Utilizing SBAR to Reduce Communication Errors

• SBAR is an acronym used in healthcare for the quick objective communication about a patient to another healthcare professional. It stands for Situation, Background, Assessment, and Recommendation. 
• Communication errors between healthcare workers have been one of the main factors leading to medication errors, surgical errors, and overall poor outcomes of patients. 
• Research shows that using the SBAR format in our communication with other healthcare professionals improves patient outcomes and avoids preventable complications due to poor communication. 

What Is SBAR?

SBAR is an acronym used in healthcare for the quick objective communication about a patient to another healthcare professional. It stands for Situation, Background, Assessment, and Recommendation. Communication errors between healthcare workers have been one of the main factors leading to medication errors, surgical errors, and overall poor outcomes of patients.  

Lack of clear and thorough communication when a patient transfers from one unit to another unit, including discharge to home has notoriously been a key culprit leading to patient deterioration.  

Because research showed communication was key in good hospital care, the SBAR format was initiated by Kaiser Permanente in Colorado in 2002.  

Any time a patient enters a hospital, they will be treated by a variety of various healthcare personnel who all impact the patient’s care. From the initial triage nurse in an emergency department, to the unit nurse who receives an admitted patient, to the discharge nurse and all nurses on each shift. Patients encounter a lot of people.  

Information about that patient needs to be communicated throughout the hospital stay to many different people. As a patient’s condition can change even from one shift to another, nurses need to be able to succinctly summarize the patient’s medical background, admitting diagnosis, age, gender, current status and physical condition and plan of care to the next nurse who will care for the client.  

Research shows that using the SBAR format in our communication with other healthcare professionals improves patient outcomes and avoids preventable complications due to poor communication.  

How Do I Use SBAR?

Using the SBAR format is a helpful format to share patient information. It’s a systematic way to stay organized in your thoughts as you share information with another nurse, provider, or healthcare team member. It should also be used in emergency situations such as when reporting information to the rapid response team.  

You have probably received a report from another nurse who was disorganized with information, scattered, and hard to follow. You then spent the first part of your new shift trying to reconstruct the pertinent information to care for the patient.  

Using the SBAR format helps. You have also probably received an SBAR from an organized nurse and then felt instantly organized in your plan for the patient for the shift. You want to be the nurse who everyone wants to follow because your report is clear, concise, and relevant. 

SBAR Format

Situation, Background, Assessment, Recommendation

Situation

Starting with a quick summary of the situation includes the patient’s name, age, gender, ethnicity, admitting diagnosis and date will quickly help another nurse picture the patient in their mind even before seeing the patient.  

Stating “Mr. John Doe, is a 63-year-old white male admitted 2 days ago for COPD exacerbation” is much clearer than saying “John Doe came in a few days ago into the ER and couldn’t breathe when he was trying to mow his lawn. He lives with his wife, and they have two adult children. I think he has been a smoker and his lungs sound really congested. His pulse ox has been stable at 94% and he needs to sit up when his wife comes to visit. He’s on a regular low salt diet.”  While the additional information is helpful, it is better to add that in the background of the SBAR rather than in the introduction of the brief situation.  

Nurses tend to give a full narrative about the patient whereas physicians generally want to hear only the main aspects of a patient’s situation. The SBAR format helps narrow down the most relevant information. This can be used with phone calls to providers too.  

For example, it’s 1 a.m. and you need to call the doctor. Which conversation sounds more effective?  

Scene 1:  

Nurse: “Hello Dr. Gonzales, I’m so sorry to have to call you so late but Mrs. Jane Doe was admitted five days ago for cholecystitis and is on a clear liquid diet. Her vital signs have been stable but she’s having trouble sleeping. Her I’s and O’s have been…. Her family was in all day to visit. Don’t you think it would be good to order a sleeping pill so she can feel better in the morning?”  

Doctor: “Zzzzzz. Nurse, you’re the one who needs a sleeping pill.”  

Scene 2:  

Nurse: “Hello Dr. Gonzales, Mrs. Jane Doe was admitted five days ago for cholecystitis and has stable vital signs and has had no complications. She would like a sleeping pill. What would you like to order?”  

Doctor: “Give her Ambien 5 mg now x 1.

Background

The background information should include a brief medical history and relevant family and social information such as who the person lives with. An example for this scenario could be “Mr. John Doe has COPD for 10 years with a 20-year pack history of cigarette smoking. He also has hypertension and has a primary care provider who treats his COPD. He ran out of his medications 2 weeks ago due to an insurance coverage change.”

Additional background information could include medical tests and results obtained so far during the hospitalization.  

Assessment

The assessment is generally the physical findings from a physical exam done by the nurse during the shift. Each nurse must complete a head-to-toe assessment during each shift, which reveals physical findings that needs to be shared with the next nurse and providers.

It is a good practice to complete the assessment and report the findings in an organized manner from head-to-toe. If there are no abnormal findings, you can summarize that by saying the body system is within normal range or limits, and then add the focused findings that are abnormal or a concern.

The assessment needs to also include current vital signs or changes throughout the shift that are significant. For example, a nurse may report “blood pressure began within the normal range but in the past hour after 1 liter of normal saline I now hear crackles in the lungs and bounding pulses.” 

Recommendations

Just pointing out abnormalities isn’t complete in a nurse’s handoff report. It is valuable to offer suggestions about the plan of care needed to help the patient achieve optimal outcomes. Although nurses do not order tests, declare a medical diagnosis, order diagnostic tests, or change medical treatments unless they are an advance practice RN, they can share the plan of care with each other, and any needed modifications based on their findings.  

We all know the very experienced nurse who gently helps coach a new resident by offering suggestions about medications or tests that should be ordered. That becomes the art of nursing when a nurse knows medical practice well and anticipates the appropriate order.  

That takes time and finesse to gain the confidence of an ordering physician to trust your recommendations. Smart physicians will rely on the ears and eyes of the nurse caring for the patient and may follow your correct recommendations.  

Just remember, you are not dictating medical practice but sharing your findings and occasionally offer a suggestion. That might sound like “Dr. Brown, I’m seeing a constant urinary leakage for the patient and the bladder scan shows 1500 ml still in the bladder. I would love to be able to do a straight catheterization on the patient with your order to see if we can help the patient urinate and feel better.”

Promoting SBAR

Hopefully your facility uses the SBAR format. If not, you can begin to improve your own report by using the SBAR format and you may be the catalyst for improvement in your facility.  

If you still feel your hand off report is jumbled, try practicing the information in an SBAR format and eventually it will feel natural and more organized.  

You could also offer an in-service to your unit about the SBAR format, which would encourage your entire unit to use the more organized format.

The Bottom Line

By being able to communicate patient information in an organized format, nurses can glean the most relevant information quickly and share the plan of care based on assessment findings that are pertinent. As nurses learn to communicate objectively, accurately, and succinctly, the quality of our reports will improve, which directly will impact better patient outcomes. 

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