SBAR (Situation-Background-Assessment-Recommendation) is a technique that is used to provide a communication framework for the healthcare team about the condition of a patient. Situation represents the reported problem to the physician, background is the patients brief history which can help in identification of the cause of the problem, assessment is the observation of the nurse which may include vital signs and symptoms while recommendation encompasses the care plan suggestion or nurse's request of the physician (Payne, 2011, 89). It allows an easy and a more focused way where the health care team set expectations on what will be communicated between the team which is essential for the safety of a patient. The purpose of the SBAR tool is for communication improvement. This tool is used by health care facilities and hospitals as an effective way to standardize communication between health care providers. It enables members of a team to set expectations in an easy and focused way which will be communicated between them which will help them foster a patient's safety culture and develop team work.
The SBAR framework enables the cutting through of extra information where it assists in transferring information between staff members in a way that portrays what is happening (Payne, 2011, 89). It has played a significant role in achievement of timely escalation care in patients with deteriorating conditions. The SBAR tool can be used at different stages of the patient's journey to shape communication from consultant to consultant referrals, GPs referral letter to discharge communication back to the GP. The tool can also be used in a clinical setting where the staff can use it to make recommendation with clear reason for communication (Payne, 2011, 89)
End of shift handoff report using the SBAR tool
Mr. O is a 62 year old male patient with cellulitis of the right leg. He spent most of his time on the bed placed in a fowler position due to pressure from his chest. His skin turned cool and cummy with difficulties in breathing where I assessed his vital signs and noted down. During my shift at 1200 hrs Mr. O received a BM test after which I placed him on the bed. I also changed his saline locks today.
"I am not used to being in bed so much"
Vital signs-T 37, P 92, R 32, BP 170/100
Pain level 2 (feeling pressure at his chest)
Pulse oximetry 98%
Fingerstick blood sugar at 1200=6.1
Change saline locks
Leg dressing is dry, clean and intact
02 at 31/min np PRN
leg placed in high fowler position
Fingerstick BG QAM at 1200
Irregular radial pulse 110
Glyburide 10 mg PO QAM
Verapamil SR 240 mg PO BID
Propranolol 20 mg PO BID
ASA 81 mg PO QAM
Colace 100 mg PO QAM
Vancomycin 500 mg IVPB Q6H
Nitro SL 0.4 mg Q5min 3 PRM chest pain
The major issues in the case scenario are that the patient Mr. O who is a 62 year old male is suffering from cellullitis. During the first shift at the hospital the nurse attending to Mr. O used the SBAR tool to write a handoff to the oncoming nurse on the current condition of Mr. O and the medication that was administered to him during her shift. Some information is missing from the case scenario that has been provided which is the radial pulse of Mr. O. The radial pulse of Mr. O is irregular and is vital information that needs to be provided for appropriate medical measures to be taken. As the nurse taking care of Mr. O I decided to include the information on the specific section of the SBAR so that the oncoming nurse may be able to have an informative handoff which has captured all aspects of the patient's condition. I recommend Mr. O blood pressure to be checked as his condition seems to deteriorate due to an increase in the BP. He is experiencing short breaths and pain on his chest which also needs to be looked at.
How do leadership and communication influence the handoff report/SBAR?
Handoffs involve the essential information transfer when there is a responsibility shift from one health care provider to another. There should be an efficient transition of critical information when done effectively in patients care continuity. The type of information, complexity, communication method and the health care provider's in charge of a patient influence the efficiency of the handoff and safety of the patient (Garber, Gross & Slonim, 2010, 72). Communication breakdown is the major cause of medical errors and without efficient communication the safety of the patient is at great risk. A good communication skill enables a medical care provider to be able to pass vital information to another medical care provider with regards to a patient's condition. All health care providers should practice communication skills that will equip them with the knowledge of writing an informative SBAR and handoff report about a patient.
Most standardized handoffs involve face-to -face communication, written and verbal communication and enough time to ensure accuracy (with both parties present). Due to this, the involved party needs to have good communication skills to ensure accuracy of information and safety of the patient (Garber, Gross & Slonim, 2010, 72). Leadership is also vital in handoffs and SBAR report. These reports needs to be accurate and delivered in time to the oncoming nurse or health care provider. Leadership ensures that the reports are prepared on time and delivered to the right recipient. It also ensures that the handoff reports are accurate and promote patients safety by reducing risks, preventing errors and also coordinating multiple patients care aspect (Linton, 2016, 54).
Garber, J. S., Gross, M., & Slonim, A. D. (2010). Avoiding common nursing errors.Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Linton, A. D. (2016). Introduction to medical-surgical nursing.
Payne, L. (2011). Nursing student's guide to clinical success. Sudbury, Mass: Jones and BartlettPublishers.
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