8/8/2019 SBAR REV Jan 10

1/23

SBARSBARIMPROVING COMMUNICATIONIMPROVING COMMUNICATION

AMONG CAREGIVERSAMONG CAREGIVERS

January 2010

Policy C-118 Handoff CommunicationDuring Patient Transfers

8/8/2019 SBAR REV Jan 10

2/23

ObjectivesObjectives

Upon completion of this module the RN will be able to:Upon completion of this module the RN will be able to:

Recall the reasons for using SBAR in the clinical settingRecall the reasons for using SBAR in the clinical setting

Describe what SBAR stands for and gives a clinicalDescribe what SBAR stands for and gives a clinicalindication for its useindication for its use

Describe steps to take if patientDescribe steps to take if patients need remains unmet afters need remains unmet after

using SBAR to communicate to a physicianusing SBAR to communicate to a physician

8/8/2019 SBAR REV Jan 10

3/23

JCAHO Patient Safety GoalJCAHO Patient Safety Goal

IMPROVE THE EFFECTIVENSS OFIMPROVE THE EFFECTIVENSS OF

COMMUNICATION AMONGCOMMUNICATION AMONGCAREGIVERSCAREGIVERS

SBAR is one method of meeting this PatientSBAR is one method of meeting this PatientSafety goal by standardizing communicationSafety goal by standardizing communicationamong caregivers.among caregivers.

8/8/2019 SBAR REV Jan 10

4/23

WHY SHOULD WE BE TALKING?WHY SHOULD WE BE TALKING?

The overwhelming majority of untoward andThe overwhelming majority of untoward and

sentinel events involve communication failuresentinel events involve communication failurebetween healthcare providersbetween healthcare providers

8/8/2019 SBAR REV Jan 10

5/23

COMMUNICATION IS EASIER IF:COMMUNICATION IS EASIER IF:

THERE IS A STANDARD MODEL FORTHERE IS A STANDARD MODEL FORCOMMUNICATIONCOMMUNICATION EVERYONE IS AWARE OF THE MODELEVERYONE IS AWARE OF THE MODEL EVERYONE USES THE MODEL TOEVERYONE USES THE MODEL TOCOMMUNICATE PATIENT INFORMATIONCOMMUNICATE PATIENT INFORMATION

8/8/2019 SBAR REV Jan 10

6/23

When to Use SBAR CommunicationWhen to Use SBAR Communication

Technique at MUHATechnique at MUHA

Transferring orTransferring or handing offhanding off a patient froma patient fromone caregiver or department to anotherone caregiver or department to another Change of shift reportChange of shift report Communicating a patient situation to a physicianCommunicating a patient situation to a physicianor other provideror other provider

8/8/2019 SBAR REV Jan 10

7/23

ASSERTION INASSERTION IN

COMMUNICATIONCOMMUNICATION

SBAR facilitates assertive communicationSBAR facilitates assertive communication

Individuals speak up and state theirIndividuals speak up and state their

information with appropriate persistence untilinformation with appropriate persistence untilthere is a clear resolutionthere is a clear resolution

8/8/2019 SBAR REV Jan 10

8/23

KEY IS BEING PREPAREDKEY IS BEING PREPARED

Have I assessed this patient myself before I call?Have I assessed this patient myself before I call?

Do I have on hand:Do I have on hand: The chart?The chart?

List of meds, IV fluids, labs?List of meds, IV fluids, labs?

Most recent vital signs?Most recent vital signs?

Have I read the most recent progress notes?Have I read the most recent progress notes?

What do I want to happen as a result of this call?What do I want to happen as a result of this call?

8/8/2019 SBAR REV Jan 10

9/23

SBAR FRAMEWORK FORSBAR FRAMEWORK FOR

COMMUNICATIONCOMMUNICATION

SS Situation:Situation: What is the problem?What is the problem?BB

Background:Background: How did we get here?How did we get here?

AA AAssessment:ssessment: What is the data?What is the data?RR

Recommendation:Recommendation: What are we going toWhat are we going to

do to address the problem?do to address the problem?

8/8/2019 SBAR REV Jan 10

10/23

SBAR Steps for CommunicationSBAR Steps for Communication

SS SITUATION:SITUATION:What is the problem?What is the problem? State your name and unitState your name and unit I am calling about (pt name and room #)I am calling about (pt name and room #) The problem I am calling about is:The problem I am calling about is:

8/8/2019 SBAR REV Jan 10

11/23

SBARSBAR

BBBACKGROUNDBACKGROUND

How did we get here?How did we get here?

Admission diagnosis and date of admissionAdmission diagnosis and date of admission PertinentPertinentmedical historymedical history AA briefbriefsynopsis of the treatment to datesynopsis of the treatment to date Code statusCode status

8/8/2019 SBAR REV Jan 10

12/23

SBARSBAR

AA--ASSESSMENTASSESSMENT

What is the data?What is the data?

Most recent vital signsMost recent vital signs SignificantSignificantassessment findingsassessment findings SignificantSignificantlabs or other resultslabs or other results

8/8/2019 SBAR REV Jan 10

13/23

SBARSBAR

RR

RECOMMENDATIONRECOMMENDATION

What are we going to do to address theWhat are we going to do to address theproblem?problem?

Transfer the patient to the ICU?Transfer the patient to the ICU?

Come see the patient ASAP?Come see the patient ASAP? Talk to patient and family about the code status?Talk to patient and family about the code status? Ask for a consultant to see the patient nowAsk for a consultant to see the patient now State treatment, i.e., fluids, chest tubes, painState treatment, i.e., fluids, chest tubes, painmedicationmedication

8/8/2019 SBAR REV Jan 10

14/23

CLINICAL EXAMPLECLINICAL EXAMPLE

SS SituationSituation -- Dr. Jones, IDr. Jones, Im Paul, an RN on 8East. Mr.m Paul, an RN on 8East. Mr.Jones in 810 is in respiratory distress.Jones in 810 is in respiratory distress. BB BackgroundBackground He was admitted for COPDHe was admitted for COPDexacerbation this morning, has been stable on 3L nasalexacerbation this morning, has been stable on 3L nasal

cannula, but is now acutely worse.cannula, but is now acutely worse.

AA AssessmentAssessment VS 98/62, HR 108, RR40, O2 sat 74%VS 98/62, HR 108, RR40, O2 sat 74%with a nonrebreather at 10L. His breath sounds arewith a nonrebreather at 10L. His breath sounds aredecreased on the right side. I think he may have adecreased on the right side. I think he may have a

pneumothorax.pneumothorax.

RR RecommendationRecommendation I need your to come see himI need your to come see himimmediately. Can we get some ABGs and a STAT portableimmediately. Can we get some ABGs and a STAT portablechest xchest x--ray?ray?

8/8/2019 SBAR REV Jan 10

15/23

HANDING OFFHANDING OFF

TRANSFERING A PATIENT TO ANOTHERTRANSFERING A PATIENT TO ANOTHERDEPARTMENT OR CAREGIVERDEPARTMENT OR CAREGIVER

MUHA has anMUHA has an SBAR HANDOFF REPORTSBAR HANDOFF REPORTGUIDEGUIDE This should always be used as the guide forThis should always be used as the guide forhanding off patients to another department orhanding off patients to another department or

caregivercaregiver Please review the information from the GuidePlease review the information from the Guideon the following slideson the following slides

8/8/2019 SBAR REV Jan 10

16/23

SBAR HANDSBAR HAND--OFF REPORT GUIDEOFF REPORT GUIDE

SITUATION: What is the problem?This is the report on (patient name & room #)

Introduce self, get name of person receiving report

Code status Isolation/type Allergies, (band on) Diagnosis Current condition (include recent changes) Special needs (spiritual, cultural, learning,communication, social)

Consults completed/planned

Admission Assessment complete

SITUATION: What is the problem?hat is the problem?This is the report on (patient name & room #)

Introduce self, get name of person receiving report

Code status Isolation/type Allergies, (band on)

Diagnosis Current condition (include recent changes) Special needs (spiritual, cultural, learning,communication, social)

Consults completed/planned

Admission Assessment complete

8/8/2019 SBAR REV Jan 10

17/23

SBAR HANDSBAR HAND--OFF REPORT GUIDEOFF REPORT GUIDE

BACKGROUND: How did we get here?

Key tests/critical results Current treatments

Plan of care

Significant patient complaints/problems (patient/family concerns/communication withphysician) Medication review due

Disposition of patient belongings

8/8/2019 SBAR REV Jan 10

18/23

8/8/2019 SBAR REV Jan 10

19/23

SBAR HANDSBAR HAND--OFF REPORT GUIDEOFF REPORT GUIDE

ASSESSMENTASSESSMENT (CONTINUED)(CONTINUED)

Intake (diet, diet status, fluid intake)Intake (diet, diet status, fluid intake)

OutputOutput

Fluids/urine/emesisFluids/urine/emesis

Other (drains, tubesOther (drains, tubes))

EliminationElimination

CatheterCatheter

Bowel soundsBowel sounds

StoolsStools

Cognitive/Mental status issues/changesCognitive/Mental status issues/changes

Safety (restraints, fall risk, aspiration, suicide)Safety (restraints, fall risk, aspiration, suicide)

Restraints (type, physician order status, assessment)Restraints (type, physician order status, assessment)

Skin temperature/conditionSkin temperature/condition

Temperature/color/edema/hematomaTemperature/color/edema/hematoma

Evidence of skin breakdown/site/treatments in placeEvidence of skin breakdown/site/treatments in place

ActivityActivity

Mobility status/use of assistive devicesMobility status/use of assistive devices

8/8/2019 SBAR REV Jan 10

20/23

SBAR HANDSBAR HAND--OFF REPORT GUIDEOFF REPORT GUIDE

RECOMMENDATIONS:RECOMMENDATIONS:

What are we going to do to address the problem?What are we going to do to address the problem?

Anticipated changesAnticipated changes Tests/treatments neededTests/treatments needed

Pending resultsPending results

Information to give physician/other members ofInformation to give physician/other members ofhealthcare teamhealthcare team

Provide patient/family following informationProvide patient/family following information

ANY OTHER INFORMATION NEEDED?ANY OTHER INFORMATION NEEDED?

8/8/2019 SBAR REV Jan 10

21/23

Remember!Remember!

Always use the SBAR Handoff Report GuideAlways use the SBAR Handoff Report Guidewhen transferring a patient from onewhen transferring a patient from onedepartment or caregiver to anotherdepartment or caregiver to another

8/8/2019 SBAR REV Jan 10

22/23

CHECK LIST FORCHECK LIST FOR

COMMUNICATIONCOMMUNICATION Get personGet persons attention/make eye contacts attention/make eye contact Use the personUse the persons names name

Express your concernExpress your concern

SS --

SituationSituation

BB -- BackgroundBackground

AA--

AssessmentAssessment

RR

RecommendationRecommendation

Reassert if necessaryReassert if necessary

Go up the chain of command if necessaryGo up the chain of command if necessary

8/8/2019 SBAR REV Jan 10

23/23

Congratulations!Congratulations!

You have completed the lesson on SBAR.You have completed the lesson on SBAR.

Thank you!Thank you!