SBAR: A Communications Framework And Technique
Romilda Ang RN, MSc(A)N, CRRN
You begin your shift bombarded with a ton of information, not only regarding the patients to whom you are assigned, but also about the activities of the unit. You are “in charge.” You implement your system to organize your day, absorb as much information as you can, and start prioritizing and checking in on your patients. Shortly into your shift, one of your patient’s medical conditions starts to deteriorate.
As a prudent nurse you intervene accordingly and now you are required to inform and communicate with the patient’s attending physician. One of the new initiatives at Vancouver Coastal Health Authority in Vancouver, British Columbia, is the application of a communication technique called SBAR. SBAR is an acronym and stands for Situation, Background, Assessment, and Recommendation. This technique was developed by Dr. M. Leonard, along with colleagues from Kaiser Permanente of Colorado (Kaiser Permanente of Colorado, 2006).
SBAR is a framework for communication regarding a patient or a situation among health care professionals. The tool consists of standardized “prompt” questions within each of the four sections, to ensure that clear, concise, and focused information is conveyed.
The use of SBAR sets an expectation that specific and relevant information will be shared every time a patient or situation is discussed, thereby promoting consistency and clarity. The SBAR process incorporates critical thinking and organization of information. The communication resulting from the utilization of the framework is assertive, direct, respectful, and results oriented.
When applying SBAR to a clinical situation regarding the patient whose condition is worsening, you would describe the specific situation about which you are calling including the patient’s name, physician (if other than the physician you called), patient location, code status, and vital signs. An example of a script would be:
“This is Romilda, a registered nurse on 2East. The reason I’m calling you is that Mrs. Smith in room 225 has become suddenly short of breath, her oxygen saturation has dropped to 88% on room air, her respiration rate is 24 per minute, her heart rate is 110 and her blood pressure is 85/50. We have placed her on 6 Litres of oxygen and her saturation is 93%, her work of breathing is increased, she is anxious, her breath sounds are clear throughout and her respiratory rate remains greater than 20. She has a full code status.”
You then proceed to inform the physician of the patient’s background: admitting diagnosis, date of admission, prior procedures performed current medications, allergies, pertinent laboratory results, and other relevant diagnostic results. This step of the process expects you to have collected information from the patient’s chart, flow sheets, and progress notes.
Mrs. Smith is a 69-year-old woman who was admitted 10 days ago, following a MVC, with a T 5 burst fracture and a T 6 ASIA B SCI. She had T 3-T 7 instrumentation and fusion 9 days ago, her only complication was a right hemothorax for which a chest tube was place. The tube was removed 5 days ago and her CXR has shown significant improvement. She has been mobilizing with physio and has been progressing well. Her hemoglobin is 100 gm/L; otherwise her blood work is within normal limits. She has been on Enoxaparin for DVT prophylaxis and Oxycodone for pain management.
Critical thinking is of significance when informing the physician of your assessment of the situation. This means that you have thought about what might be the underlying reason for your patient’s condition. Not only have you reviewed your findings from your assessment, you have also consolidated these with other objective indicators such as laboratory results. If you do not have an assessment, however, you may say:
“I think she may have had a pulmonary embolus” or “I’m not sure what the problem is, but I am worried.”
Finally, what is your recommendation? That is, what would you like to happen by the end of the conversation with the physician? Any order that is given on the phone needs to be repeated to ensure accuracy (verbal read-back).
“Would you like me get a stat CXR? and ABGs? Start an IV?
“Should I begin organizing a spiral CT?”
When are you going to be able to get here?
One of the programs at the Vancouver Coastal Health adapted SBAR for its specific use. The staff are incorporating this problem-solving language and process into their daily practice and into their daily conversations. A seasoned nurse, thinking that she already communicates assertively, used the framework and technique to “test” it. Little did she know how powerful the tool is when her conversation with a physician turned out to be more compelling and results-oriented than she expected. Junior and senior nurses who surrounded her (hearing only one side of the conversation) were amazed at how she modeled the process and the action plan which resulted from it. From one physician’s perspective, he states: “After seeing how SBAR can effectively reduce communication errors, I have encouraged all the other hospitalists to use SBAR when discussing patient concerns with nursing staff” (”Experiencing SBAR in Action,” 2006).
Conclusion
The climate of our current health care system is such that we experience and encounter information overload and multiple demands on our time. Therefore, the ability to articulate information thoughtfully and succinctly is greatly needed to effectively achieve positive clinical outcomes for our patients.
References
Experiencing SBAR in action. (2006, March).
Current at Vancouver Costal Health, 4(3), 8. Retrieved March 23, 2006 from http://www.vch.ca/publications/docs/current/current_march_2006.pdf.
Kaiser Permanente of Colorado (2006, March). SBAR technique for communication: A situational briefing model. IHI.org. Institute for Healthcare Improvement. Retrieved March 19, 2006 from http://www.ihi.org. Search for “SBAR.”
Romilda Ang, RN, MSc(A)N, CRRN is director of Professional Practice, Nursing and Allied Health at Vancouver Coastal Health in Vancouver, British Columbia. Questions, comments, and suggestions for Innovation Station are welcome and should be directed to romilda.ang@vch.ca