Transcript Communication and SBAR to PICU June 2007

Communication and SBAR
June 2007
PICU Education Days
Janice Seeley, RN, MN
Quality Services
Outline
Why talk about this – rationale,
background
 Communication – what it is and isn’t
 SBAR – what it is
 Practical examples from your worklife
 Wrap up

Why communicate?
Why SBAR?

Breakdowns in patient care are not the
result of incompetence, but the result of
systems failures, often replaying back to
an inadequate system for relaying critical
information.1

Successful communication is a critical part
of creating a ‘culture of safety’2
1. Leonard M, Graham S, Bonacum D, The human factor: the critical importance of effective teamwork and
communication in providing safe care. Qual Saf Health Care 2004;13(suppl 1):i85-i90
2. Risk Analysis, Communication, Risk and Quality Management Strategies, HRC Supplement, ECRI, 5200
Butler Pike, Plymouth Meeting, PA, July 2006
“They (People in situations) read intentions,
motives, and reasons into why things are
being said and done…….we must remain
sensitive to the impact this can have on
the quality of communication in the
complex organisational circumstances of
(health care)”
Leslie A, Middleton D, Give and take in neonatal transport:
communication hazards in handover, J Neonatal Nur.
1995;1(5):27-31
Effective Communication
Get Person’s attention
Express Concern
State Problem
Propose Action
Reach decision
Effective communication

Effective communication ensures that the
thoughts and opinions of the speaker are
conveyed in a clear, succinct manor,
ensuring the receiver has understood the
impact of the situation.
Why is communication important?
•
Communication breakdown is noted as a
contributing cause to a high percentage of
adverse events in hospital settings.
•
In recent sentinel events in Saskatoon Health
Region, communication breakdown has been
identified as a major contributing cause.
•
This is similar to the literature on adverse events,
which states that 60% of sentinel events can be
linked back to communication breakdown
between clinicians. 1
1 Leonard M, Bonacum D, Taggart B, Using SBAR to improve Communication Among Caregivers; Sessions 1:
Making the Case, Institute for Healthcare Improvement, PowerPoint presentation, June 29th, 2006
What do problems in communication
lead to?
What does communication breakdown
lead to?

A handoff in which communication fails can lead
to uncertainty in patient care decision making,
potentially resulting in patient harm.[i]

60-70% of medication errors have been related
to communication[ii]

Communication issues and knowledge deficit
were cited as the causes of medication errors
most often leading to patient harm.[i]
[i] Risk Analysis, Communication, Risk and Quality Management Strategies, HRC Supplement, ECRI, 5200 Butler
Pike, Plymouth Meeting, PA, July 2006
[ii] Schneider D, SBAR initiative to improve staff communication, Healthcare Bench Qual Imp, 2005;April:40-41
Why is clinical communication a
problem?

Healthcare teaches standardized technical skills without
teaching standardized communication skills

There are varied communication styles within hospitals
which lead to communication breakdown



Nurses are trained to be narrative and descriptive
Doctors are trained to give/want headline
The culture in hospitals tends to be heavily embedded in
hierarchy, which leads to an environment non-conducive to
open honest communication
Why is clinical communication a
problem?

Nurses are taught that they do not give
diagnosis; tend to use the “hint and Hope”
method.



‘hint’ to the other person what the situation is, and
‘hope’ that they pick up on the urgency
A doctor whom is known as being disrespectful may not
be called as soon as is necessary, leading to the
nurses/other caregivers trying to fix the problem
themselves, potentially leaving situations to the last
minute.
Nurses will know that something is not right but are
tentative or scared to speak up for fear of reprisal.
Lertzman R, No more hinting and hoping: an interview with Frances Griffin, Safer
Health Care, 2005; July 27
Why is clinical communication a
problem?

There is a lack of critical language, which
implies “there is a problem and something
needs to be done right now”.


Some examples: “I need you to come now and see
this patient”, “this is critical, I need ____”, “I am
uncomfortable”
Successful communication is a critical part
of creating a ‘culture of safety’
SBAR: A How To Guide!
What is SBAR

Originally developed in the military

Adapted to aviation to combat communication
barriers inherent in the work environment, which
were causing life threatening crashes.

Adopted by healthcare after the realisation that
there are fundamental similarities between
healthcare and aviation/military environments

Both are high risk, high stress, time sensitive
environments, where wrong decisions can be life
threatening.
What is SBAR?
SBAR is a structured communication tool
intended to add predictability and
consistency to critical points of information
transfer.
 SBAR helps to reduce the influence of
individual communication styles on clarity
of information being relayed.

What is SBAR

A way to get everyone ‘in the same movie’
before proceeding, as to increase chances
of best possible patient care.

A hybrid of physician and nursing
communication styles.
What is SBAR?
Situation: what is going on
Background: brief hx, relevant context
Assessment: what I think, conclusions
Recommendation: What I need, in what
time
frame
When should SBAR be used?
Ideally SBAR should be used every time
that patient information needs to be
relayed from one clinician to another.
 The most critical points are:






Physician contact
Patient handoff
Patient transfer
Team briefings
Rounds
Through a case: step by step

3 y.o. POD#3, Acute subdural hematoma
and # tibia



Hx type I diabetic
Was doing well, eating, working with PT
Now SOB, respirations look laboured





RR34, O2 sat 93%
BP 90/60
Crackles to bases
I/O +1000 past 24 hours
No chest pain
[i] IHI, SBAR: Application and critical success factors, Participant WebEX training, Wittington J,
Nagamine
Traditional Model Of
Communication

“I’m calling about the patient in bed 3,
he’s SOB”

Play 20 questions, then come up with a
plan that may or may not be mutually
acceptable[i]
[i]IHI, SBAR: Application and critical success factors, Participant webEX training, Wittington J,
Nagamine
Using SBAR Model of
Communication

RN : “I don’t like what I’m seeing”[i]
Problem solve
 Organise data/information
 Communicate and collaborate

[i]IHI, SBAR: Application and critical success factors, Participant webEX training, Wittington J,
Nagamine
Thought process of RN
S
B
A
[i]
– I don’t like what I see.

What am I seeing?
R
[i]IHI, SBAR: Application and critical success factors, Participant webEX training, Wittington J,
Nagamine
Thought Process of RN
S
B – RR is 34, O2 sat is 93%, BP is
90/60 crackles, I/O +1000/24hr
A – Fluid overload?
R
IHI, SBAR: Application and critical success factors, Participant webEX training, Wittington J,
Nagamine
SBAR format
Situation: I’m calling about the little boy in
bed 3; he says he’s SOB and his breathing
looks laboured to me.
Background: 3 y.o. POD#3, Acute subdural
hematoma and # tibi; Hx type I diabetic;
Was doing well, eating, working with PT;
Now SOB, respirations look laboured;
RR34, O2 sat 93%; BP 90/60; Crackles to
bases; I/O +1000 past 24 hours
IHI, SBAR: Application and critical success factors, Participant webEX training, Wittington J,
Nagamine
SBAR Format
Asssessment: I think he might be in fluid
overload.
Recommendation: I’d like to Hep lock his IV
and get an MD to evaluate him as soon as
possible.
IHI, SBAR: Application and critical success factors, Participant webEX training, Wittington J,
Nagamine
SBAR Process
Some do this naturally
 For others it takes practice

Gut Feeling
or
Vague Notion
Problem-Solve
and package
Articulate
IHI, SBAR: Application and critical success factors, Participant webEX training, Wittington J,
Nagamine
Who should be using SBAR
Nurses
 Doctors
 Residents
 Interns
 OT
 PT
 Dieticians
 pharmacists

How will this help me?
By employing SBAR when communicating
regarding a patient, you will ensure that
pertinent information is conveyed in a
clear manner, the first time around.
 Time efficient.
 Helps to raise level of patient care.
 Increases stability of interactions with coworkers.

A Win-Win

Expectation or an Assessment and
Recommendation accomplishes the
following



Sends the message that “I value your assessment”,
promotes mutual respect
Gives psychological safety to the junior person to
help the with assertion, sharing of ideas
Reduces ambiguity, guesswork, variability
for both sender and receiver.
IHI, SBAR: Application and critical success factors, Participant webEX training, Wittington J,
Nagamine
Now practice

Scenario 1 – from your best case
examples
QUIZ!!!
Where did SBAR originate?
 Why did SBAR originate?
 What does SBAR stand for?
 Why is SHR implementing SBAR use?
 How can SBAR improve clinical
communication?
 Who should be using SBAR?

Go Forth and SBAR!!!
You’ll be happy you did!