SBAR

Clinical Skills Simulation Team

Mrs Clare Cann, Senior Clinical Skills (Simulation) Tutor & Dr Katja Empson, Emergency Department Consultant, UHW July 2015

Situation, Background, Assessment, Recommendation – Recall (SBAR-R) Communication Tool

SBAR

Aims & Learning Outcomes

The aim of this module is to facilitate learning of the appropriate use of the SBAR communication tool

The learning outcomes are to:

Describe the four components of the SBAR tool and importance of Recall.

Discuss the relevant information which may be relayed in each component of SBAR.

Display the ability to use SBAR-R as both a face to face mechanism and as a model used to convey information via th telephone.

Evaluate own learning and recognise how improvements can be made.

Aims & Learning Outcomes

SBAR

Communication tool

The World Health Organisation suggest that undergraduates receive training on effective hand-over communication and that this continues in the post graduate sector.

The NHS Institute for Innovation and Improvement has recommended the Situation, Background, Assessment and Recommendation (SBAR) approach for such communications.

Communication tool

SBAR

Introduction

Healthcare professionals including doctors naturally work as teams and understand that effective communicationbetween team members is essential in order that patients receive the excellent standard of care they deserve.

The SBAR communication tool is an easy to remember mechanism and is thus used widely in healthcare settings.

The tool consists of standardised prompt questions within four sections, to ensure staff are sharing concise andfocused information. It allows staff to communicate assertively and effectively, reducing the need for repetition.

Introduction

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SBAR

Introduction

Relayng important information is only one part of the loop. It is equally important to ensure that the recipient ofthe information understands what this information means.

One method of ensuring that the receiver is clear about the information is for them to repeat the informationback to the original information sender. This is known as the Recall.

Introduction

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SBAR

SBAR in Acutely Ill Patients

Communication of important patient information is crucial in all patient pathways; primary, secondary and tertiary care, particularly in the acutely ill patient.

SBAR-R is particularly useful when transferring information regarding an acutely ill patient. When you assess and manage acutely ill patients the situation may induce you to feel overwhelmed. However, this feeling may be reduced by using this communication tool which is well known amongst healthcare professionals and will help you to order your thoughts and remain logical.

It is anticipated that becoming familiar with the SBAR-R tool one will benefit by having an understanding what information is important to convey and also will aid your development of working as a team member and aid a culture of patient safety.

SBAR in Acutely Ill Patient

SBAR

Background

SBAR was originally used in the

• military

• aviation industry

SBAR was developed by Dr Leonard and colleagues in Colorado, USA

An example of a clinical improvement following the implementation of the SBAR tool is that which occurred in one healthcare setting; the incidence of harm to patients fell by 50%

Background

SBAR

Preparation

SBAR-R is often used when you require urgent senior help or advice regarding an acutely ill patient.

You may want urgent advice or assistance.

Steps to delivering an effective SBAR:-

• Relax

• Gather your thoughts, think why you are creating an SBAR for this patient

• Write down your SBAR. You may find printed SBAR forms in certain clinical areas

• Have relevant documents to hand. This may include patient case notes, patient hospital number, NEWS chart and prescription chart

Preparation

SBAR

Step 1

Identify yourself

State the area you are calling from

State the name of the patient you are calling about

State the reason for your communication & describe your concern

Step 1: Situation

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Step 1

Identify yourself – “Hello. This is Jo. I am a third year medical student.”

State the area you are calling from – “I am calling from B ward.”

State the name of the patient you are calling about – “I am calling about Mr John Jones.”

State the reason for your communication & describe your concern- ”He is complaining of acute shortness of breath and unwell. Over the last few hours he has been coughing and is now pyrexial, 38.5°C . His saturations have fallen to 92%. On auscultation there are bilateral basal crackles. I placed him on 4 litres of oxygen via nasal cannulae his saturations are now 93%”

Step 1: Situation

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SBAR

Step 2

Give the patient's reason for admission

Explain significant medical history

Highlight patient's background: admitting diagnosis, date of admission, prior procedures, current medications, allergies, pertinent laboratory results and other relevant diagnostic results.

This information may be retrieved from the patient's NEWS chart, prescription chart, blood results and other investigation reports

Step 2: Background

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SBAR

Step 2

Give the patient's reason for admission – “He was admitted 2 days ago, following an uncomplicated total knee replacement. He was doing well until a few hours ago.”

Explain significant medical history – “He is 69, has type 2 diabetes, smokes 20 cigarettes a day.”

Highlight patient's background: admitting diagnosis, date of admission, prior procedures, current medications, allergies, pertinent laboratory results and other relevant diagnostic results.

This information may be retrieved from the patient's NEWS chart, prescription chart, blood results and other investigation reports – “His pain has been well controlled as per usual regime although he is reluctant to mobilise as per care pathway."

Step 2: Background

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SBAR

Step 3

Vital signs

Clinical impressions, concerns

You need to think critically when informing a healthcare professional of your assessment of the situation. You need to consider 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.

Step 3: Assessment

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Step 3

Vital signs – “He is Alert, SpO2 93% on 4l, Resp rate 20, HR 110 bpm, BP 103/60 mmHg, Temp 38.5.°

He has bilateral basal crackles. NEWS score =7.”

Clinical impressions, concerns – ”I think he might have a chest infection.”

You need to think critically when informing a healthcare professional of your assessment of the situation. You need to consider 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.

Step 3: Assessment

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SBAR

Step 4

Explain what you need - be specific about request and time frame

Make suggestions

Clarify expectations

Finally, what is your recommendation?

What would you like to happen by the end of the conversation?

Any order that is given on the phone needs to be repeated back to ensure accuracy.

Step 4: Recommendation

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SBAR

Step 4

Explain what you need - be specific about request and time frame – “I would be grateful if you would review this patient within the next fifteen minutes.”

Make suggestions – “I will arrange for a Chest X Ray.”

Clarify expectations – “I believe he might have a chest infection and may require antibiotics.”

Finally, what is your recommendation?

What would you like to happen by the end of the conversation?

Any order that is given on the phone needs to be repeated back to ensure accuracy.

Step 4: Recommendation

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Step 5

Ensure that the receiver of the information understands what you have said

The receiver following hearing the SBAR should:-

1. Repeat the SBAR back to sender

2. Ensure you state clearly what you perceive you are being told and what you are being asked to do about it

3. If unclear ask for clarification

4. Advise on an action plan

5. It might be necessary to give a verbal order

6. If unable to attend in the stated time frame vocalise an alternative option

Step 5: Recall

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SBAR

Step 5

Ensure that the receiver of the information understands what you have said

The receiver following hearing the SBAR should:-

1. Repeat the SBAR back to sender – “Ok, so you are ringing about Mr Jones…………………

2. Ensure you state clearly what you perceive you are being told and what you are being asked to do about it – “I understand that you would like me to review him and would like me to come within the next fifteen minutes.”

3, If unclear ask for clarification – “I can`t remember if you said that he had a temperature? Is he coughing anything up? If so what colour is it?”

Step 5: Recall

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Step 5

4. Advise on an action plan - “Have blood cultures already been performed on Mr Jones? If no could someone take some blood cultures. Has he recently had paracetamol for his pyrexia? Please would you state what Mr Jones hospital number is?”

5. It might be necessary to give a verbal order – “Jo, please would you give Mr Jones 1gm of paracetamol orally”.

6. If unable to attend in the stated time frame vocalise an alternative option – “Jo, I don’t think that I will be able to get there in fifteen minutes as I am on my own in HDU. Please would you call my registrar and explain that he will need to attend. However, if Mr Jones does deteriorate please do not hesitate to phone me back.”

Step 5: Recall

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SBAR

Referral

Following the bedside assessment it is likely that the junior doctor will need to discuss further management with a senior colleague.

Referral of Acutely Ill Patient using the SBAR Approach

•Identify yourself (name, role, location)

•Confirm the identity of the person you are speaking to

•Identify the patient (name, age, sex, and location)

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SITUATION

•Relate the history

•Date of admission

•Diagnosis

•Management

•Describe the current interventions

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BACKGROUND •State what you think is happening

•e.g. “I think the patient has septic shock secondary to pneumonia”

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ASSESSMENT

•State the request

•e.g. “I need you to see this patient urgently; please come to the ward immediately”

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RECOMMENDATION

SBAR

Responder to recall

Responder to recall SBAR-R

•Repeat the SBAR back to the person who spoke to you

•Ensure that you ask for clarification if necessary

•If any important information has been omitted ask for it

•Vocalise what advice / actions you will take regarding the SBAR

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Recall

SBAR

SBAR-R

• Recommended communication model

• Used interprofessionally by many healthcare professionals

• Useful to prepare yourself before delivering an SBAR

• If you are receiving an SBAR always RECALL (SBAR-R)

• On clinical placements critically listen to SBAR-R communications

• Get practising when you have a chance

Summary

SBAR

Useful Resources

SBAR tool:

http://www.institute.nhs.uk/safer_care/safer_care/sbar_handover_films.html

http://www.institute.nhs.uk/safer_care/safer_care/Situation_Background_Assessment_Recommendation.html

Useful Resources