SBAR

Communication Model


Situation, Background, Assessment,

and Recommendation
 
Objectives

 Familiarize what SBAR stands for.

 Establish reasononing why SBAR is
important to use.
 Describe how SBAR affects patient
safety.
 Describe the difference between
assertiveness and aggressiveness.
 Verbalize appropriate responses in
practice scenarios.
 
SBAR

Ineffective communication poses a significant

threat to the safety of hospitalized patients.
SBAR is a useful and effective communication tool
that allows healthcare professionals to share
concise but important information in a short
amount of time.
 Michael Leonard, physician leader for patient safety at
Kaiser Permanente introduced SBAR that was modified
for use in health care from the method used in the
aviation industry to reduce communication errors among
crew members

Nurses are often taught to

report in a narrative
form. Physicians are
taught to communicate
using brief “bullet
points” that provide key
information.
SBAR – why it is important to use


According to the Joint Commission, communication issues

are the leading cause of sentinel events in hospitals.
Improving the exchange of information between nurses and
physicians have been cited as a key element to preventing
medical errors and promoting a safe environment.
(Manning, 2006)
Miscommunication leads to patient safety issues.
(HCPro, 2004)
 
SBAR Communication Model

Easy to remember tool that provides a

structured, orderly approach to
improve effective communication of
accurate, relevant information. The
goal is to deliver your message in 1 to
1 ½ minutes.
Helps limit the jargon, keeps the
message clear, and removes the
influence of hierarchy and personality.
 SBAR broken down…


SITUATION: State what is happening at the present time that

has warranted the SBAR communication. (State your name &
unit, what patient you are calling about, & what the problem is)

Example:
Hello Dr. ______, this is ________, from ____unit. I am calling about __(pt
name & room #)___. The patient’s code status is ____. I have just
assessed the patient myself. I am concerned about ________________.
(Examples can be BP over or under parameters, pulse over 140 or less
than 50, respirations less than 5 or over 40, elevated temp or many other
situations). Note: These are examples, your hospital or physician may
have established parameters to call about.
 SBAR broken down cont’d…


BACKGROUND: Explain circumstances leading up to

this situation. (State admission diagnosis, date of
admission, brief pertinent medical history, and
treatment to date)

Example:
The patient’s mental status is ______, vital signs are
_________, skin is _____, O2 is (not on) or on at ___,
oximeter reading is at ___, the patient complains of
_______.
 SBAR broken down, cont’d….


ASSESSMENT: Indicate what you think the problem is (Provide

last vital signs, oxygen if being used, & any changes from prior
assessment: vital signs, heart rhythm, pain, wound drainage,
neuro changes, etc.

Example:
I believe the problem is: (state what you believe the problem is,
i.e. cardiac, infection, neurologic, respiratory, other).
OR: I don’t know what the problem is but the patient is
deteriorating.
OR: The patient seems to be unstable.
 SBAR broken down cont’d….


RECOMMENDATION: Express what you believe the patient

needs or what order specifically you want i.e. give fluids, order
labs, x-ray, have the physician come see the patient, transfer the
patient to ICU, ask for a consulting physician to see the patient,
etc.
Example:
I suggest/request/recommend that you __________ (see
immediately, transfer the patient to ICU, ask the
hospitalist/resident to see the patient now, talk to family about
code status, etc.
OR: Suggest tests/interventions that would be needed (Chest x-
ray, ABG’s, EKG, CBC, BMP, give additional fluids, pain meds,
etc.) If no improvement, when should we call again?
 Sample

of SBAR worksheet to use to
organize your thoughts
There are several examples of
SBAR worksheets that you can
find on-line that are designed for
calling a physician, and others for
use with change of shift report.
Some are even specialty specific
such as for OB, NICU, ICU, and
others.

Also recommend viewing some of

the SBAR videos found on
Youtube for both good and bad
examples of SBAR in use as
another learning tool for you.
 Practice

example of making a
recommendation: The “R” in
SBAR: Which is better?

A. The nurse picks up B. The nurse says “I

the chart & notices noticed that Mrs.
that the physician did Smith’s hct was 26
not order labs despite yesterday, what about
a low hematocrit. The repeating the
nurse says “excuse hematcrit?”
me, did you want to
order labs today?”

B is better

 The “A” response is not specific enough leaving

some guesswork into what to order and perhaps
delaying the right intervention/s or not getting it at
all.

 “B” offers a specific request eliminating a missed

intervention. This could also be framed as “what do
you think about repeating the HCT?”
 Practicing the “R” in SBAR,


Which is being a better?
A. “I noticed that this is
the 3rd day that the foley
catheter has been in
place & believe the
patient no longer meets
any of the criteria to leave
it in. Are you in agreement
to remove it?
cont’d
B. The nurse doesn’t
mention to the physician
or mid-level that it is the
3rd that the foley catheter
has been in and is hoping
that they will remember to
write an order to take it
out.


A is better…

“A” is not only bringing something to the

physician/mid-level’s attention but also makes the
recommendation or suggestion to remove in order to
avoid a potential UTI
 
Effective, Assertive Communication:
Good or Bad?

“I’m sorry to bother you but………..”

OR
Avoiding unpleasant doctors that are difficult to
communicate with.

Answer: Both are bad: apologizing for bringing forward relevant

information regarding a patient condition portrays a lack of confidence
and sets the tone for the conversation. And while tough at times, you
cannot avoid a necessary conversation regarding a patient because a
physician is unpleasant.

Importance of Effective
Communication
Nurses are the front-line care givers
responsible for notifying physicians
of patient care issues, acting as the
patient advocate, & protecting the
patient from further harm, yet
current nurse-physician
relationships & cultures often do not
empower nurses to communicate
effectively with physicians.
 Ways to Improve Communication

 Work at developing relationships with

a personal connection, ask about
their weekend, family, etc.
 Don’t be afraid to use humor in your
communications as you develop
relationships based on mutual
respect
 Be prepared with all relevant
information before making the call or
starting the conversation
 And, most importantly, utilize a
succinct communication model such
as SBAR when providing patient
information
 Improving Communication, cont’d


 Assume that you and the physician are on the same team
& that you have the same broad goals for the patient.
 Stressing again to be ready with patient data before you
call or communicate with the physician.
 Communicate clearly your title & your relationship with
the patient, example primary nurse, wound care nurse,
etc.
 Connecting on a human level can be a powerful catalyst.
 Utilize appropriate assertiveness (not aggressive) as you
advocate for your patient.

Characteristics of an Assertive
Nurse (versus aggressive)

 Appears self-confident & composed

 Maintains eye contact
 Uses clear, concise speech
 Speaks firmly & positively
 Is non-apologetic
 Takes initiative to guide situations
 Gives the same message verbally &
nonverbally
 Speaks genuinely, without sarcasm

(Communication in Nursing, 2004)

Dealing with Difficult Physicians or
Other Healthcare team members

 Connecting on a human level can be

a powerful catalyst.
 Do not be afraid to express what
you think and believe about this
patient.
 Have a memorized response to fall
back on so you can respond when
caught off guard by an inappropriate
comment or behavior.
Examples of a response to have prepared in
your mind when caught off guard by rude
behavior

 “I am almost through, and would like to finish my thought.”

 “Please don’t yell at me, I am here to do what is best for the

patient.”
 “You are being rude and inappropriate, it is not helping us take
care of the patient.”

Take 5 minutes right now and come up with a comment that you
can memorize and have available

Dealing with difficult physicians &
others on the healthcare team

Remember:

Nobody benefits if the nurse doesn’t assert

themselves under certain conditions.

This does get easier with practice and being prepared!

 
Summary
 Use of SBAR to organize the exchange of information has
demonstrated effectiveness in reducing communication errors
(Beyea, 2004)
 Promoting nurses’ confident use of SBAR has great potential
to decrease miscommunication and increase patient safety
 Nurses may experience discomfort using SBAR because it
moves beyond the traditional approaches of merely reporting
information into newer territory of joint decision making which
includes providing opinions and making recommendations

Summary, cont’d

 Commit to practicing using the SBAR model until it

becomes your normal routine

 Role playing in the context of communicating with a

difficult physician (and using your memorized
statement) may also be helpful to improving your
ability to communicate effectively
 Conclusion

STAND IN AWE OF WHAT YOU DO AND

RECOGNIZE YOUR TREMENDOUS VALUE
 
References
Beyea, S.C. (2004). Improving verbal communication in clinical care.
AORN Journal, 79(5), 1053-1057.

HCPro, (2004). Get in gear. Six road-tested ways to communicate

critical test results. Briefings on Patient Safety, 5(11), 2-6.

Manning, M.L. (2006). Improving clinical communication through

structured conversation. Nursing Economics, 24(5), 268-271.

Raica, D.A. (2009). Effect of action-oriented communication training on

nurses’ communication self-efficacy. MedSurg Nursing, 18(6), 343-
356, 360.