Giving SBAR

ReportSituation

Background

Assessment

Recommendation

What is SBAR?

SBAR is an acronym for a standardized

method of giving report between

healthcare providers

S: Situation

B: Background

A: Assessment

R: Recommendation

Why SBAR? Improving Safety

The Institute of Medicine report To Err is Human (1999) challenged healthcare workers to examine several preventable errors that lead to poor patient outcomes

Communication failure was listed as one of the errors that can be prevented

SBAR standardizes the way patient information is communicated between healthcare providers, decreasing the likelihood that important information is missed during transitions of care

Why SBAR?

Improving Communication

Joint Commission National Patient Safety

Goal 2: Improve the effectiveness of

communication among caregivers

The Joint Commission’s Transition of Care

(2012) report revealed communication

breakdowns to be one of the root causes of

ineffective patient transitions and poor

patient outcomes

Barriers to Effective

Communication

Caregivers have differing expectations of

what to expect in report

Organizational cultures that do not

promote successful handoffs

Inadequate amount of time to give a

detailed handoff report

Lack of standardization of handoff reports

Why SBAR? Improving Collaboration

The ANA Code of Ethics calls nurses to collaborate with all members of the healthcare team

Collaboration requires “mutual trust, recognition and respect…shared decision making…and open dialogue…”(Provision 2.3) among all members of the healthcare team

The use of SBAR reporting standardizes communication allowing the healthcare team to focus their efforts on developing a multidisciplinary plan of care instead of gaps in communication

Breaking it DownWhat it all means…

S: Situation

What is going on?

What is the patient’s name?

Why is the patient coming for treatment?

How did they obtain the wound?

How long have they had the wound?

How is the patient currently treating their

wound?

Example #1: Mr. P. Mr. P., 27yo, is here for a periorbital laceration that he

sustained in a fight 10 days ago He was originally admitted to the hospital for treatment

and was discharged with instructions to follow up with his PCP or Patient First to have the stitches removed

When he went to Patient First two days ago, the physician there refused to remove the stitches because he suspected infection

The Patient First physician prescribed Bactrim and told him to make an appointment with the wound center.

He is currently treating the wounds with antibiotic ointment and gauze

He changes his dressings once a day

B: Background What is the pertinent history?

Include only relevant information

Patient’s PCP, brief social background

Lives alone, nursing home, home care, homeless, etc.

Patient’s medical/surgical history

Diabetes, PVD, PAD, malignancies, obesity, DVT, etc.

Allergies

Especially to medications/products that are commonly used to treat wounds

Sulfa, PCN, silver, iodine, etc.

Medications that may effect the patient’s ability to heal or the way the physician can treat the patient

Steroids, chemotherapy, anticoagulants, illicit drug use, smoking, ETOH, etc.

Recent labs, wound cultures, biopsies, radiology reports, vascular testing, etc.

Be as specific as possible; include dates, actions taken

Example #1: Mr. P. Mr. P. does not have a PCP He has a history of methamphetamine and IV heroin abuse

He states that it has been 47 days since he last used either drug

He reports that he recently completed a stay in rehab and regularly attends NA meetings

He has no other medical history

Mr. P. is on his 3rd day of Bactrim He is also taking Tramadol for pain

He takes no other medications

A hospital x-ray of Mr. P’s face was negative for any fractures

No wound culture was taken at the Patient First before he was prescribed his antibiotic

A: Assessment

What are your assessment findings?

How many wounds are there?

What are their sizes?

May generalize if multiple wounds

Are there any causes for concern?

s/s infection, dehiscence, pain, malodor, etc.

Example #1: Mr. P. Mr. P.’s wound is on his L lower periorbital region

It measures 3.2 cm x 0.4 cm x 0.3 cm

The sutures are intact at the distal portion of the wound The wound has started to dehisce at the proximal portion

The wound is mostly yellow slough with a small amount of red granulation tissue

The wound has a moderate amount of non-purulent serosanguinous drainage

There is no odor but there is erythema, increased warmth and edema of the periwound

The patient also c/o 8/10 wound pain Constant wound pain of 4-5/10

Mr. P. is not running a fever and he is not complaining of chills or body aches

R: Recommendation

What do you think the next course of action should be?

Are any diagnostic tests or labs needed?

Does the wound need to be debrided?

Will the patient need home care to help with management of the wound?

What kind of dressing do you anticipate the patient needing?

What are the educational needs of the patient/caregiver?

Example #1: Mr. P. The wound looks like it should probably be debrided

I also think that we should take a culture of the wound since one has never been done and the wound does not appear to be responding to the Bactrim

Since the wound appears infected and is producing a moderate amount of drainage Aquacel Ag may be a good choice for a dressing since it is absorptive and antimicrobial

Mr. S. can be taught how to perform his dressing changes and is physically able to do so I do not anticipate him needing any skilled nursing care

Your TurnHow would you give an SBAR report on a patient?

SBAR Assignment Imagine that Mr. S. has come to the wound

center as a new patient for treatment of his wounds

The information on the next few slides is what you learned about him during your initial assessment

Use the Wound Healing Center SBAR Report Sheet to help you organize your report

Bring completed SBAR Report Sheet to your one-on-one meeting with Ore

Mr. S.: Patient Profile Mr. S., 43yo police officer

injured in the line of duty

After being nearly paralyzed

he is now unable to walk

without assistance

Height: 5’7”

Weight: 215 lbs

Spends majority of his day in

bed or sitting in his

wheelchair

PCP: Dr. Saul Goodman

Pharmacy: Boetticher

Pharmaceuticals

History:

Obesity, high blood pressure, high cholesterol, diabetes, PTSD, cholecystectomy 10 yrs. ago, L leg DVT w/ IVC filter placement 2 mos. ago

Recent diagnostics:

HbA1c 10.3

AM finger stick 279

INR 2.6

Current medications:

Metoprolol, Janumet, Lipitor, Lantus, Percocet, Colace, MVT, Coumadin

Mr. S.: Patient Profile Social history

Occasional cigar smoker

Used to drink 1-2 beers after work since the accident now drinks up to a 6-pack/night

Recently began refusing to participate with his physical therapy

He is receiving physical therapy and skilled nursing care in his home

Living conditions Lives at home with his

wife, no children

Juan Tabo Home Health provides skilled nursing and PT

Hospital bed with a regular mattress

Wheelchair with a pillow in the seat for padding

Rolling walker

Mr. S.: Wound Assessment L heel ulcer:

1 month old

3.2 cm x 2.7 cm x 0.5 cm

100% necrotic tissue Black eschar and yellow

slough

Periwound scarring

Minimal serosanguinousdrainage

Dry dressing applied daily

BIL LE pitting edema

Pulses BIL DP/PT non-palpable, R

DP/PT biphasic, L DP monophasic, PT inaudible

Mr. S.: Wound Assessment Coccyx:

5 days old

2.5 cm x 1.2 cm x 0.1 cm intact serum filled blister cluster

No drainage

Periwound 6.3 cm x 10.7 cm x 0.1 nonblanchable pink, intact skin

Zinc oxide daily and as needed

References American Nurses Association. (2001). Code of ethics for nurses with

interpretive statements. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf

Institute of Medicine. (1999). To err is human: Building a safer health system.Retrieved from https://www.iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf

The Joint Commission. (2012). Transitions of care: The need for a more effective approach to continuing patient care. Retrieved from http://www.jointcommission.org/assets/1/18/hot_topics_transitions_of_care.pdf

Kaiser Permanente. (n.d.). Guidelines for communicating with physicians using the SBAR process. Retrieved from file:///C:/Documents%20and%20Settings/oreezi/My%20Documents/Downloads/SBAR%20Guidelines%20Kaiser%20Permanente%20(2).pdf

Narayan, M.C. (2013). Using SBAR communications in efforts to prevent patient rehospitalizations. Home Healthcare Nurse,31(9), 504-515 doi: 10.1097/NHH.0b013e3182a87711