from dietary to hold a meal, with a laboratory technician to arrange for phlebotomy before the patient leaves the floor, and with a radiology technician to find out what time the patient is to be scheduled for a CT scan. Naturally, every department has different needs as to what type and how much information should be given. But clarity and organization are essential in each case.
In nurse/physician communication, SBAR provides a structured framework that is both organized and concise and easy to follow. Training modules and communication tools employing SBAR can be found and downloaded at the Institute for Healthcare Improvement website. SBAR avoids long narrative descriptions and ensures the physician gets facts which are essential for proper assessment of the patient's needs. This assists the physician in being able to give orders that are safe and appropriate for the current circumstance.
Prior to calling the physician, the nurse first assesses the patient and makes sure the chart is available as well as recent lab and other test results. The nurse also needs to read the most recent physician progress note and the nursing progress note from the previous shift to make sure she has the complete context. The communication begins with the Situation. The nurse states what is going on with the patient at the time of the call. For example, "This is Sarah Jones, R.N. I am calling about Jane White, a 54 year old female in room 206 on 2 West. The patient is anxious and hallucinating. Her vital signs are 97-140-28 with a blood pressure of 168/100."
The communication then moves on to the Background. Here the nurse provides pertinent information such as: "She was admitted on February 2 with a complaint of chest pain, which is now resolved, and her labs are all within normal limits. She has no known allergies. She is not on any medications at this time. Her past medical history is negative other than a C-section at age 28. On admission, she was alert and oriented but is now confused. She is a full code. Her daughter is in the room and states that her mother drinks alcohol on a daily basis but is unsure of the amount."
The next portion of the communication is Assessment. This is where the nurse states what he or she feels is happening. In this case, the nurse might say, "I am concerned that Mrs. White is demonstrating signs of alcohol withdrawal."
Finally, the nurse moves on to the Recommendation. Here the nurse suggests a course of action. Appropriate requests might be, "Would you like to place Mrs. White on the ETOH Withdrawal Protocol? Are there any labs you want drawn? Will you be coming to see her? "
Having a communication tool that works well and assists in the provision of safe care is an invaluable asset for both healthcare professionals and patients. SBAR is such a tool.
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