Giving SBAR Report

1. Giving SBAR
Report
Situation
Background
Assessment
Recommendation

2. What is SBAR?
SBAR is an acronym for a standardized
method of giving report between
healthcare providers
S: Situation
B: Background
A: Assessment
R: Recommendation

3. Why SBAR?
Improving Safety
The Institute of Medicine report To Err is Human
(1999) challenged healthcare workers to
examine several preventable errors that lead to
poor patient outcomes
Communication failure was listed as one of the
errors that can be prevented
SBAR standardizes the way patient information is
communicated between healthcare providers,
decreasing the likelihood that important
information is missed during transitions of care

4. Why SBAR?
Improving Communication
Joint Commission National Patient Safety
Goal 2: Improve the effectiveness of
communication among caregivers
The Joint Commission’s Transition of Care
(2012) report revealed communication
breakdowns to be one of the root causes of
ineffective patient transitions and poor
patient outcomes

5. Barriers to Effective
Communication
Caregivers have differing expectations of
what to expect in report
Organizational cultures that do not
promote successful handoffs
Inadequate amount of time to give a
detailed handoff report
Lack of standardization of handoff reports

6. Why SBAR?
Improving Collaboration
The ANA Code of Ethics calls nurses to
collaborate with all members of the healthcare
team
Collaboration requires “mutual trust, recognition
and respect…shared decision making…and
open dialogue…”(Provision 2.3) among all
members of the healthcare team
The use of SBAR reporting standardizes
communication allowing the healthcare team
to focus their efforts on developing a
multidisciplinary plan of care instead of gaps in
communication

7. Breaking it Down
What it all means…

8. S: Situation
What is going on?
What is the patient’s name?
Why is the patient coming for treatment?
How did they obtain the wound?
How long have they had the wound?
How is the patient currently treating their
wound?

9. Example #1: Mr. P.
Mr. P., 27yo, is here for a periorbital laceration that he
sustained in a fight 10 days ago
He was originally admitted to the hospital for treatment
and was discharged with instructions to follow up with his
PCP or Patient First to have the stitches removed
When he went to Patient First two days ago, the physician
there refused to remove the stitches because he suspected
infection
The Patient First physician prescribed Bactrim and told him
to make an appointment with the wound center.
He is currently treating the wounds with antibiotic ointment
and gauze
He changes his dressings once a day

10. B: Background
What is the pertinenthistory?
Include only relevant information
Patient’s PCP, brief social background
Lives alone, nursing home, home care, homeless, etc.
Patient’s medical/surgical history
Diabetes, PVD, PAD, malignancies, obesity, DVT, etc.
Allergies
Especially to medications/products that are commonly used to
treat wounds
Sulfa, PCN, silver, iodine, etc.
Medications that may effect the patient’s ability to heal or the
way the physician can treat the patient
Steroids, chemotherapy, anticoagulants, illicit drug use,
smoking, ETOH, etc.
Recent labs, wound cultures, biopsies, radiology reports, vascular
testing, etc.
Be as specific as possible; include dates, actions taken

11. Example #1: Mr. P.
Mr. P. does not have a PCP
He has a history of methamphetamine and IV heroin abuse
He states that it has been 47 days since he last used either drug
He reports that he recently completed a stay in rehab and
regularly attends NA meetings
He has no other medical history
Mr. P. is on his 3
rd
day of Bactrim
He is also taking Tramadol for pain
He takes no other medications
A hospital x-ray of Mr. P’s face was negative for any
fractures
No wound culture was taken at the Patient First before he
was prescribed his antibiotic

12. A: Assessment
What are your assessment findings?
How many wounds are there?
What are their sizes?
May generalize if multiple wounds
Are there any causes for concern?
s/s infection, dehiscence, pain, malodor, etc.

13. Example #1: Mr. P.
Mr. P.’s wound is on his L lower periorbitalregion
It measures 3.2 cm x 0.4 cm x 0.3 cm
The sutures are intact at the distal portion of the wound
The wound has started to dehisce at the proximal portion
The wound is mostly yellow slough with a small amount of
red granulation tissue
The wound has a moderate amount of non-purulent
serosanguinousdrainage
There is no odor but there is erythema, increased warmth
and edema of the periwound
The patient also c/o 8/10 wound pain
Constant wound pain of 4-5/10
Mr. P. is not running a fever and he is not complaining of
chills or body aches

14. R: Recommendation
What do you think the next course of
action should be?
Are any diagnostic tests or labs needed?
Does the wound need to be debrided?
Will the patient need home care to help
with management of the wound?
What kind of dressing do you anticipate the
patient needing?
What are the educational needs of the
patient/caregiver?

15. Example #1: Mr. P.
The wound looks like it should probably be debrided
I also think that we should take a culture of the
wound since one has never been done and the
wound does not appear to be responding to the
Bactrim
Since the wound appears infected and is producing
a moderate amount of drainage Aquacel Ag may
be a good choice for a dressing since it is absorptive
and antimicrobial
Mr. S. can be taught how to perform his dressing
changes and is physically able to do so
I do not anticipate him needing any skilled nursing care

16. Your Turn
How would you give an SBAR report on a patient?

17. SBAR Assignment
Imagine that Mr. S. has come to the wound
center as a new patient for treatment of his
wounds
The information on the next few slides is what
you learned about him during your initial
assessment
Use the Wound Healing Center SBAR Report
Sheet to help you organize your report
Bring completed SBAR Report Sheet to your
one-on-one meeting with Ore

18. Mr. S.: Patient Profile
Mr. S., 43yo police officer
injured in the line of duty
After being nearly paralyzed
he is now unable to walk
without assistance
Height: 5’7”
Weight: 215 lbs
Spends majority of his day in
bed or sitting in his
wheelchair
PCP: Dr. Saul Goodman
Pharmacy: Boetticher
Pharmaceuticals
History:
Obesity, high blood
pressure, high cholesterol,
diabetes, PTSD,
cholecystectomy 10 yrs.
ago, L leg DVT w/ IVC
filter placement 2 mos.
ago
Recent diagnostics:
HbA1c 10.3
AM finger stick 279
INR 2.6
Current medications:
Metoprolol, Janumet,
Lipitor, Lantus, Percocet,
Colace, MVT, Coumadin

19. Mr. S.: Patient Profile
Social history
Occasional cigar
smoker
Used to drink 1-2 beers
after work since the
accident now drinks up
to a 6-pack/night
Recently began refusing
to participate with his
physical therapy
He is receiving physical
therapy and skilled
nursing care in his home
Living conditions
Lives at home with his
wife, no children
Juan TaboHome
Health provides skilled
nursing and PT
Hospital bed with a
regular mattress
Wheelchair with a
pillow in the seat for
padding
Rolling walker

20. Mr. S.: Wound Assessment
L heel ulcer:
1 month old
3.2 cm x 2.7 cm x 0.5 cm
100% necrotic tissue
Black eschar and yellow
slough
Periwound scarring
Minimal serosanguinous
drainage
Dry dressing applied daily
BIL LE pitting edema
Pulses
BIL DP/PT non-palpable, R
DP/PT biphasic, L DP
monophasic, PT inaudible

21. Mr. S.: Wound Assessment
Coccyx:
5 days old
2.5 cm x 1.2 cm x 0.1
cm intact serum
filled blister cluster
No drainage
Periwound 6.3 cm x
10.7 cm x 0.1
nonblanchable pink,
intact skin
Zinc oxide daily and
as needed

22. References
American Nurses Association. (2001). Code of ethics for nurses with
interpretive statements. Retrieved from
http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofE
thicsforNurses/Code-of-Ethics.pdf
Institute of Medicine. (1999). To err is human: Building a safer health system.
Retrieved from https://www.iom.edu/~/media/Files/Report%20Files/1999/To-
Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf
The Joint Commission. (2012). Transitions of care: The need for a more
effective approach to continuing patient care. Retrieved from
http://www.jointcommission.org/assets/1/18/hot_topics_transitions_of_care.pd
f
Kaiser Permanente. (n.d.). Guidelines for communicating with physicians using
the SBAR process. Retrieved from
file:///C:/Documents%20and%20Settings/oreezi/My%20Documents/Download
s/SBAR%20Guidelines%20Kaiser%20Permanente%20(2).pdf
Narayan, M.C. (2013). Using SBAR communications in efforts to prevent
patient rehospitalizations. Home Healthcare Nurse,31(9), 504-515 doi:
10.1097/NHH.0b013e3182a87711