Transcript SBAR - Communities of Practice

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:
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Physician contact
Patient handoff
Patient transfer
Team briefings
Rounds
Through a case: step by step
• 85 y.o. POD#3 hip repair[i]
• Hx CHF, HTN, DM
• Was doing well, eating, working with PT
• Now SOB, respirations look laboured
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RR26, O2 sat 93%
BP 130/65
Lungs with crackles ½ up, I/O +1500 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 Mr. Smith, 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 26, O2 sat is 93%, BP is 130/60
lungs have crackels ½ up,
I/O +1500/24hr
A – Fluid overload?
R
IHI, SBAR: Application and critical success factors, Participant webEX training, Wittington J,
Nagamine
SBAR format
Situation: I’m calling about Mr. Smith; he says he’s
SOB and his breathing looks laboured to me.
Background: He’s POD#3 from hip replacement and
has hx of HTN, and CHF. He’s been doing well until
today – he was eating, working with PT. Now his RR
is 26, O2 sat 93%. Lungs have crackles half way up,
I/O +1.5L
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
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Nurses
Doctors
Residents
Interns
OT
PT
Dieticians
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
Scenario 2
QUIZ!!!
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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!