Transcript SBAR - Valley Health System

SBAR
Effective
Communication for
Patient Safety
SBAR
• From 1995 – 2005 JCAHO reviewed over 2537 sentinel
events in General Hospitals and Emergency
Departments
• Communication issues identified as being the root cause
and the major contributor in these events
• In 2005 nearly 70% of sentinel events, the root cause
was communication.
Why does communication
break down?
• Different communication styles
• High level of activity
• Frequent interruptions
• No standardization in organizing essential information
• Loss of information
What Can Go Wrong?
• CONCERN was communicated – BUT:
– PROBLEM:
was not clearly stated
– PROPOSED ACTION: didn’t happen
– DECISION: was not reached
Physician-RN Communication
• Differences in:
– Training and practice
– Style of communication
– Past experience
– Level of empowerment
– Tone of voice and level of respect
Physician-RN Communication Styles
• Nurses are narrative and descriptive
• Physicians are guided to be problem solvers- “just the
facts please”
• Other complicating factors
– Gender, cultural differences
– Prior relationships, hierarchy
– Perceptions of teamwork depends on point
of view
Commnication Handoffs
SBAR
Is an effective tool
for all types of
communication
handoffs
What is SBAR?
• The SBAR model is a simple method to
help standardize communication
• SBAR allows all parties to have common
expectations:
– What is going to be communicated
– How the communication is structured
– Required elements
• Focuses on the problem, not the people
Who Uses SBAR?
• Nuclear Submarines
• Southwest Airlines
• Kaiser Permanente
• Iowa Health System
TVH Patient Care Services
Initiative for 2006
• Implement SBAR by 4th quarter, 2006
• Goals:
– Clear, concise and thorough communication of pertinent
clinical information
– Improved patient safety and clinical outcomes
TVH Patient Care Services
Initiative 2006
• Implementation of SBAR will:
– Meet Joint Commission’s requirements for appropriate
communication for patient hand-offs
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Admissions
Transfers
Shift to shift report
Daily rounds
– Improve physician/clinician communication in critical and noncritical patient care situations
TVH Patient Care Services
Initiative 2006
• Implementing SBAR for patient handoffs
– Handoffs include verbal communication
– Face-to-face interaction
– Opportunity to ask and answer questions
– Documentation
TVH Patient Care Services
Initiative 2006
• Expected outcomes for SBAR use:
– Conversation with physicians – in person or phone
– Conversations with peers – change of shift
– Escalating a concern
SBAR USE
• Other uses for the near future:
– Discussions with other departments
– Shared model of communication throughout the
Valley Health system
– Assisting patients to learn how to talk with their
physicians
SBAR
• Situation
• Background
• Assessment
• Recommendation
S–B–A-R
• Situation – the problem
• Background – brief, related, to the point
• Assessment - what you found, what you think
• Recommendation – what you want
SITUATION
• State: your name and unit
• I am calling about:: (Patient Name &
Room Number)
• The problem: The reason I am calling
…..
BACKGROUND
• State the admission diagnosis and
date of admission
• State the pertinent medical history
• A Brief Synopsis of the treatment to
date
Assessment
• Pertinent objective & subjective information
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Most recent vitals
Mental status
Respiratory rate and quality
B/P, pulse rate & quality
Pain
Neuro changes
Skin color
Rhythm changes
RECOMMENDATION
• State what you would like to see done:
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Transfer the patient?
Change treatment?
Come to see the patient at this time?
Talk to the family and patient about….?
Ask for a consulting physician to see the patient?
RECOMMENDATION
• Other suggestions
– CXR
– CBC
ABG
Other?
EKG
• If a change in treatment is ordered, ask:
“How often?”
• Ask: “If the patient does not improve, when
would you want to be called again?”
Example
• Situation:
– Dr. Jones, I’m calling about Mr. Smith who is short
of breath.
• Background:
– He’s a patient with chronic lung disease and has had
increased SOB over the past 4 hours. He is now
acutely worse. His oxygen saturation has been 95%
on 3L nc until this evening.
Example
• Assessment:
– He has expiratory wheezes in all lung fields, his
oxygen saturation is 85% on oxygen 3L nc and he is
very restless
• Recommendation:
– I think he needs to be transferred to IMC or ICU
SBAR Video
• Video
Review of SBAR tools
• Tools- SBAR incorporated into:
– Shift to shift report
– Transfer forms
– Computer Documentation screens
– Telephone conversation guide
SBAR Tools
Questions?