SBARGuada Allen, RN, BSN, CMSRN

Staff Educator SLMV

Hand – Off Communication

Interactive process of passing patient specific information from one caregiver to another PURPOSE:

Ensure continuity and safety of the patient’s care

Provide accurate information about a patient’s care, treatment, and services, current condition and any recent or anticipated changes

Provides an opportunity to ask and respond to questions

JCAHO, 2007

What is hand-off communication?

Poor communication and patient hand-off is a common source of sentinel events 70% of sentinel events in 2005 were

caused by poor communication ½ of those events occurred during patient

hand-off 2008 National Patient Safety Goals

Requires hospitals to implement a standardized approach to communication during patient hand-off

Agency for Healthcare Research and Quality, 2009

Why is it important?

Examples of patient hand-offNurse to Nurse – Shift ChangeNurse to Ancillary StaffNurse to PhysicianInterdepartmentalFacility to FacilityTransferring On-Call ResponsibilityReporting Critical Results

Not listening Giving advice Expressing approval or disapproval Defending Requesting an explanation – Why? Belittling feelings Changing the subjectRural Connection, 2007

Barriers to communication

Strategies to improve communication Use clear, concise words Use language that the listener

understands Choose the right environment Select the right time Understand the other person’s stress

level Participate in active listening

Rural Connection, 2007

Standardized approach to hand-off communicationDiscussion: Think about a time you participated

or observed a good hand-off. What types of information did you

receive? Think about a time that you

participated or observed a poor hand-off What types of information did you NOT

receive?

SBAR for hand-off commumicationS – SituationB – BackgroundA – AssessmentR - Recommendation

Sbar1. S=Situation

-Introduction, Patient Problem, Assessment (Vital Signs), Stated Concern related to assessment.

2. B=Background-Pertinent information related to

the situation: admit date, surgical day, current meds, lab results, other clinical information.

Sbar3. A=Assessment

-What is the nurse’s assessment of the situation?: I think the problem is __________.

I’m not sure what the problem is, but the patient is deteriorating.

4. R=Recommendation-I suggest or request that you: transfer

the patient, come see the patient, talk to the patient…

-Do you want any tests like (CXR, ABG, EKG…)

Prior to calling: Assess Prepare data Discuss Know whom to call Know admitting diagnosis Read (read the progress note) Have list of allergies, medications and

lab/test results Know code status

Rural Connection, 2007

Telephone & Verbal orders Verbal communication of orders should

be limited to urgent situation They must:

Be used infrequently Be reduced immediately to writing and

signed by the individual receiving the orders Be documented in the patient’s medical

record and be reviewed and countersigned by the prescriber as soon as possible

Telephone & Verbal ordersCreate a culture in which it is

acceptable and strongly encouraged for staff to question the prescribers

Questions should be resolved prior to preparation, dispensing or administration of medication

Telephone & Verbal Orders Elements that should be included:

Name of patient Age and weight, when appropriate Date and time of the order Drug name Dosage Exact strength or concentration Dose, frequency and route Purpose or indication Specific instructions for use Name of prescriber Signature of recipient

Telephone & Verbal Orders

Must always be

READ BACK!

Do NOT use abbreviations! Do not use abbreviations

– Q.O.D./ QOD/ q.o.d./ qod – Q.D./ QD/ qd/ q.d. – Trailing zero (X.0 mg) – Lack of leading zero (.X mg) – MS, MSO4, MgSO4 -IU, U

Examples Dosage parameter used must be written.

Example:Prednisone 6mg po daily x 10 days

Orders must specify the medication dose for liquid drugs. Do not order it by volume.

Example: Tylenol 150mg NOT 5ml

SBAR SCENERIO Nurse communicating with Physician

Read the following scenario and then fill in the SBAR as you would tell it to the physician.

Mrs. Vastin is an 80 year old women admitted to the hospital yesterday with a diagnosis of abdominal pain. She is on a clear liquid diet. She was stable until approximately 2 hours ago when she started to complain of increased abdominal pain. Dr Rispy was called at that time and ordered Morphine 2mg IV every 2 hours as needed. Morphine 2mg relieved her pain and she was doing better. A hour later, the nursing assistant went into the room to do vital signs and called you immediately. Her vitals were Temp 101.8 BP 80/62 HR 122 RR 25 and her level of consciousness was decreased. She has not had any labs since this am and has a capped IV.

S B AR

SBAR SCENERIO Nurse communicating with Physician

S BAR

Dr. Rispy this is Julie RN I have a 80 year old female Pt who has decreased responsiveness. Her systolic blood Pressure has dropped 20points and her LOC is decreased..

Current vitals 80/62 122 25 temp 101.8 Decreased level of consciousness

She was admitted yesterday with abdominal pain. She was stable until 2 hours ago when she started to complain of more pain which you gave a morphine order for. That relieved her pain and she seemed to be doing fine until just a few minutes ago.

I am concerned about this patient may have an Infection and that she may get shocky. Would you like me to do a stat CBC, blood cultures and start fluids? When should I call you again if necessary?

SBAR SCENERIO RN communicating to another RN Read the following scenario and then

fill in the SBAR to communicate with another nurse.

Shift Report: Patient Mr. Celli, in Rm 56 was

admitted 3days ago for pneumonia by Dr Lava. Today the patient’s breathing treatments have been switched to every 4 hours due to increase difficulty in breathing. He seems comfortable after getting the breathing treatments. His lungs are decreased at the bases with crackles on the right. He is wearing oxygen at 4 Liters which was just increased. His pulse oximetry is at 91%. Bp 120/68 R 24 (per breathing treatment) P 100 Temp 100. Just recently paged the Dr Lava and received an order for a stat chest x-ray and CBC and Tylenol prn The chest x-ray and CBC are getting done now and Mr. Celli just received a breathing treatment and 2 Tylenol. You should page Dr Lava with results.

S

B

A

R

SBAR SCENERIO RN communicating to another RN

S

B

A

R

Admitted for pneumonia. Respiratory status decreasing.

History of lung cancer. Increase in oxygen need. Respiratory treatments q4hours. Physician aware.

Vitals 120/68, R 24 (pre treatment), Temp 100. Decreased lung sounds, 4l O2 @ 91 %, decrease in lung sounds & crackles in bases. X-ray & labs being done Tylenol given.

Watch pt closely and call MD with results of chest x-ray. Continue 4 hour breathing treatments.

Let’s Practice It is 3:00am and Patient Suzie Q is

complaining of pain and is in need of additional analgesics. Nurse Ratchet called Dr. Moody to inform him of the patient complaints. He replied by saying, “Go ahead and increase her morphine to 4mg.” What would you do? What additional information would you request? Would you question the prescriber? How would you document the order in the patient

record?

References Agency of Healthcare Research and Quality.

(2009). Available at: http://www.innovations.ahrq.gov/content.aspx?id=2313

Joint Commission (2007). Available at :http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/08_hap_npsgs.htm Rural Connection. (2007). Nurses as

Teachers. Boise, Idaho.