SBAR Communication

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SBAR Communication
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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

• Situation
• Background
• Assessment
• Recommendation

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Background

• US Navy Nuclear Submarine Service
• 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 patients condition)
• U I am Uncomfortable (with my patients
  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
  read-backs
• Ensure the receiver of the information has the
  opportunity to review relevant data, including
  previous care treatment services

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SBAR

• 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 patients 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 clinicians 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 patients condition?
• ? In what time frame do you expect this action
  to take place?

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SBAR Guidelines

• Physician preference
• 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 patients 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. Elmers 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 didnt 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. Todays 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.
  Smiths 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. Smiths SOB and urine
  output. Mrs. Smith will be instructed on the s/s
  to watch for and to call if the patients 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. Joness 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 patients 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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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.