Sbarr communication tool

The SBARR communication in nursing

1. The SBARR
Communication Tool
“Situation, Background, Assessment, Recommendation
Response”

2. Communication Challenges
Hand-off communication is a high-risk process.
Communication failures commonly cause accidental
patient harm.
60 -70% of the more than 2,455 sentinel events
reported to JCAHO revealed that communication failure
was the primary root cause--approximately 75% of
these patients died.
Many hospitals have had critical incidents related to
communication issues.

3. SBARR: What is it?
Situational briefing model that provides a
common, predictable structure to communication
Originally used in U.S. military and aviation
industry
Adapted for use in healthcare by Kaiser
Permanente in 2002
Can be used in virtually any clinical setting
It is better when compared with CUS Model

4. Aviation – United Airlines
We have a serious problem. Stop and listen
to me!
C = I am Concerned
(with my patient’s condition).
U = I am Uncomfortable
(with my patient’s condition).
S = The Safety (of the patient) is at risk
CUS Model

5. SBARR: The basics
1.Situation: The problem
 What is going on with the patient?
1.Background: Brief, related, to the point
 What is the clinical background or context?
1.Assessment: What you found/think
 What do I think the problem is?
1.Recommendation: What you want
 What would I do to correct it?
5.Response: Receiver acknowledges information given
 What is the receivers response?

6. Overview of SBARR
“Situation, Background, Assessment, Recommendation Response”
Benefits of SBARR
Practical application of SBARR

7. Barriers to effective communication
Culture/Priorities
Physicians vs. nurses
Gender, cultural differences
Complex, hierarchical systems
Fear/threats
Inhibits feeling safe to speak up
Not everyone has the ability to speak up
Environment
Human factors/limitations
Interruptions and distractions contribute to the nurses’ ability
to remember pertinent information.
Time
No structured procedures

8. Assertion
Speak up and state your information with appropriate persistence until
there is a clear resolution
What is it?
Organized in thought
and communication
Valued by the entire
team
Looking for clarification
& common
understanding
What is it not?
•Aggressive or hostile
•Ridiculing
•Confrontational
•Ambiguous

9. Assertion Cycle. This is a model to guide and improve
assertion in the interest of patient safety
GET PERSON’S
ATTENTION
EXPRESS
CONCERN
REACH
DECISION
STATE
PROBLEM
PROPOSE
ACTION
Source: M. Leonard, S Graham, D Bonacum

10. Effective Communication
Complete
Accurate
Unambiguous
Timely
Understood
Dialogue

11. Essential communication elements
Being organized – in thought and communication
Being Competent
Owned by the Entire Team – this is not just a
“subordinate” skill-set
Valued by the receiver

12. Benefits of SBARR
Teamwork :
Framework for effective communication
Creation of a safe environment
Framing a conversation, especially emergent ones
Expectations
Consistency, familiarity
Critical Thinking Skills
Sharing of relevant, timely, concise, organized,
efficient information
Patient Safety
Reduces the risk of adverse events
Fosters a culture of patient safety

13. Benefits of SBARR
Important elements:
Assertive communication:
Individuals speak up, state information with persistence
until there is a clear resolution
Helps create a shared understanding of what is happening
Is crucial to patient safety
Critical language:
Avoids natural tendency to speak indirectly and
deferentially
Situational awareness:
Staff maintaining the big picture
Ongoing dialogue—planning/thinking ahead
Recognizing adverse events
Common understanding of task

14. SBAR Guidelines
1.Have all the patient’s information
available before you contact the
physician.
Name
Age
Diagnosis
Medication list
Allergies
Vital signs
Lab results

15. SBAR Guidelines (cont.)
2. A physical assessment has been
conducted
Have I seen and assessed the patient
myself before calling?
Review the chart for appropriate physician
to call.

16. SBAR Guidelines (cont.)
3. When calling the physician, follow
the SBARR process:
(S) Situation: What is the situation
you are calling about?
Identify self, ward or unit, patient, patient
location.
What is going on with the patient. A
concise statement of the problem.

17. SBAR Guidelines (cont.)
(B) Background: What is the clinical
background information that is pertinent to
the situation.
The admitting diagnosis and date of
admission.
List of current medications, allergies, IV
fluids, etc.
Most recent vital signs.
Lab results: provide the date and time test
was done and results of previous tests for
comparison.

18. SBAR Guidelines (cont.)
(A)Assessment:
What are the
nurse’s findings?
What is the
analysis and
consideration of
options?
Is this problem
severe or life
threatening?

19. SBAR Guidelines (cont.)
(R) Recommendation :
What action/recommendation is needed to
correct the problem?
What solution can you offer the physician?
What do you need from the physician to
improve the patient’s condition?

20. SBAR Guidelines (cont.)
(R) Response:
What is the physician's feedback?

21. SBARR Example
Situation: What is going on with the patient?
Dr. Ali, I’m calling about Yousef, a 15 year old-patient
who was admitted for a closed head injury after having
fallen off a ladder yesterday. He has developed new
onset confusion and restlessness.
Background: What is the clinical background or
context?
Yousef was alert and oriented overnight. His pupils were
equal and briskly reactive. His GCS was 14 and now it is
10.
Assessment: What do I think the problem is?
I am concerned that he may have a decreasing level of
consciousness.

22. SBARR Example (continued)
Recommendation:
What would I do to address it?
I would like you to come and assess this patient
in person
Response:
What is the receiver’s feedback?
Thanks, this sounds like a significant change. He
may have edema or bleeding. Please do a set of
vital signs and I will be down to see him right
away.

23. SBAR Example 2
S –Mr. M has sudden onset of radiating chest pain &
shortness of breath
B – He has a history of MI’s, & his vitals are 186/76, 180,
24 & he is on 5L of O2 per nasal cannula sats 84%
A – I think Mr. M might be having an MI
R – I need you to come evaluate the
patient, how soon will you be here?
R – I am coming, please ask for 12 leads ECG

24. Conclusion
SBARR can help health care provider improve
their communication so that safe, quality
patient care is delivered.
Using SBARR requires practice, teamwork,
and commitment from all health care
provider.
Initial focus/expectation is to use SBARR for
CUS (concerned, uncomfortable, safety)
situations.

25. Questions?