Communication using the sbar tool

© NHS Improving Quality 2014

Communication using the SBAR Tool


Aims and Objectives

• Communication failures often contribute to patient safety incidents and harm

• Communication is about shared understanding of an

issue

• The SBAR tool is easy to use and remember

• The SBAR tool can be used for all forms of communication


Communication

… two-way process of reaching mutual understanding, in which participants not only

exchange information but also create and share meaning …


Communication

• Verbal – face-to-face (1 to 1)– Referral / handover / briefing

• Verbal – face-to-face (1 to group)– Handover/ briefing

• Verbal - telephone (live)– Referral / handover/ briefing/ question / advice

• Verbal – telephone (recorded message)– Referral / question / advice

• Written – email– Referral/ question / advice

• Written - letter– Referral/ question / advice

• Written – report– Update / interim report / final report

• Written – telephone message• Emergency / urgent / non-urgent


Communication and Patient Safety

• Significant proportion of patient safety incidents are the result of communication failures:– between healthcare professionals - clinical and non-clinical– between healthcare staff and patients

• Communication failure results from;– poor structure of message– lack of planning– lack of key information– poor prioritisation– desired result not achieved

JCAHO – communication failure is the leading cause of inadvertent patient harm (2004)


Examples

• Nurse asks doctor to take blood from patient, bed 3 bay 1. Later nurse asks all patients in bay 1 if they have had they pre-op bloods taken. Patient in bed 3 says he has had bloods done twice.

• Manager talks to colleague about a project which has not been completed on time. Colleague apologises and says he has had a ‘virus’. Manager assumes viral illness, colleague means a computer virus.

• What examples can you think of?


Communication in Healthcare

HandoverContinuity of care

BriefingSharing mental

models

Call for help

Escalation of concerns

• Roles and responsibilities

• Chain of command

• Assertiveness

• Preparing to act• Sharing a plan• Co-ordination of

effort

• Data information and insight

• Acceptance of responsibility

• Point of transfer


Attention Loop

DecreasingAttention

Time

Transmission

Evaluating

Reflecting

Listening

Formulating Response

Listening

Challenging or Unwelcome News


Organising thoughts

• Prepare– Why are you having the conversation ?– What is the message?– Ensure the receiver is ready– How will you know if you have the right result?

• Precis– Select the key issue (s)– Provide sufficient additional information to provide context but remove

extraneous detail– Use short sentences – Avoid jargon

• Prioritise– Put the key points first– Clarify anything which might be ambiguous


Delivery

• Who are you?• Where are you ?• Who are you talking to ?• Big Hits

– Critical Information

• Big Picture– Context and boundaries

• Relevant Detail– Keep it short


SBAR

• Many exchanges are not face-to-face so only the spoken / written word is available.

• The person being called will respond only to what you say and they may have limited time or capacity to deal with your concerns

• There may be no support from shared documents or images so the language which you use must be clear and unambiguous.

• There may not be an established personal relationship between the person calling for help and the person being called upon.

• The person taking the call may not be in a position to listen carefully, take notes or give you their undivided attention when they first answer.


What is SBAR?• SBAR is a structured method for communicating critical information that

requires immediate attention and action

• SBAR improve communication, effective escalation and increased safety

• Its use is well established in many settings including the military, aviation

and some acute medical environments

• SBAR has 4 steps

– Situation

– Background

– Assessment

– Recommendation


SBARSituationWhat is happening now ?

BackgroundWhat has happened in the past that is relevant ?

Assessment What is the problem / issue in your view ?

Recommendation What do you think needs to happen now ?What does the receiver want you to do ?

© NHS Improving Quality 2014© NHS Institute for Innovation and Improvement Safer Care

Why use SBAR?• To reduce the barrier to effective communication across different

disciplines and levels of staff.

• SBAR creates a shared mental model around all patient handoffs

and situations requiring escalation, or critical exchange of information (handovers)

• SBAR is memory prompt; easy to remember and encourages prior preparation for communication

• SBAR reduces the incidence of missed communications


How can SBAR help me?• Easy to remember• Clarifies what information needs

communicating quickly• Points to action

Prevents “hinting and hoping”


Uses and Settings for SBAR• Inpatient or outpatient • Urgent or non urgent communications • Conversations with a physician, either in person or over the phone • - Particularly useful in nurse to doctor communications

- Also helpful in doctor to doctor consultation • Discussions with allied health professionals • - eg Respiratory therapy

- eg Physiotherapy • Conversations with peers • - eg Change of shift report • Escalating a concern • Handover from an ambulance crew to hospital staff


Situation

• Identify yourself the site/unit you are calling from • Identify the patient by name and the reason for your

report • Describe your concern • Firstly, describe the specific situation about which you

are calling, including the patient's name, consultant, patient location, resuscitation status, and vital signs.

For example:

"This is Lou, a registered nurse on Nightingale Ward. The reason I'm calling is that Mrs Taylor in room 225 has become suddenly short of breath, her oxygen

saturation has dropped to 88 per cent on room air, her respiration rate is 24 per minute, her heart rate is 110 and her blood pressure is 85/50.”


Background

• Give the patient's reason for admission • Explain significant medical history • Overview of the patient's background: admitting diagnosis,

date of admission, prior procedures, current medications, allergies, pertinent laboratory results and other relevant diagnostic results. For this, you need to have collected information from the patient's chart, flow sheets and progress notes.

For example:

"Mrs. Taylor is a 69-year-old woman who was admitted from home three days ago with a community acquired chest infection. She has been on intravenous antibiotics and appeared, until now, to be doing well. She is normally fit and

well and independent.”


Assessment

• Vital signs • Clinical impressions, concerns

For example:

• You need to think critically when informing the doctor of your assessment of the situation. This means that you have considered what might be the underlying reason for your patient's condition.

• If you do not have an assessment, you may say:

"Mrs. Taylor’s vital signs have been stable from admission but deteriorated suddenly. She is also complaining of chest pain and there appears to be blood

in her sputum. She has not been receiving any venous thromboembolism prophylaxis.”

“I’m not sure what the problem is, but I am worried.”


Recommendation

• Explain what you need - be specific about request and timeframe • Make suggestions • Clarify expectations • Finally, what is your recommendation? That is, what would you like

to happen by the end of the conversation with the physician? Any order that is given on the phone needs to be repeated back to ensure accuracy.

"Would you like me get a stat CXR? and ABGs? Start an IV? I would like you to come immediately”


• Incorporating SBAR may seem simple, but it takes considerable training

• It can be very difficult to change the way people communicate, particularly with senior staff

Summary


Using SBAR

• Table Exercise and discussion

Communication using the sbar tool

Healthcare

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