By Debra Wood, RN, contributor
When reporting a condition change to a physician or handing off a patient’s care to another nurse, clear communication between health care professionals improves outcomes. Many hospitals have turned to Situation-Background-Assessment-Recommendation (SBAR), a tool that helps frame the conversation, to standardize and improve communication among their entire health care staff.
“Communication impacts patient safety, and many times, breakdowns in it cause problems,” said Maureen Bowman, RN, BSN, administrative hospital director at Beaumont Hospital in Royal Oak, Michigan, which began using SBAR more than two years ago. “Nurses and physicians don’t always communicate information in the same matter. Nurses look at the broad picture and want to give details, and physicians want the pertinent clinical information quickly.”
With SBAR, the nurse briefly explains the situation with the patient, gives some background information about what led up to the development, provides an assessment and then makes a recommendation.
“If you tell somebody something the same way every time, they know you will cover all the things they need to know,” said Debbie Rigby, RN, CPN, BS, a clinical nurse educator at Children’s Healthcare of Atlanta at Scottish Rite. “This format makes it easier for people to listen accurately and completely.”
Borrowing from nuclear submarine communication techniques, Suzanne Graham, PhD, RN; Michael Leonard, MD; and Doug Bonacum at Kaiser Permanente in Colorado tailored SBAR for health care professionals. They encourage hospitals to be sure that physicians and nurses receive training in the technique, practice it and recognize its value.
Nursing students at the University of Portland in Oregon learn SBAR in school and practice it in the simulation lab. The school began teaching it in 2004, years before the Joint Commission made better handoffs a patient safety goal. However, nurses at the clinical sites were not letting the students call physicians, so the students never had the opportunity to practice the skill.
“In order for our students to be practice-ready, they really had to be strong communicators; not only how you communicate but cognitively what you communicate, and the framework, which is where SBAR comes in,” said Lorretta Krautscheid, RN, MSN, instructor of nursing at the University of Portland. “What you tell the physician on the phone can make or break patient care.”
Krautscheid found during a 2005 clinical-assessment simulation that only 61 percent of the students told the doctor the patient’s diagnosis of peptic ulcer and the patient’s name, only 21 percent informed the doctor about the patient’s baseline blood pressure, and only 26 percent brought up the fact there was blood coming from the nasogastric tube into the drainage canister.
Consequently, the school began practicing SBAR in the simulation lab. It also requires students to write a SBAR handoff report. The effort is paying off. In the fall of 2007, 89 percent of the students told the doctor the diagnosis, 75 percent gave the physician the initial vital signs, and 78 percent informed the doctor about the amount of bloody drainage in the NG canister.
“We make the opportunity happen,” Krautscheid said. “We are thrilled that we did this.”
Experienced nurses new to SBAR also need practice to avoid losing the skill. Presbyterian Intercommunity Hospital in Whittier, California, a VHA member hospital, incorporates the SBAR technique into its orientation program but also asks preceptors to provide experiences for the new nurse.
“Unless it’s reinforced, it doesn’t become part of their nature,” said Cindy Place, RN, MSN, administrative clinical coordinator at Presbyterian Intercommunity. “We need to have the preceptors ingrain it, so nurses always use it when calling the physician.”
Bowman said many nurses embrace the communication tool quickly, while others may need more practice with it. Nurses use the tool to concisely gather their thoughts and all the data they will need to present in a logical sequence and formulate an opinion about what needs to happen before placing a call to the physician.
Recommendations may include asking the physician to come in or requesting orders for something specific, perhaps a diagnostic test. New nurses typically have more trouble voicing their recommendation than experienced nurses.
Place suggests that newer nurses who are unsure what to request should simply ask the physician what would be the best thing to do. She said experienced nurses like the technique because they can tell the physician what they need and usually get what they want.
“It has made nurses more of a colleague with physicians,” Bowman said. “It improves communication, gets to the point and promotes team training and working together.”
Nurses at Children’s Healthcare and at Baylor Health in Dallas also use it when giving reports at change of shift or when transferring a patient to the floor after an interventional radiology procedure. Jewel Price, RN, ADN, a radiology nurse at Baylor, found it easy to learn.
“SBAR gives you a systematic method when you hand off and give report,” Price said.
“The continuum of care is improved with the SBAR.”
For more information, download the SBAR toolkit on the Institute for Healthcare Improvement (IHI) web site.
© 2008. AMN Healthcare, Inc. All Rights Reserved.
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