Transcript SBAR_Made_Easy_pub_

Clinician Module
OBJECTIVES
Recognize the need for a structured
communication process
Define SBAR
Describe how improving communication
will support reducing avoidable acute
care hospitalizations
Apply SBAR technique into daily practice
HOME CARE CHALLENGES
Changes in payment system
Burdensome paperwork/data
collection
Higher acuity level
Communication methods beyond
face to face (e.g. phone, fax, email)
US Navy Nuclear Submarine
THE NEED:
The ability to communicate
clearly, effectively and
efficiently in just seconds
Communication Model
S = Situation
B = Background
A = Assessment
R = Resolution
IHI, 2006
HEALTHCARE AND SUBMARINES
How are submarines &
healthcare operations alike?
•Exist in “harms’ way”
•Require timely action to avert
disaster
• 24X7 operations
•Lots of turnover and cultural
diversity
•Deal with fear, fatigue,
interruptions, distractions
•At the root of their adverse
outcomes unclear, in concise, or
inaccurate information
SBAR: IHI CONNECTION
Institute for Healthcare Improvement

Focus on improving health care
Modified the Navy’s SBAR

R – Recommendation rather than Resolution
SBAR: HOME CARE CONNECTION
Condenses messages
Promotes critical thinking
Interdisciplinary communication
Physician communication
S-B-A-R STANDS FOR …
S = Situation
What is going on with the patient
B = Background
What is the clinical background information
that is pertinent to the situation
A = Assessment
What I think—conclusions
R = Recommendation
What is needed and in what time frame
SBAR: PREPARATION
Ensure all pertinent patient information is available
before you contact the physician









Name
Medical record number
Age
Diagnosis
Medication list
Allergies
Vital signs
Lab results
Advance Directive
COMMUNICATING WITH PHYSICIANS
•40 patients a day
•need to cue the
physician to who we
are and who the
patient is
• may only see our
patients every couple
months or less
SBAR TECHNIQUE
(S) Situation: What is the situation you are
reporting?

Identify self, agency, patient, patient location

What is going on with the patient. A concise
statement of the problem

10-15 SECONDS only
SBAR TECHNIQUE
(B) Background:
Clinical background information that is
pertinent to the situation
The 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
Advance Directive
SBAR TECHNIQUE
(A) Assessment:
What are the clinician’s?
What is the analysis ?
Is this problem severe or
life threatening?
SBAR TECHNIQUE
(R) Recommendation:
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?
SBAR: ACTIVITY #1
SBAR
Interdisciplinary
Communication
Example
SITUATION
–
State what is happening at the present time that has
warranted the SBAR communication.
Example: Hi, Kathy, this is Brian. I am calling to report that my
patient, Mrs. L., has an elevated blood pressure this morning and
admits to feeling very anxious.
BACKGROUND –
Explain circumstances leading up to this situation. Put the situation into
context for the reader/listener.
Example: Mrs. L’s blood pressure is 188/92 (R) which is up from
126/80, 186/90 (L). Her pulse has increased from 64 bpm (regular
rate and rhythm) to 98 bpm (regular rate and rhythm). There are
no other abnormal symptoms are present during my assessment.
The patient has verbalized that she is somewhat nervous and jumpy
but denies any unusual activity or stress. She also has a history of
panic attacks.
BACKGROUND –
Explain circumstances leading up to this situation. Put the situation into
context for the reader/listener.
Example: Mrs. L’s blood pressure is 188/92 (R) which is up from
126/80, 186/90 (L). Her pulse has increased from 64 bpm (regular
rate and rhythm) to 98 bpm (regular rate and rhythm). There are no
other abnormal symptoms are present during my assessment. The
patient has verbalized that she is somewhat nervous and jumpy but
denies any unusual activity or stress. She also has a history of panic
attacks.
Assessment
State what is happening at the present time that has
warranted the SBAR communication.
Example: “ Kathy, I think Mrs. L is anxious and might be having a
panic attack. She states this is similar to ones she has had before.
Recommendation
What would you do to correct the problem?
Example: “I would like to notify the physician of these
findings and ask if we can have a social worker referral for an
evaluation to r/o psychosocial issues that may be causing Mrs.
L’s suspected panic attacks. I would also like to visit the
patient in the a.m. to assess her vital signs. I will plan to call
the physician tomorrow with our findings to see if he would
like to schedule Mrs. L for an office visit.”
SBAR IN ACTION -LESS THAN 20 SECONDS
S-Hi, Kathy, this is Brian. I am calling to report that my patient, Mrs. L., has an
elevated blood pressure this morning and admits to feeling very anxious.
B-Mrs. L’s blood pressure is 188/92 (R) which is up from 126/80, 186/90 (L). Her pulse
has increased from 64 bpm (regular rate and rhythm) to 98 bpm (regular rate and
rhythm). There are no other abnormal symptoms are present during my assessment.
The patient has verbalized that she is somewhat nervous and jumpy but denies any
unusual activity or stress. She also has a history of panic attacks.
A-Kathy, I think Mrs. L is anxious and might be having a panic attack. She states this is
similar to ones she has had before.
R-“I would like to notify the physician of these findings and ask if we can have a social
worker referral for an evaluation to r/o psychosocial issues that may be causing Mrs. L’s
suspected panic attacks. I would also like to visit the patient in the a.m. to assess her
vital signs. I will plan to call the physician tomorrow with our findings to see if he would
like to schedule Mrs. L for an office visit.”
HOW TO USE SBAR
AT DHCH
Interdisciplinary Communication:
Voice mail/face to face
Hand offs
Report to managers and peers
Message to office staff to forward to
physician
During case conferences
FROM THE PHYSICIAN…
“How the nurse communicates patient
information will depend on whether I
listen to the nurse or not.”
SBAR: ACTIVITY #2
SBAR Physician
Communication sample
The following example demonstrates
using SBAR to communicate
issues, problems or opportunities
for improvement to physicians
SITUATION –
State what is happening at the present time that
has warranted the SBAR communication.
Example: This is Carol from Duke Home Care. We are
seeing Mrs. L for pressure ulcer treatment. I am calling to
report, Mrs. L, has an elevated blood pressure this morning.
She also told me that she feels very anxious
BACKGROUND –
Explain circumstances leading up to this situation. Put the
situation into context for the reader/listener
Example: Duke Home Health has been seeing Mrs. L for three weeks
for care of a pressure ulcer. This is the first time her blood pressure has
been elevated. Today her blood pressure is 188/92 (R); up from 126/80;
186/90 (L). Her pulse has increased from 64 bpm (regular rate and
rhythm) to 98 bpm (regular rate and rhythm). No other abnormal
symptoms evident during my assessment. The patient has verbalized
that she is nervous and jumpy but denies any unusual activity or
stress. She also stated that she has a history of panic attacks.
ASSESSMENT
What do you think the problem is?
Example: She has elevated blood pressure and
pulse.
RECOMMENDATION –
What would you do to correct the problem?
Example: I can draw electrolytes and enzymes this
morning and call you will the results. I am also
requesting to have an order for a social worker to visit
to r/o psychosocial issues. I will revisit Mrs. L
tomorrow and contact you with our findings.
HOW TO USE THE SBAR FORM WITH
PHYSICIANS
Script for phone call to physician’s office
Fax
Hand deliver
ACH CONNECTION
Improving Physician
Communications with
SBAR
 Physician
understanding of
patient problem
 Physician trust with
clinician
 Opportunity for early,
appropriate intervention that
may  reduce avoidable ACH