This document provides information on SBAR, a standardized communication tool used in healthcare. SBAR stands for Situation, Background, Assessment, and Recommendation. It structures patient information to improve safety, communication, and collaboration during care transitions. The document explains each component of SBAR and gives examples of how to use it. It also discusses barriers to effective communication and how SBAR addresses these issues.
This presentation describes the use of the SBAR tool. This SBAR tool was developed by Kaiser Permanente. Please feel free to sue and reproduce these materials in the spirit of patient safely, and please retain this footer in the spirit of appropriate recognition.
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This presentation describes the use of the SBAR tool. This SBAR tool was developed by Kaiser Permanente. Please feel free to sue and reproduce these materials in the spirit of patient safely, and please retain this footer in the spirit of appropriate recognition.
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more at http://www.nhsiq.nhs.uk/improvement-programmes/patient-safety.aspx
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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
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 pertinent history?
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 3rd 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 periorbital region
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
serosanguinous drainage
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
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 Tabo Home
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
