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SBAR Communication

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by

Rob Hartman

on 22 July 2014

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Transcript of SBAR Communication

SBAR Communication
Just The Facts Ma'am
Communication
Linda, Honey Your Not Listening
SBAR Developed by the Navy
Nuclear Power at Sea
526 nuclear power cores
127 million miles submerged (265 round trips to the moon)
Zero (0) radiological/reactor incidents in over 50 years
Operated by 20 year olds
Inadequate documentation
Failure to obtain an adequate history
Inappropriate relationship
Acting outside your scope of practice or not utilizing best practices for your treatment.
Significant injury or reaction during treatment such as a burn or fracture.
Failure to appropriately supervise treatment or procedure.
Not reporting an event.
Not receiving an informed consent for treatment.
Inappropriately disclosing patient information to an unapproved person or party (confidentiality breach).



Be alert for potential litigation due to:

Expected outcomes for SBAR use:
Provide an example of at least one documentation using the computerized SBAR tool following a telephone conversation with a physician


JMH Patient Care Services
Directive 2014

Situation: What has happened that warranted the SBAR communication.
Background: Patient’ circumstances leading up to the incident. Current pain level, details of the reaction, etc.
Assessment: What do you feel the problem was/is caused by?
Recommendation: What would you recommend as the best course of action acting in the patient’s best interest?


SBAR Communication
Therapy Example

Document all aspects of the patient treatment session in detail and avoid ambiguity.
If the patient has anything “unusual” happen such as an adverse reaction or a fall, the physician should be contacted immediately and be notified of the circumstances of the incident.
Document all details of the incident as you would for an RIR (i.e. time, circumstances, witnesses, etc.)


PT, OT, and SLP documentation

Every time an RN asks the RT to check or evaluate a patient there should be a Patient Note
Any time something unusual happens during therapy, it requires more documentation
When setting up Home Care for patients, a full note with what was set up and the company chosen to provide home care needs to be documented.



RT Documentation

Should always be used during the following circumstances
During shift report
When speaking with MD’s


SBAR for RT

No orders received
Physician acknowledged my report
Continued concern, notified my supervisor
Physician to place orders in CPOE
Order by physician was to continue to observe the patient for changes
Nursing intervention of_____ initiated
Monitor and call in ___ hours

Standardized Documentation Phrases

Once the conversation is complete your actions need to be documented using the SBAR format in Meditech or your charting system

Documentation

State what you would like to see done or what your request is for the patient:
Transfer
Treatment change
Need to see the patient at this time
Talk to family and patient about….
Ask for a consulting physician
Labs
When would you want to be called again?


Recommendation:
Key Word -Solution

State the admission diagnosis and date of admission

State the pertinent medial History

A brief synopsis of the treatment to date

Background: Key Word - Context

State: Your name and unit

I am calling about: Patient name and room number

The problem: The reason I’m calling…

Situation: Keyword – Focus!

The recipient needs the punch line first –
To frame the issues
To concentrate on the relevant issues
We are not taught how to –
Verbally impart urgent information
Verbally frame information in the best manner for the recipient
Document the situation and actions taken in a concise manner

So Why SBAR?

Promotes critical thinking
Promotes assertion and “critical” language
Promotes psychological safety – structure provides safety to document facts or assert for what is needed
Standardizes communication techniques both verbal and written
Increases effectiveness during:
Physician/nurse calls r/t patient needs
Shift to shift report
Hand off communication situations
Failure to rescue




How Can SBAR Help?

Situation or Data
Action
Response


SAR format

Should we use the SBAR format with every encounter?
May not need all components if you have been working with a consistent physician or the nurse practitioner on an issue, but may need to use components such as situation and recommendation
Use the appropriate component in your documentation


Use varies among units
OB has it hardwired into centricity
ED uses it
Med surg, CCU, and ARU do not use it
Records show we have been working on implementation of this tool since 2008

Use of SBAR at JMH

Structured Communication Tool:
Simple,brief, concise
Focuses on the situation, not the people
Useful anytime accurate, concise communication is needed
Well-suited for complex, critical situations
Creates common expectation and predictability for communication:
What is going to be communicated
How the communication is structured
Required elements

What is SBAR?

Two types of communication:
Verbal
Written documentation of the conversation

Improved Communication = Increased Patient Safety

Why Use SBAR?

Contact physician
Team Leader
Rehab Manager: Brian Murphy
Director of Ancillary Services: Rick Kester
COO- Steve Wohlford


Therapy Chain of Command

If the RT is uncertain what to do in any situation, be sure to call the Supervisor.
If orders do not seem appropriate
Speak with the ordering MD (if he/she insists on doing something that doesn’t feel right)
Initiate Chain of Command
Brenda Wilkerson
Michelle Bisesi
Anita Keller
Dr. Deppe


RT Chain of Command

Administrator on site for housewide emergencies: fire, code white, haz mat assistance, violent patients
Oversight for staffing decision making and staffing planning for the nursing units
Resource for decision making, assist in difficult situations, assist the staff in chain of command issues
Rapid Response and Code Blue responder
Patient status placement in the absence of Case Management
Trained supervisors can do PICC placement

Role of the House Supervisor
Another Tool of Support

President/Chief Executive Officer (CEO)
Chief Operating Officer (COO)
Chief Nursing Officer (CNO)
Divisional Lead Executive Officer
Chief Financial Officer (CFO)
Chief Development Officer (CDO)
Chief Information Officer (CIO)
Nursing Supervisor


Administrative Chain of Command

Chief of Staff;
Medical Staff Secretary;
Medical or Surgical Department Chairperson, depending on patient need or emergent situation;
Medical or Surgical Department Vice Chairperson, depending on patient need or emergent situation;
Chief Medical Officer;
Emergency Room physician on duty;
Hospital President;
Chief Nursing Officer;
Chief Operating Officer; and
Chief Financial Officer.


Medical Staff Chain of Command

Defined structure of support
Allows people involved to understand their role

Chain of Command

Pertinent objective and subjective information
Most recent vital signs
Mental status
Respiratory rate and quality
B/P, pulse rate and quality
Pain
Neuro changes
Skin color
Rhythm changes


Assessment: Key Word - Problem

Have at Hand:
Chart
Most recent assessment
Most current test results
List of medications
Code status
Most recent vital signs


When You Call…

Before you call:
Be sure you’re calling the right physician
Are there standing orders to cover this situation?
Review for physician preferences for when and where to call
Check: Does anyone else need to talk to this physician?
See and assess the patient yourself
Read the most recent MD progress notes and notes from the nurse on the previous shift.

First Things First…Preparing to Call the Physician

Situation – the problem

Background – brief, related, to the point

Assessment – what you found, what you think

Recommendation/Request – what you want

S-B-A-R

CNO

Nursing Director
Medical Director

Charge
Nurse

Manager,
House
Supervisor

RN

LPN

CNA, UAP
PCT, US

Departmental Chain of Command

Nursing Chain of Command:

Chief of Staff;
Medical Staff Secretary;
Medical or Surgical Department Chairperson, depending on patient need or emergent situation;
Medical or Surgical Department Vice Chairperson, depending on patient need or emergent situation;
Chief Medical Officer;
Emergency Room physician on duty;
Hospital President;
Chief Nursing Officer;
Chief Operating Officer; and
Chief Financial Officer.


Medical Staff Chain of Command

CNO

Nursing Director
Medical Director

Charge
Nurse

Manager,
House
Supervisor

RN

LPN

CNA, UAP
PCT, US

Departmental Chain of Command

Nursing Chain of Command:

The Single Biggest Problem in Communication
Is The Illusion That It Has Taken Place.







George Bernard Shaw
Submarine officers and crew needed a situational briefing model to communicate clearly, effectively and efficiently.

SBAR organizes the message in a consistent and concise manner.

Michael Leonard, MD, Physician Leader for Patient Safety, along with colleagues Doug Bonacum and Suzanne Graham at Kaiser Permanente of Colorado developed this method for healthcare.
S.B.A.R. Communication


Situation-Background-Assessment-Recommendation

Situation:
State what is happening at the present time that has warranted the SBAR communication.


Identify yourself and where you are calling from


Identify the patient by name and the problem or concern you are calling about
Background:
Explain circumstances leading up to this
situation. Put the situation in context for the reader/listener.

State the primary diagnosis and the reason the patient
is being seen.

State pertinent medical history

Most recent/pertinent findings (e.g. vital signs, mental status changes, lung sounds, edema, signs of infection, wound changes, pain not controlled by current regimen, changes in functional status including weakness, lab results, current medications that are pertinent to situation)

Assessment:
What do you think the problem is?

Clinical impressions, concerns


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.

I am not sure what the problem is but I am concerned that the patient
has had a change in condition.

Recommendation:
What would you do to correct the problem?

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

Clarify expectations

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.


Chain of Command
Contact Physician
Team Leader
Rehab Manager
Director of Ancillary Services
COO
Full transcript