Safety Briefs can help you to share information about potential safety problems and concerns on a daily basis.
SBAR is an easy to remember mechanism that you can use to frame conversations, especially critical ones, requiring a clinician’s immediate attention and action. It enables you to clarify what information should be communicated between members of the team, and how. It can also help you to develop teamwork and foster a culture of patient safety.
The tool consists of standardised prompt questions within four sections, to ensure that staff are sharing concise and focused information. It allows staff to communicate assertively and effectively, reducing the need for repetition.
The tool helps staff anticipate the information needed by colleagues and encourages assessment skills. Using SBAR prompts staff to formulate information with the right level of detail.
he NHS is often criticised for poor communication, however, there are few tools around that actively focus on how to improve communication, in particular verbal communication.
The tool can be used to shape communication at any stage of the patient’s journey, from the content of a GP’s referral letter, consultant to consultant referrals through to communicating discharge back to a GP.
When staff use the tool in a clinical setting, they make a recommendation which ensures that the reason for the communication is clear. This is particularly important in situations where staff may be uncomfortable about making a recommendation i.e. those who are inexperienced or who need to communicate up the hierarchy. The use of SBAR prevents the hit and miss process of ‘hinting and hoping’.
A sample NHS SBAR template to show how to use SBAR in your hospital can be viewed in the following document: SBAR diagram.
A detailed description of the steps involved:
S Situation:
Firstly, describe the specific situation about which you are calling, including the patient’s name, consultant, patient location, code status, and vital signs. An example of a script would be:
“This is Lou, a registered nurse on Nightingale Ward. The reason I’m calling is that Mrs Taylor in room 225 has become suddenly short of breath, her oxygen saturation has dropped to 88 per cent 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 per cent, 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.”
B Background:
“Mrs. Smith is a 69-year-old woman who was admitted ten 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 nine days ago, her only complication was a right haemothorax for which a chest tube was put in place. The tube was removed five days ago and her CXR has shown significant improvement. She has been mobilising with physio and has been progressing well. Her haemoglobin 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.”
A Assessment:
You need to think critically when informing the doctor of your assessment of the situation. This means that you have considered 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, you may say:
“I think she may have had a pulmonary embolus.’”
“I’m not sure what the problem is, but I am worried.”
R Recommendation:
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 back to ensure accuracy.
“Would you like me get a stat CXR? and ABGs? Start an IV?”
“Should I begin organising a spiral CT?”
“When are you going to be able to get here?”
Incorporating SBAR may seem simple, but it takes considerable training. It can be very difficult to change the way people communicate, particularly with senior staff.
Anxiety about giving recommendations
In the UK, less experienced clinical staff have sometimes found making recommendations a challenge. Recommendation is important as it clearly describes the action the messenger needs. Where staff are anxious about giving recommendations, they will need extra support and encouragement. A good place to start is by trying the tool with supportive colleagues.
Remembering to use the communication tool
Hospitals using SBAR have found the following useful:
Examples
The multidisciplinary team meeting is an example of the process in action. Many clinicians are present. Most will be in a position to help formulate the most appropriate management for the patient. The doctor directly responsible presents the present situation and the relevant background. The assessment will include a discussion with the clinician to clarify the clinical findings and a joint review of the results of all relevant investigations. Recommendations will be agreed by all present. These will be documented in the patient’s records for implementation.
Another example where this tool would add to clarity and better care is the emergency call to a sleeping senior colleague for advice about patient management. When woken in the night it takes some time to absorb the facts and respond. This is greatly aided by a clear presentation of the situation, the background, the assessment and the proposed treatment. In the surgical situation it is possible and even quite likely that the senior colleague is needed to help with the assessment and / or to carry out the recommended surgery. The request for direct help should be made clear as part of the recommendation so there is no misunderstanding. After all, it would not be surprising if the senior colleague’s preference was to go back to sleep!
Once you have started testing this as a communication tool, you will need to assess if it has made a difference. You should focus on making sure that the checklist (you could invent your own) and principles of good communication are being used by people in practice. If it is proving successful, the next step is to get this into people’s everyday habits, so it becomes ‘the way things are done around here’.
Ways of doing this include:
Another excellent communications tool that would aid the use of SBAR is the art of listening.
Additional resources
The IHI website contains some SBAR tools that have been adapted for specific settings.
Background
Originally used in the military and aviation industries, SBAR was developed for healthcare by Dr M Leonard and colleagues from Kaiser Permanente in Colorado, USA. In one healthcare setting, the incidence of harm to patients fell by 50 per cent after implementing SBAR.
A model of care in which multiple members of the care team come together to discuss the care of a patient in real time.
This template is available for all teams who wish to communicate their progress locally. It was built on Canva , a free online design platform.
You will be able insert content that is relevant to your team/directorate and either save as an image and send via e-mail or print on A4 paper.
Please feel free to use this tool and contact us if you need assistance.
Step 1: Create a free account on Canva. Use your ELFT e-mail to create an account
Step 2: Open the template >> Local QI Newsletter template
Step 3 Before you start editing, create a copy of the template and rename it as you wish. Please do not start editing straight away. This is very important so the master template remains available for other teams.Here’s what you need to do before you start editing:
You can now start editing!
You can upload images of your team members, other photos and add training dates. Visit the QI training page or contact us if you need help.
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