What is SBAR? Where it is Used in Nursing

SBAR is a standardized communication framework used to effectively communicate critical information between healthcare professionals, ensuring clear and concise exchange of information.

Purpose:

1. Improve communication accuracy
2. Enhance patient safety
3. Reduce errors
4. Facilitate timely decision-making

Components:

1.Situation: Describe the current situation or problem.

Situation states what is currently happening with the patient. It usually begins with the identity of the person communicating the SBAR, patient identifiers such as age and gender, and a brief statement of the current problem or situation.

2.Background: Provide relevant context and historical information.

Background covers clinical background such as patient history related to the current situation, signs and symptoms of the presenting complaint, and any test results, such as lab or imaging reports.

3.Assessment: Share your evaluation of the situation.

Assessment reports what the person communicating the SBAR thinks the problem is. It states what the nurse or other provider has assessed based on the background information, patient history, and observations. Assessment asks what else it can be, provides sense making, considers sources of other information to provide clarity, and relates actions to consequences. Assessment can also include objective data such as vital signs.

4.Recommendation: Offer a specific action or decision.

Repeat-Back Recommendations and Requests states an initial recommendation, what is needed and when, and repeats back the stated response from the other provider or patient to ensure accuracy.

Example:

Situation: “Ms. Smith, 45-year-old patient in Room 3, experiencing sudden chest pain.”

Background: “She has a history of hypertension and was admitted for elective surgery yesterday.”

Assessment: “Vital signs show tachycardia and elevated blood pressure. ECG indicates possible MI.”

Recommendation: “I recommend immediate cardiac consultation and consideration for stat ECG and troponin levels.”

How to Use SBAR for Communication  

There are many templates available to guide you through the use of SBAR, but committing the easy-to-remember organizational framework to memory will help you standardize its use for communicating about your patients. 
 
SBAR helps you prioritize and organize what is most critical about each individual patient’s situation, regardless of whether you are explaining it in person, on the phone, or in writing. Its use ensures that the most vital information is relayed quickly so that appropriate action can be taken. 
 
The most important things for you to remember when using SBAR are:

• Keep all points relevant
• Keep all points concise
• Eliminate unnecessary information 

The information conveyed via SBAR is meant to be comprehensive, but not overly detailed. It may invite additional questions that you should be prepared to answer, but even without those questions being asked should serve to provide enough information for another healthcare professional to move forward. 
 
It’s also important to note that the recommendations may include medical interventions (such as medication recommendations, radiology, or lab draws), but ultimately, it is up to the medical provider to place orders for the patient and determine the next steps. 
 
Nurses are often asked for their professional recommendations because they spend the most time with the patient and might be picking up on subtle cues from the patient.

Benefits:

1. Clarifies communication
2. Reduces miscommunication errors
3. Enhances teamwork
4. Improves patient outcomes
5. Supports critical thinking

Healthcare Settings:

1. Handoffs (shift changes, transfers)
2. Emergency situations (code blues, rapid response)
3. Critical care (ICU, ER)
4. Surgical settings (pre-op, post-op)
5. Multidisciplinary team meetings

Implementing SBAR:

Step 1: Develop a Plan

1. Identify stakeholders (nursing, medicine, administration)
2. Establish implementation team
3. Define goals and objectives
4. Determine scope (units, departments, organization-wide)

Step 2: Educate and Train

1. Provide overview of SBAR benefits and components
2. Offer hands-on training and practice
3. Use case studies and scenarios
4. Address common challenges and questions

Step 3: Develop SBAR Tools and Resources

1. Create standardized SBAR templates
2. Develop communication guidelines
3. Establish clear expectations for SBAR use
4. Integrate SBAR into existing workflows

Step 4: Implement and Monitor

1. Pilot SBAR in select units or departments
2. Monitor usage and effectiveness
3. Gather feedback from stakeholders
4. Make adjustments and refine process

Step 5: Evaluate and Sustain

1. Conduct regular audits and assessments
2. Evaluate impact on patient outcomes and safety
3. Identify areas for improvement
4. Continuously reinforce SBAR use

Challenges and Solutions:

1. Resistance to change: Engage stakeholders, provide education
2. Time constraints: Integrate SBAR into existing workflows
3. Technical issues: Ensure user-friendly templates and tools
4. Sustainability: Regularly evaluate and reinforce SBAR use

Customizing SBAR for Specific Clinical Scenarios:

1.Scenarios:

1. Code Blue (Cardiac Arrest)
2. Rapid Response (Deteriorating Patient)
3. Medication Error
4. Surgical Handoff
5. ICU Transfer

2.Tailoring SBAR:

1. Identify key information for each scenario
2. Develop scenario-specific templates
3. Incorporate relevant clinical guidelines
4. Consider technology integration (e.g., electronic handoff tools)

3.Code Blue Example:

• Situation: “Code Blue, patient XYZ in Room 123”
• Background: “75-year-old with history of MI, currently on telemetry”
• Assessment: “Patient unresponsive, no pulse, ECG shows VFib”
• Recommendation: “Activate cardiac arrest protocol, request anesthesia and cardiology stat”

4.Rapid Response Example:

• Situation: “Rapid Response, patient ABC in Room 456”
• Background: “45-year-old with pneumonia, deteriorating oxygen saturation”
• Assessment: “Patient shows signs of respiratory distress, SpO2 80%”
• Recommendation: “Intubate patient, start oxygen therapy, notify ICU”

5.Medication Error Example:

• Situation: “Medication error, patient DEF in Room 789”
• Background: “Patient receiving incorrect medication dose”
• Assessment: “Patient stable, no adverse reaction”
• Recommendation: “Hold medication, notify pharmacy, review orders”

6.Surgical Handoff Example:

• Situation: “Surgical handoff, patient GHI in OR 1”
• Background: “Patient undergoing elective surgery”
• Assessment: “Patient stable, vital signs within normal limits”
• Recommendation: “Continue surgery, notify anesthesia of any changes”

7.ICU Transfer Example:

• Situation: “ICU transfer, patient JKL from ER”
• Background: “Patient critically ill, requires ICU care”
• Assessment: “Patient unstable, requires close monitoring”
• Recommendation: “Transfer patient to ICU, notify ICU team”

REFERENCES

1. Leonard M, Graham S, and Bonacum D: The human factor: the critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care 2004;13: i85 – i90
2. Arora V, Johnson J, Lovinger D, Humphrey H J, and Meltzer D O:
   Communication failures in patient sign-out and suggestions for
   improvement: a critical incident analysis. Qual. Saf. Health Care
   2005; 14(6): 401 – 407
3. Haig K M, Sutton S, Whittington J: SBAR: A shared mental model for improving communication between clinicians. Joint Commission Journal on Quality and Patient Safety, Volume 32, Number 3, March 2006, pp. 167-175(9)
4. Joint Commission Perspectives on Patient Safety. The SBAR
   technique: Improves communication, enhances patient safety.
   February 2005. Volume 5, Issue 2.
5. Patient Safety First ‘How to Guides’ for Reducing harm from
   deterioration, http://www.patientsafetyfirst.nhs.uk/ashx/Asset.ashx?path=/How-toguides-2008-09-19/Deterioration%201.1_17Sept08.pdf
6. Patient Safety First ‘How to Guides’ for Implementing human factors in healthcare, http://www.patientsafetyfirst.nhs.uk/ashx/Asset.ashx?path=/Intervention-support/Human%20Factors%20How to%20Guide%20 v1.2.pdf

Stories are the threads that bind us; through them, we understand each other, grow, and heal.

JOHN NOORD

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