SBAR A

Communication

Technique Deb Wolski

Clinical Educator

Cardiac Program

March 2008/rev.July 2011

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Objectives

• To understand the reason for using this tool

• To ensure the right information is conveyed in

the right way to get the results needed

• To understand the components of SBAR

• To demonstrate the use of this form

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SBAR A structured communication tool

used between health team members

to effectively communicate about a

patient

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• Endorsed by Safer Healthcare Now

and the Institute for Healthcare

Improvement (IHI)

• Quick to learn, easy to remember

and use

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Consists of Four Components:

1. Situation

2. Background

3. Assessment

4. Recommendation

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S Situation

Describe the situation

WHAT IS GOING ON NOW ?

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B Background

Deliver a concise history

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A Assessment

Describe your findings

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R Recommendations

What needs to happen?

WHAT WOULD YOU SUGGEST HAPPEN ?

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SBAR REPORT TO A

PHYSICIAN

• BEFORE CALLING THE PHYSICIAN

First: Batch calls; ask if anyone else needs to speak to

the resident

1. Assess the patient

2. Review the chart for the appropriate physician

to call

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3. Know the admitting diagnosis, date of surgery

or procedure

4. Read the most recent Progress Notes and the

assessment by the nurse from the prior shift.

5. Have available when speaking with the physician:

Chart

Allergies

Meds

IV fluids

Labs & Results

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The SBAR

Form:

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S

SITUATION

State your name and unit

„I am calling about‟: (Patient Name & Room Number)

„The problem I am calling about is‟:

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B

BACKGROUND

State the admission diagnosis and date of admission

State the pertinent medical history

Provide a Brief Synopsis of the treatment to date

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A

ASSESSMENT

Provide the following information:

Most recent vital signs: BP Pulse

Respirations (rate and quality)

Retractions / use of accessory muscles

on or not on Oxygen

Temperature if abnormal

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Changes from prior assessments, such as:

- VS - Rhythm - Skin Color

- Pain - Mental Status

- Wound drainage - Neuro status

- Musculoskeletal (joint deformity, weakness)

- GI/GU (Nausea /Vomiting/Diarrhea/Urine

Output)

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R RECOMMENDATION

Do you think we should:

(State what you would like to see done)

Transfer the patient to ICU or PICU ?

Come to see the patient at this time ?

Talk to the patient and/or family about the code status ?

Ask for a consultant to see the patient now ?

Other suggestion ?

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RECOMMENDATION

Are any tests needed ?

Do you need any tests like

CXR ABG EKG CBC

Others?

If a change in treatment is ordered, then ask:

How often do you want vital signs ? _________________________________

If the patient does not improve, when

would you want us to call again?

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Example

S – Situation

• “Hi, it‟s Jane Smith, RN, from 6IP calling about Mrs.

Green, a patient of Dr. Heart‟s, in Rm A6202C.

She is complaining of being short of breath at rest

and is using her accessory muscles to breath. Her

oxygen saturation levels are in the low 80‟s on 5L

NP.”

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B – Background

• “Are you familiar with this patient?”

• If yes, continue to assessment.

• If no, give pertinent medical history and

synopsis of treatment to date.

• “Mrs. Green was admitted with ACS on Sept. 8th.

She had a CABG x 3 and AVR (mechanical) replacement on Sept. 9th. She has IDDM

and a history of CRF.”

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A – Assessment

• Coarse crackles in mid and lower lobes bilaterally

• BP 172/80, P 100, RR 42 & regular, oxygen sat levels of 80-83% on 5L NP with HOB in high fowlers

• RT assessing & has her sats at 90% on 75% face mask

• Clammy & pale; lips and nail beds are cyanosed

• Restless and anxious, although still alert and orientated

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Assessment cont’d

• u/o borderline, +ve fluid balance of 2000cc for the previous 12hrs

• continues to have +ve balance of 400cc thus far on this shift

• IV is 5%DW and .9% NaCl at 50cc/hr

• Lasix 40mg IV on days and diuresed 800cc

• Creat. 243, urea 20.3, HB 82, Na 127, K+4.8, INR 2.5

• EKG - sinus tachycardia with frequent PVC‟s.

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R = Recommendation

• “I‟m really concerned about Mrs. Smith. I think you need to come and assess her ASAP or transfer her to ICU before a pre arrest happens.”

• “I will be right in.”

• “Is there anything you would like me to do? Any labs, meds or a CXR in the meantime?”

• “Yes, do a STAT portable CXR, STAT lytes, CBC, Mg, Ca, Phos. And give her Lasix 80mg IV now.”

• “Thank You – in the meantime, I‟m calling CCOT to see the patient too.”

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References

• Institute for Healthcare Improvement:

Kaiser Permanente of Colorado,

SBAR Technique for Communication: A

situational briefing model; www.ihi.org

• Lyer, Patricia, Med League Support Services,

Inc., :

Articles: Medical Errors – SBAR;

www.medleague.com

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References cont’d

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• Cardiac Program, London Health Sciences Centre,

Creating a Healthy Workplace through

Employee Engagement: Implementation of the

SBAR Communication Tool;

powerpoint presentation; June 6-8,2007

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Thank you for your attention.

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Questions?