Transcript SBAR - Lake Health System Emergency Services

SBAR
Improving Patient Safety through
Effective Communication
Objectives
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Describe factors that contribute to
ineffective communication
Identify the components of the SBAR
communication model
Utilize SBAR in the expected
communication situations
Why should we be
communicating effectively?
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The overwhelming majority of untoward
events involve communication failure
Per JCAHO – Communication
breakdowns remain the primary root
cause of more than 60% of the 2,034
sentinel events analyzed.
Root Causes of Sentinel
Events 1995-2002
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Communication
Orientation/Training
Patient Assessments
Availability of Information
Physical Environment
65%
58%
35%
20%
18%
Communication as a Root
Cause
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Mode of Communication
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Oral
Written
Electronic
55%
35%
10%
Participants
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Among staff
With or among providers
With patient or family
60%
25%
15%
Other Contributing Factors
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Nurses are narrative and descriptive
Physicians want “just the facts”- what
specifically is wrong and what do you
want me to do?
Gender issues
Cultural issues
Hierarchy
Prior relationships
Where Communication Fails
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Lack of Closed Loop Communication:
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Failure to get attention
Failure to communicate level of concern
Failure to communicate real problem
Failure to communicate desired action
Failure to reach decision together before
communication cut-off
Assertion Model
Get
Attention
Reach
Decision
Propose
Action
Express
Concern
State Problem
Strategies for Improved
Closed Loop Communication
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Read Back
Critical Language
Second Challenge
SBAR
SBAR – What is it?
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Communication tool
Originated from the U. S. Navy
SBAR – What does it stand for?
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Situation - What is happening now, chief
complaint, acute change?
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Background – What factors led up to this
event, pertinent history?
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Assessment - What do you see, clinical
assessment?
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Recommendation - What do you want
done? What action do you propose?
SBAR – Why use it?
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Provides standard communication tool –
makes communication less random and
person dependent
Ensures completeness of information
Places every clinical person on the same
communication level
Creates a safe, respectful, organized
communication
SBAR – When can it be used?
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All ‘hand off’ communications:
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Shift to Shift report
Transfers between units/departments
Calling physicians with patient problems
Each situation uses the same structure
with modifications to content in each
section of the acronym.
SBAR for Shift Report
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Situation:
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Patient’s name, physician, room number
Admitting diagnosis
Brief statement of main concern
SBAR for Shift Report
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Background:
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Brief history of hospital course
Vital signs
Clinical assessment (include only
abnormal)
Abnormal lab, imaging tests, telemetry
Status of IV
Gait/fall precautions
Diet
Discharge plan
SBAR for Shift Report
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Assessment:
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Let incoming nurse know what you think is
going on
Do you have concerns? If so, what are
they?
Is there a problem that could be life
threatening?
Did you start anything that could not be
finished on this shift?
SBAR for Shift Report
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Recommendation:
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What would you like the incoming nurse to
attend to?
What have the physicians been told? Not
yet told?
Has anything been left undone?
SBAR for Unit Transfers
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Situation:
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Patient’s name, physician, background
Admitting diagnosis
DNR status
SBAR for Unit Transfers
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Background:
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Brief history of hospital course
Priorities/plan of care/pt. problem list
Reason for transfer (if applicable)
Medical interventions (chest tube, drains,
lines, etc.)
Gait/fall precautions
Isolation precautions
SBAR for Unit Transfers
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Assessment:
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Patient assessment data
Critical, pertinent diagnostic results
Vital signs
Medication changes
Respiratory status
Mental status
Restraint status
Pain management
Diabetes management (if applicable)
SBAR for Unit Transfers
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Recommendation:
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Patient education needs
Skin care needs
Behavioral/Psychosocial needs
Reassessment needs (pain, falls, etc.)
Discharge plan
SBAR – Nursing Unit to
Procedure Area
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Situation:
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Reason for Test/Procedure
Active DNR status
Background:
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Latex/Contrast Dye allergies
Implanted Metallic Devices (pacemakers, ortho implants,
etc.
IV status
Anticoagulation therapy
Diabetes management
Isolation precautions
Mobility status – able to lie flat?
SBAR – Nursing Unit to
Procedure Area
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Assessment:
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Patient assessment data
Mental status
Respiratory issues
Recommendation:
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Special patient needs (pain, sitter,
restraints, etc.)
Diabetic needs (next scheduled BGM,
insulin, etc.
SBAR – Return from Procedure
Area to Nursing Unit
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Situation:
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Background:
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Unstable vital signs and unusual events during
procedure, change in pt. condition
Medications received during procedure
Assessment:
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Procedure – type, entry site, dressing
Current vital signs/patient assessment data
New dressing and IV sites
Recommendation:
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Post procedure orders
SBAR – Physician
Communication
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Situation:
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State your name/unit
“I am calling you about….”
“I have just assessed the patient and I am
concerned about…
SBAR – Physician
Communication
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Background
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State the admission diagnosis and date of
admission
State the pertinent medical history
Provide a brief synopsis of the
treatment/procedures to date
Provide name of admitting/consulting
physicians
DNR status
SBAR – Physician
Communication
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Assessment
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Vital signs
Assessments of the following systems:
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Neuro, Musculoskeletal, Respiratory, C-V, GI/GU, Skin
Pertinent diagnostic test results
Wound (drainage?)
Change from prior assessments
*IDENTIFY problems, concern, or decline in
condition
SBAR – Physician
Communication
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Recommendations
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What would you like to see done?
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Transfer the patient
Come to see the patient at this time
Have a House Officer/Resident see the patient
Change the treatment
Order lab or other diagnostic test
Other suggestions…
Resistance….
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We don’t need this
I already know how to do this
We don’t have a problem
It’s just more work to do
It’s too ‘soft and fluffy’
Cultural issues – won’t speak up
Doesn’t feel safe
Benefits of Using SBAR
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Clear way to communicate
Reduces ambiguity, guesswork,
variability for both sender and receiver
Saves time for patients, physicians and
staff
Avoids staff /physician frustration
Everyone is on the same ‘wavelength’
Summary
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Remember…in most cases you have
already gathered this information
Now you are placing that information in
an organized, consistent framework