User:Rs13cs/SBAR

This will be a copy of the article for editing and practice, then the group will move the edits to the actual article.

'''To our peer editors giving feedback on our article, we have edited the entire article, so we didn't want to bold the entire thing as we thought that would look a little strange. Thank you for taking the time to give us feedback, if you want to write the feedback out on the actual article's talk page you are more than welcome to, as the SBAR talk page is quite quiet.''' Vr13zk (talk) 15:36, 7 November 2014 (UTC)

SBAR, an acronym that stands for: Situation, Background, Assessment, Recommendation, is a technique used for prompt and appropriate communication in the health care organizations. This communication model has become the standard for communicating across medical based professions such as nursing. It is a way for health care professionals to communicate effectively with one another, and also allows for important information to be transferred accurately. The format of SBAR allows for short, organized and predictable flow of information between professionals, improving communication skills. This form of communication has established its effectiveness at improving patient’s outcomes, enhancing the satisfaction of patients and clients and helping to stabilize and regulate healthcare costs; it has also been recognized for assisting home healthcare professionals with efforts to prevent hospitalizations when avoidable.

History
SBAR was first developed by the military specifically the nuclear submarine industry, then the aviation industry adopted a similar model before it was put into use in health care where it was first implemented to the rapid response teams(RRT) .It was adopted by Michael Leonard, Doug Bonacum, and Suzanne Graham of Kaiser Permanente in Colorado in 2002, to investigate patient safety. The main purpose was to alleviate communication problems traced from the differences in communication styles between healthcare professionals such as the detailed approach by nurses and the brief approach by physicians. SBAR communication was later adopted by many other health care organizations and it continued to demonstrate participation and teamwork between health care professionals and strengthen relationships with patients and their families.

Situation
Determine what is going on and why are health care professionals needed? One has to become familiar with oneself, surroundings and the patient. Identify the problem and concern and provide a brief description of it. Be able to describe what is going on with the patient and why they are experiencing what is going on. During this stage of the communication, one should be able to communicate what is happening. This element should last no more than 10 seconds

Note

Identify the person to whom you are speaking

Identify yourself, occupation and where you are calling from

Identify the patient by name, age, sex, reason for admission

Identify what is going on with the patient (Chest pain, nausea, etc...)

Background
One should be able to identify and provide the diagnosis or reason for the patient’s admission, their medical status, and history. One should also determine the background or context of the patient's visit. During this stage one should have the patients chart ready and provide as much important medical based information required for the set up of the assessment data.

Note:

Give the patient's presenting complaint

Give the patient's relevant past medical history

Brief summary of background

Assessment
Survey the situation to determine the most appropriate course of action. One must be able to provide information on medical based aspects of the patient such as vital signs, recent labs and other quantitative or qualitative data that might be available. Determine whether or not a diagnosis at the time is appropriate. If it is appropriate, provide a temporary diagnosis, and if it is not, shows signs of empathy and concern. Remember to try to avoid impertinent information unless asked.

Note:

Vital signs: heart rate, respiratory rate, blood pressure, temperature, oxygen saturation, pain scale, level of consciousness

List if any vital signs that are outside of parameters

What is your clinical impression

Severity of patient, additional concern

Recommendation
One must give very precise and descriptive explanations on exactly what you need during that time frame. Make sure to offer possible solutions that could correct correct the situation at hand to other health care providers. Notably, suggesting ideas to physicians are a weak point of nurses.

Note:

Explanation of what you require, how urgent and when action needs to be taken

Make suggestions of what action is to be taken

Clarify what action you expect to be taken

Preparation is an integral part of SBAR and as such one must be ready for any question the physician may ask. Review the patient's medical record and read the notes. Discussion with another colleague may help. Be sure to have the patient's medical record, medication administration record, and patient flow sheet before calling a physician. Be ready with any other useful information such as lab results if pertinent.

Example of SBAR Communiction in a Clinical Setting
This is a direct example that shows how SBAR communication is used in a hospital setting involving communication between two nurses to effectively assess and diagnose the patient and correct the problem. This example is between an preoperative nurse to operating room nurse.

Situation: "Mary, I'm going to be sending Mrs. Porter over to you in a few minutes for repair of her fractured ankle. I want you to know what's going on with her. I'm concerned about her emotional status. I've also alerted Dr Anesthesia and Dr Surgeon about my concern, but they have agreed to go ahead with the surgery because she needs this procedure to salvage her foot."

Background: "She was in an auto accident last Friday, and her husband was killed. Her children are all at the j funeral home making arrangements for his burial. She's made some comments about not wanting to live. Her vital signs are stable; the foot is cool and slightly mottled. We've just given her some Versed."

Assessment: "I think her emotional status is such that this will be a very difficult period of time for her, especially during induction and awakening from anesthesia."

Recommendation: "I suggest that you meet her as soon as possible and j stay with her during induction and emergence from anesthesia."

Effects of SBAR use
Using the SBAR communication model provides for more effective and enhanced family and patient outcomes on pediatric units. Using SBAR when producing beside reports increases patient and family satisfaction and also increases their level of comfort when dealing with outlying situations. SBAR also allows nurses to be more effective when giving reports outside of the patients room. SBAR is a model used in communication that standardizes information to be given and lessons on communication variability, making report concise, objective and relevant.

Another benefit of using SBAR is that it allows patients to have the time to ask any questions that they might have, and allows patients to gain exact knowledge of information related to their plan of care. SBAR allows patients to be fully aware of whom their nurse is on every shift and this adds to the patients sense of comfort knowing that there will always be someone around looking after them during shift change.

SBAR use has not only improved the relationship between the doctors and the nurses but had a dramatic increase of overall health of patients and decrease hospitalizations and deaths efficiently improved the nurse and doctor communication which led to a reduction of unexpected deaths. The problem between the communication between nurses and doctors is that the levels of teamwork and interaction are different therefore causing ineffective communication. Nurses communicate using a timeline descriptive communication method whereas physicians just use bullet points. Nurses also feel uncomfortable communicating with a doctor because they feel as if I it won't make a "difference and if they say something wrong they will only get insulted . Well, SBAR has completely changed communication between these two health care providers.

Limitations
Some disadvantages to using SBAR communication are:


 * Physicians are unfamiliar with the concept of SBAR. Since SBAR is based upon cooperation, physicians are required to be open-minded if SBAR is to work effectively


 * SBAR is a difficult concept to learn and practice and as such requires thorough education about the subject matter complete with necessary follow-up. A supportive environment, role-playing, and a skills assessment may help with the process.


 * Further emphasis must also be given on recommendation since it has been seen the the R in SBAR has been the weak point of nurses. Giving advice to physicians on what to do is found to be intimidating for some nurses.


 * A disadvantage to using the SBAR communication model within bedside reporting can be the issue of having to wake up patients and families when the practice of bedside charting occurs. Health care professionals and units must find an alternative way to deal with the patients and their families decisions if they chose not to be awakened and involved in bedside charting.


 * Another disadvantage to using SBAR when bedside charting is the issue of disclosing sensitive topics or new information that has not been shared with the patient and/or family before or after the bedside charting takes place. An alternative to this can be for nurses to makes plans to share new or sensitive information before or after bedside report.


 * Using SBAR communication when bedside charting causes a disadvantage for itself through the sharing of confidential information with the patient where it could be over heard by other patients. The effective communication that SBAR promotes leaves room for confidential information to be disclosed when nurses and doctors have discussions with patients causing patients and their families having negative opinion about participating in beside charting, ultimately interfering with the use of the SBAR communication model.