Title: The SBARR Communication Tool: Situation, Background, Assessment, Recommendation Response Enhancing P
1 The SBARR Communication Tool Situation Background Assessment Recommendation ResponseEnhancing Patient Safety 2 SBARR What is it
Situational briefing model that provides a common predictable structure to communication
Originally used in U.S. military and aviation industry
Adapted for use in healthcare by Kaiser Permanente in 2002
Can be used in virtually any clinical setting
3 SBARR The basics
Situation The problem
What is going on with the patient
Background Brief related to the point
What is the clinical background or context
Assessment What you found/think
What do I think the problem is
Recommendation What you want
What would I do to correct it
Response Receiver acknowledges information given
What is the receivers response
4 Overview of SBARRSituation Background Assessment Recommendation Response
Communication challenges in health care
Benefits of SBARR
Practical application of SBARR
5 Communication Challenges
Hand-off communication is a high-risk process.
Communication failures commonly cause inadvertent patient harm.
60 -70 of the more than 2455 sentinel events reported to JCAHO revealed that communication failure was the primary root cause--approximately 75 of these patients died.
CHW has had critical incidents related to communication issues.
Standardization of hand-off communication is a 2006 NPSG.
(Leonard Graham Bonacum 2004)
6 Barriers to effective communication
Physicians vs. nurses
Gender cultural differences
Complex hierarchical systems
Inhibits feeling safe to speak up hint/hope approach
No structured procedures
7 Effective Communication
8 Essential communication elements
Being organized in thought and communication
Being Competent technically and socially
Disavowing Perfection while looking for clarification/common understanding
Owned by the Entire Team this is not just a subordinate skill-set
Valued by the receiver
9 Benefits of SBARR
Framework for effective communication
Creation of a safe environment
Framing a conversation especially emergent ones
Critical Thinking Skills
Sharing of relevant timely concise organized efficient information
Reduces the risk of adverse events
Fosters a culture of patient safety
10 Benefits of SBARRImportant elements
Individuals speak up state information with persistence until there is a clear resolution
Helps create a shared understanding of what is happening
Is crucial to patient safety
Avoids natural tendency to speak indirectly and deferentially
CUS words concerned uncomfortable unsafe safety scared
Staff maintaining the big picture
Ongoing dialogueplanning/thinking ahead
Recognizing adverse events
Common understanding of task
11 SBARR Example
Situation What is going on with the patient
Dr. Jones Im calling about Matthew a 15 year old-patient who was admitted for a closed head injury after having fallen off a ladder yesterday. He has developed new onset confusion and restlessness.
Background What is the clinical background or context
Matthew was alert and oriented overnight. His pupils were equal and briskly reactive. His GCS was 14 and now it is 10.
Assessment What do I think the problem is
I am concerned that he may have a decreasing level of consciousness.
12 SBARR Example (continued)
What would I do to address it
I would like you to come and assess this patient in person
What is the receivers feedback
Thanks this sounds like a significant change. He may have edema or bleeding. Please do a set of vital signs and I will be down to see him right away.
13 Another Example
-Hello Sally(RCP) this is Mary the nurse caring for Jane Doe in room 678. She is an asthmatic and is having increased respiratory distress.
-Jane was admitted last night and put on the q 4 hour nebs per the respiratory protocol. It has been 2 hours since her last neb and she has a respiratory rate has gone from 30 to 50 with increased retractions and more wheezing.
14 Example 2
-I am uncomfortable with how she is doing. I think she is having increased bronchospasm.
-I would like you to come and assess her for another nebulizer treatment right away.
15 Example 2
- I am finishing a treatment on 4 for a critical patient. I can be there in 15 minutes. Do you think the patient is stable enough to wait that long
Additional dialogue as needed
16 Final Thoughts
SBARR can help CHW improve its communication so that safe quality patient care is delivered.
Using SBARR requires practice teamwork and commitment from all CHW employees.
Initial focus/expectation is to use SBARR for CUS (concerned uncomfortable safety) situations.
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