Ineffective SBAR

Communication

Effective SBAR Co
mmunication

SBAR Communicat
ion

What is SBAR and What is SBAR Communication?

A Communication Technique for Today's Healthcare
Professional

Situation Background Assessment Recommendation

(SBAR) is a standardized way of communicating. It
promotes patient safety because it helps individuals
communicate with each other with a shared set of
expectations. Staff and physicians can use SBAR to
share patient information in a concise and structured
format. It improves efficiency and accuracy. SBAR
stands for:
Situation
Background
Assessment
Recommendation

 Originally developed by the US Navy as a

communication technique that could be
used on nuclear submarines, Safer
Healthcare introduced SBAR into
healthcare settings in the late 1990s as
part of its Crew Resource Management
training curriculum. Since that time,
SBAR has been adopted by hospitals and
care facilities around the world as a
simple but effective way to standardize
communication between care givers.

Using SBAR, patient reports are more

accurate, efficient, and consistent
enterprise-wide. This simple, yet
highly effective communication
technique can be used when:
A nurse is calling a physician
Nurses are handing off patients to one
another
Nurses are transferring patients to other
facilities or to other levels of care

Recommended uses and settings for SBAR:

Inpatient or outpatient
Urgent or non urgent communications
Conversations with a physician, either in person or
over the phone
- Particularly useful in nurse to doctor
communications
- Also helpful in doctor to doctor
consultation
-Discussions with allied health professionals
Respiratory therapy

PhysiotherapyConversations with peers
- Change of shift reportEscalating a concern

Situation:
Identify yourself the site/unit you are calling from
Identify the patient by name and the reason for your report
Describe your concern
Firstly, describe the specific situation about which you are
calling, including the patient's name, consultant, patient
location, code status, and vital signs. An example of a script
would be:
"This is Lou, a registered nurse on Nightingale Ward. The
reason I'm calling is that Mrs Taylor in room 225 has become
suddenly short of breath, her oxygen saturation has dropped
to 88 per centon room air, her respiration rate is 24 per
minute, her heart rate is 110 and her blood pressure is 85/50.
We have placed her on 6 litres of oxygen and her saturation is
93 per cent, her work of breathing is increased, she is anxious,
her breath sounds are clear throughout and her respiratory
rate remains greater than 20. She has a full code status."

Background:
Give the patient's reason for admission
Explain significant medical history
You then inform the consultant of the patient's background:
admitting diagnosis, date of admission, prior procedures, current
medications, allergies, pertinent laboratory results and other
relevant diagnostic results. For this, you need to have collected
information from the patient's chart, flow sheets and progress notes.
For example:

"Mrs. Smith is a 69-year-old woman who was admittedten days ago,

following a MVC, with a T 5 burst fracture and a T 6 ASIA B SCI. She
had T 3-T 7 instrumentation and fusionnine days ago, her only
complication was a right haemothorax for which a chest tube was
put in place. The tube was removedfive days ago and her CXR has
shown significant improvement. She has been mobilising with physio
and has been progressing well. Her haemoglobin is 100 gm/L;
otherwise her blood work is within normal limits. She has been on
Enoxaparin for DVT prophylaxis and Oxycodone for pain
management."

A Assessment:
Vital signs
Contraction pattern
Clinical impressions, concerns
You need to think critically when informing the doctor of
yourassessmentof the situation. This means that you
have considered what might be the underlying reason
for your patient's condition. Not only have you reviewed
your findings from your assessment, you have also
consolidated these with other objective indicators, such
as laboratory results.
If you do not have an assessment, you may say:
"I think she may have had a pulmonary embolus.'"
"I'm not sure what the problem is, but I am worried."

R Recommendation:
Explain what you need - be specific about request and
time frame
Make suggestions
Clarify expectations
Finally, what is yourrecommendation? That is, what would
you like to happen by the end of the conversation with the
physician? Any order that is given on the phone needs to
be repeated back to ensure accuracy.
"Would you like me get a stat CXR? and ABGs? Start an
IV?"
"Should I begin organising a spiral CT?"
"When are you going to be able to get here?"
Incorporating SBAR may seem simple, but it takes
considerable training. It can be very difficult to change the
way people communicate, particularly with senior staff.

What is it and how can it help me?

SBAR is an easy to remember mechanism that you can use
to frame conversations, especially critical ones, requiring a
clinician's immediate attention and action.
It enables you to clarify what information should be
communicated between members of the team, and how.
It can also help you to develop teamwork and foster a
culture of patient safety.
The tool consists of standardised prompt questions within
four sections, to ensure that staff are sharing concise and
focused information.
It allows staff to communicate assertively and effectively,
reducing the need for repetition.
The tool helps staff anticipate the information needed by
colleagues and encourages assessment skills. Using SBAR
prompts staff to formulate information with the right level of
detail.

S-B-A-R
SCENARI
OS

SCENE 1
Mr.G is a 40 year old man with history of HPN
Aand substance abuse.He calls you to his room
and tells you he feels like there is a load of
bricks on his chest and he has a pain running
up and down his left arm.You take his vital
sign and find BP 140/80,HR 120,RR 26 ,T 36.5
You are the Nurse calling the
physician.Youworried that the patient might be
having angina pectoris and would like the
physician to see the patient.You feel also feel
that an ECG or lab works must be done or that
the patient must be given some medications.

S-B-A-R
S- Doc,this is Nurse Jane from Station 4.This
is about Mr.G.at room 248.He is
experiencing chest pain with pain radiating
to his left arm.
B- Hes 40 year old,a patient of Dr.
Vivas.With history of HPN and substance
abuse.
A- It seems that he is having a cradiac
episode.Maybe angina or MI?
R-pwede po bang paassess ako ng patient
ASAP? Gusto nyo po ba magpa ECG or Trop
I?How about Isordil po?

SCENE 2
Mrs. S. Is a 79 year old female who came in to
the hospital for dialysis. She has a history of
diabetes,hypertension and chronic kidney
disease.You go into her room at 5pm,and she
tells you she had drank more than 2 liters of
water but still,no urine output was noted.You
notice she has a rapid respiratory rate (RR) of
30 cycles per minute.
You are the nurse calling the physician.You
think that the patient is retaining fluids which
could have affected her breathing.You also feel
that the patient should be hooked to oxygen
and be referred to the physician immediately.

S-B-A-R
S- Doc, about Mrs. S. room 209.RR is 30 per
minute.
B- The patient is still for dialysis .She also
mentioned that she had more than 2 L of
water.But no urine output for the past 12
hours.
A- Im concerned.She might be having
congestion.
R- Can you please see her? Do you want me
to start Oxygen supplementation now?

SBAR Communi
cation Check
list

S-B-A-R

WORKSHOP
30 MINUTES

SCENE 3
MS. LS of room 206, 38 year old female under
the service of Dra. Montano is admitted with
diagnosis of DM Ttype 1
You are taking the afternoon VS and found the
patient somnolent and hard to wake up which is
very unusual because most of the time,she is
very much conscious and talkative. You took the
vital signs which revealed normal results.
You are worried that something is wrong
because the patient has a daily maintenance
dose of insulin and had histories of
hypoglycemia.You feel that a spot check of BGM
must be done and the patient be seen
immediately by the doctor.

S-B-A-R
S- Doc ,regarding Ms.LS room 206.She s
somnolent and Im having a hard time
waking her up.
B- Shes a patient of Dra. Montano.DM type
1. Usually shes concious and very
talkative.She had histories of hypoglycemia
before.
A- Im concerned that she might be
experiencing hypoglycemia.
R- Do you want me to do spot checking of
Capillary Blood Glucose?

SCENE 4
While doing your rounds,you found the newly
admitted geriatric (old-aged) patient of Dr. Reyes
sitting on the floor. When you asked him what
happened ,he told you that he fell when he tried
to go to the bath room and needs assistance
getting up up since according to him weak
knees.You helped him back to his bed and took
his vital signs which revealed normal results. The
patient also has no complaints of pain.
However ,you are worried that he sustained
fractures or any complications from the fall and
needs further evaluation by the physician.

S-B-A-R
S- Doc, regarding Mr. R. Room 208A.He
fell while on his way to the bathroom.
B- Hes the newly admitted geriatric
patient of Dr. Reyes .His VS are normal
and the patient does not complain of
pain.
A- I am just worried he might have
sustained fractures.
R- Can you please assess the patient?
Do you want to order for an Xray?

SCENE 5
You noticed that recently-vacated room 208B
hasnt been cleaned yet by the housekeeper.Youve
paged your usual housekeeper in your ward for 20
minutes already but you have not recieved any
returned call.The Emergency Room (ER) have also
called you 3x already saying that they must
transfer a patient to room 208B in 15 minutes
because there are so many patients waiting in ER.
You are the nurse calling the Housekeeping
section. You feel that the situation is impacting the
ability of your ward to provide services to the
patients. Hence, you think that thy should send in
another housekeeper immediately so that the
room will be ready in 15 minutes.

S-B-A-R
S- This is Teresa from Station 2 and we need room
208B be cleaned for a new admission right away.
B- We have paged our usual housekeeper 3x in the
past 20 minutes,but have not recieved a returned
call.The ER has called 3x,saying they must transfer
this patient because they have many patients
waiting for ER bed.
A- We need this room cleaned right away.The ER will
be transporting the patient to us in 15 minutes. This
situation is impacting our ability to provide the
service and care we all want to provide our patients.
R- Can you please call another housekeeper to step
in and clean this room so it is ready within the next
15 minutes before our patient arrives?

SCENE 6
Mrs. Santos room 208B, is a 30 year old female
under the service of Dr. Ramos. She had serum
Potassium determination that day.Upon checking
the result of serum potassium determination,you
have found that it increased from 2.9 mEq/L to
5.0 mEq/L in a span of 1 day.
You are quite doubtful of this result since you
have learned based on the statement of Mrs.
Santos that the Med.tech extracted blood
specimen on the left arm which has an ongoing
infusion of PNSS with 10meqs of Potassium
Chloride which could have altered the result.
You are the nurse calling the physician.You feel
that a rechecking must be done.

S-B-A-R
S- Im Mazy, nurse of Mrs.Santos of room 208B
Station 2. Her serum Potassium result came out
juat now and Im quite doubtful about it.
B- She was admitted under the service of Dr.
Ramos due to low potassium level.Yesterday ,her
serum potassium is 2.9 mEq/L.Today ,its 5.0.
According to her, the Med.Tech extracted the
blood specimen on her left arm.which incidentally
where a PNSS with Potassium Chloride is infusing.
A- I think this could have altered the result.
R- Would you like for the laboratory department
do a recheck on this by extracting another
specimen?

SBAR Use in Charting

SBAR Charting
Improvements
First Column
Column
-situation
evaluation
-background
-problem list
1.
2.
3.

Second column
-intervention

3 rd
-