Hand Off Communication - SBAR
GMHHC
Objectives
SUMMARY
- List and define SBAR
- 3 reasons why SBAR is important to use
- How SBAR affects patient safety
Situation
Background
Assessment
Recommendation
FOCUS
AREA
1
What is SBAR?
- The SBAR model is a simple method to help standardize communication
- SBAR allows all parties to have common expectations:
- What is going to be communicated
- How the communication is structured
- Required elements
- Focuses on the problem, not the people
Contributing Factors
- Inadequate hand-off communication is a contributing factor to adverse events
- The Joint Commission's sentinel event database includes reports of inadequate hand-off communication causing:
- Wrong-site surgery
- Delay in treatment
- Falls
- Medication errors
- Study in 2016 estimated 30% of malpractice claims were due to communication failures in US hospitals
- Resulting in: 1,744 deaths and $1.7 billion in malpractice costs over 5 years
Why it's important to use
- According to the Joint Commission, communication issues are the leading cause of sentinel events in hospitals.
- The Institute of Medicine (IOM) reported that “it is in inadequate handoffs that safety often fails first.”
- The transfer of essential information and the responsibility for care of the patient from one health care provider to another is an integral component of communication in health care. (https://www.ncbi.nlm.nih.gov/books/NBK2649/)
SBAR tool that should be used
Assessment
Situation
Patient is 25 years old. She is 32 weeks, complaining of cramping and bloody show. She is a G8 P4.
Patient is on the monitor showing contractions 2-3 minutes apart. Vitals are stable. Fetal heart monitor times 140 with a Category 1 tracing. She is Nitrazine positive and dilated 6 cm 0 station.
Recommendations
Background
Patient has had 2 previous preterm births at 32-34 weeks. She has not had prenatal care
Admit the patient to labor. Draw labs. Do a drug screening. Get a stat ultrasound. Have NICU on standby.
Results
Situation
Assessment
Nurse calls OB to inform doctor of the situation
Patient is 25 years old. She is 32 weeks complaining of cramping and bloody show.
Recommendation
Background
Patient has had 2 previous births.
OB states he/she is coming in.
Results
Doctor misses the birth due failed communication.