Transcript SBAR Communication - Student Nurse Journey

SBAR Communication
Faculty Disclosure Statement
• The speaker is not an employee of Ohio
KePRO and is being compensated for her
presentation.
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Objectives
• Describe the meaning of SBAR
• Discuss why SBAR is needed
• Describe the SBAR process
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SBAR
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Situation
Background
Assessment
Recommendation
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Background
• US Navy Nuclear Submarine Service
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S = Situation
B = Background
A = Assessment
R = Resolution
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Background
Aviation – United Airlines
We have a serious problem. Stop and listen to
me!
C = I am Concerned (with my patient’s condition)
U = I am Uncomfortable (with my patient’s
condition)
S = The Safety (of the patient) is at risk
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Background
• Healthcare
– Hand-offs
• Clinician to physician
• Clinician to clinician
• Home Health Aide to clinician
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Background
• Hand-offs
– Definition
• The transfer of care from one provider to
another provider
• A mechanism for transferring information,
responsibility, and authority from one set of
caregivers to another
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Background
• Principles of error-free hand-offs
– Communicate interactively – allow and promote
questions
– Communicate up-to-date information regarding care,
treatment, services, condition
– Limit interruptions to avoid losing or skewing information
– Allow sufficient time to complete hand-off
– Require a verification process – repeat-backs or readbacks
– Ensure the receiver of the information has the opportunity
to review relevant data, including previous care treatment
services
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SBAR
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Situation
Background
Assessment
Recommendation
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Why do we need SBAR?
• Situation: poor communication
errors
• Background:
– Training on communication styles varies among clinicians
– Hierarchy
lack of assertiveness
– Distractions
missing information
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Why do we need SBAR?
• Assessment: we need a new communication style
that all healthcare professionals can use
• Recommendation: SBAR is a simple tool that has
effectively improved communication in other
settings and has been effectively applied to
healthcare
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Why do we need SBAR?
• Physician engagement
• SBAR provides answers to 3 important questions
• What is the problem?
• What do you need me to do?
• When do I have to respond?
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Why SBAR?
• Similar to the SOAP model
• Provides answers to physicians’ three main
questions
• What is the problem?
• What do you need me to do?
• When do I have to respond?
• Standardized approach that promotes efficient
transfer of key information
• Helps create an environment that allows clinicians
to express their concerns
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Why SBAR?
• Clinician to Clinician
– Provides direction
– Provides opportunity for improved care
planning
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Why SBAR?
• Home Health Aide to Clinician
– Provides valuable patient information
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SBAR Guidelines: Step 1
Have all the patient’s information available before you contact
the physician.
 Name
 Medical record number
 Age
 Diagnosis
 Medication list
 Allergies
 Vital signs
 Lab results
 Advance Directive
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SBAR Guidelines: Step 2
A physical assessment has been conducted
 Have I seen and assessed the patient myself before
calling?
 Review the chart for appropriate physician to call.
 Complete a telehealth encounter (phone monitoring,
telemonitoring or teletriage)
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SBAR Guidelines: Step 3
(S) Situation: What is the situation you are calling
about?
 Identify self, agency, and patient name
 What is going on with the patient that is a cause for
concern. A concise statement of the problem
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SBAR Guidelines: Step 3
(cont.)
(B) Background: What is the clinical background
information that is pertinent to the situation?
 Admitting diagnosis and date of admission
 List of current medications, allergies, IV fluids, etc.
 Most recent vital signs
 Lab results: provide the date and time test was done
and results of previous tests for comparison
 Medical history
 Recent clinical findings
 Advance Directive/code status
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SBAR Guidelines: Step 3
(cont.)
(A) Assessment: Share
the results of your
clinical assessment
 What are the clinician’s
findings?
 What is the analysis and
consideration of options?
 Is this problem severe or life
threatening?
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SBAR Guidelines: Step 3
(cont.)
(R) Recommendation: What do you want to happen
and by when?
 What action/recommendation is needed to correct the
problem?
 What solution can you offer the physician?
 What do you need from the physician to improve the
patient’s condition?
 In what time frame do you expect this action to take place?
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SBAR Guidelines
• Physician preference
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Telephone
Fax
Use of resident physicians
Coverage issues
Frequency of patient status updates
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Scenario – Home Care Aide
• Helen the home health aide visits Mrs. Elmer twice
a week for bathing. When Helen assists Mrs. Elmer
to the bathroom today, she notices that the patient
became increasingly short of breath. When Helen
asks Mrs. Elmer about her increase in her
shortness of breath, Mrs. Elmer responded by
saying that it started last night. This morning
when she weighed herself she noticed that she was
2 lbs heavier. Helen sat Mrs. Elmer on the chair
and called Tammy, the patient’s primary nurse to
find out what she should do.
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Scenario – Home Care Aide
• S = Hi Tammy (nurse) this is Helen Adams the
home health aide. I am at Mrs. Elmer’s house and
she is experiencing more shortness of breath
(SOB) when walking today.
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Scenario – Home Care Aide
• B = When I walked Mrs. Elmer to the bathroom for
her bath she had SOB than she didn’t have on
Monday (today is Wednesday). Mrs. Elmer also
verbalized that she weighs 2 lbs more than
yesterday. I also noticed that her ankles are
swollen. If I press on the swollen area and remove
my finger you can see the indentation.
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Scenario – Home Care Aide
• A = I think that it is her Congestive Heart
Failure (CHF) again
• R = I think that you need to see Mrs. Elmer.
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Scenario - Nursing
• Mr. Smith is a 78-year-old patient with CHF and
HTN who lives with elderly wife. Today’s vital signs
were: T - 98.6, BP - 188/90, RR - 24. He is more
SOB today as evidenced by an increased
respiration rate and now SOB ambulating 8 feet
(baseline ability - ambulate 20 feet). Lung sounds
were previously clear, but today he has crackles in
the posterior bilateral lower bases (1/3rd lung
fields). He usually has +1 edema, but today it is
now +2 and slightly pitting. Mr. Smith’s wife forgot
to weigh him for the last 3 days, but he has now
gained 6 lbs. over 4 days.
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Scenario - Nursing
• His current med regime includes: Digoxin, 0.125 mg, every
day; Lasix, 20 mg, every day; Slow-K, 20 meq, every day;
and Prinivil, 5 mg, every day. He has no standing/prn orders.
You talk with his wife about his compliance with his
medication regimen and she states her daughter pre-fills the
medications once a week. Upon examining the pillbox, it
appears that the medications were given as ordered. His diet
recall was not much different than his normal 2 gm Na diet,
except for a ham dinner 2 days ago. His wife is anxious over
his change in status. Nancy Nurse calls Dr. Gannon with the
update.
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Scenario - Nursing
• S = Dr. Gannon, I am Nancy Nurse from ABC
Home Care. I am calling about Mr. James Smith,
whose blood pressure, respirations & weight are
elevated.
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Scenario - Nursing
• B = Mr. Smith, a 78-year-old patient, with
diagnosis of CHF & HTN. BP has increased to
188/90, resp. to 24. SOB when ambulating 8 feet,
previously SOB at 20 feet. Wgt increased 6#/4
days. Crackles in the posterior bilateral lower
bases (1/3rd lung field). Compliant with
medications. For the most part he is compliant with
his 2 gm Na diet, with the exception of eating ham
for dinner two days ago.
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Scenario – Nursing
• A = Mr. Smith is experiencing fluid retention which
may or may not have been exacerbated by the
ham dinner.
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Scenario – Nursing
• R = I would like to give Mr. Smith a dose of IV
Lasix now and then continue with his daily Lasix
p.o. dose in the a.m. I will have his wife measure
his urine output for the next 24 hours to assess his
diuresis. I would like an order to visit in the a.m. to
assess his respiratory status, and urine output.
May I draw a stat K+ level? I will call you with the
visit results in the a.m. The on-call nurse will call
his wife in 2 hours to assess Mr. Smith’s SOB and
urine output. Mrs. Smith will be instructed on the
s/s to watch for and to call if the patient’s SOB
worsens.
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Scenario – Physical therapist
• Mrs. Jones is a 78-year-old female. She lives in a
one-story home with her elderly husband, who is
also a patient on home care, and she is his primary
caregiver. Mrs. Jones’s past medical diagnosis is
HTN. She has become increasingly unsteady on
her feet within the last several weeks. A referral
was made to PT to evaluate lower extremity
strengthening and gait training.
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Scenario – Physical therapist
• Phillip Thomas’ (physical therapist) findings
include: ambulates 15 – 20 feet using furniture &
walls. Both ambulation and standing balance fair
(-). Strength BLE 3+/5 & BUE 3+/5. No other gait
abnormalities exist. Pt. showers alone and there
are no grab bars or any other shower equipment. A
fall risk assessment evidences the patient scored as
high risk. PT initiates call to Dr. Gannon, the
patient’s physician.
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Scenario – Physical therapist
• S = Dr. Gannon, I am Phillip Thomas, a physical
therapist at ABC Home Care. I am calling about
Mrs. Helen Jones who was referred with
weakness, and I am identifying as a high risk for
falling.
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Scenario – Physical therapist
• B = Mrs. Jones, a 78-year-old patient, lives at
home with her elderly, ill husband. She scored at
high risk on our falls risk assessment related to
ambulating only with walls and furniture for
support short distances; her balance is fair (-). She
does not have any safety equipment in the
bathroom (no grab bars). Her standing balance is
fair. There is no other s/s at this time.
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Scenario – Physical therapist
• A = Patient has developed some weakness with
her legs and she has a balance issue that is
putting her at risk for a fall.
• R = Patient needs an order for: a standard walker
and a medical social worker referral to assess Mrs.
Jones declining condition, which may negatively
impact her ability to care for her husband
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Summary
• SBAR provides a method of clearly
communicating the pertinent information from
a clinical encounter
• Empowers all members of the healthcare team
to provide their input into the patient situation
including recommendations
• Assessment and recommendation phases
provide an opportunity for discussion among
the members of the health care team
• May not be comfortable at first for either
senders or receivers of information
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Ohio KePRO
Rock Run Center, Suite 100
5700 Lombardo Center Drive
Tel: 1.800.385.5080
Fax 216.447.7925
www.ohiokepro.com
Seven Hills, Ohio 44131
All material presented or referenced herein is intended for general informational purposes and is not intended to provide
or replace the independent judgment of a qualified healthcare provider treating a particular patient. Ohio KePRO
disclaims any representation or warranty with respect to any treatments or course of treatment based upon information
provided.
Publication No. 8002-OH-073-4/2007. This material was prepared by Ohio KePRO, the Medicare Quality Improvement
Organization for Ohio, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the
Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.
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