SBAR Technique for communication

Scenarios:

Scenario 1

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CHOOSE ONE OF THESE SCENARIOS AND WRITE AN SBAR FOR IT.

Scenario 1:

Mr. O is 63 years old. He was dizzy and light-headed at home and almost fell. His wife brought him by car to the ER. Mr. O was admitted to AMU with syncope. This is not his first time being admitted to the hospital. He has been treated in the past for congestive heart failure and acute myocardial infarction. He feels like he is pretty healthy as he only takes NSAIDs at home for chronic back pain.

Mr. O got to AMU at 1600. His nurse is Jenny, RN. Jenny, RN assessed him and found his blood pressure 138/84, pulse 76 and regular, and his respiratory rate 16. He is afebrile at 98.6. Mr. O’s labs were normal, but his IV infiltrated during transport. Jenny, RN started a new IV and put a warm compress on the old site. Jenny, RN reported off to Ben, RN at 1900.

At 2130, the PCA found Ben, RN and told him that he had just helped get Mr. O. off the bedpan. Mr. O had a large, black tarry stool and was complaining of not feeling well. Ben, RN went into assess Mr. O. His vital signs were; blood pressure 94/66, pulse 114, and respiratory rate 24. His pulse ox was 97%. He was pale and his skin was clammy.

Ben, RN asked him how he was feeling. Mr. O said he just didn’t feel well and could not get comfortable. He asked if he could have something for his belly. “It is really hurting!” Ben, RN assessed his abdomen and found that it was distended and Mr. O had diffuse abdominal pain. He rated his pain a 6 on a scale of 1-10.

Scenario 2

Mrs. S is a 72 year old retired school teacher. She lives alone with her dog Ginger and is very independent. She was shoveling snow on Monday morning after the big storm. While shoveling she developed a crushing sensation in her chest. This is not the first time she has had chest pain. Mrs. S has a history of angina, though she has never had a heart attack. She takes an aspirin every day at home and keeps nitroglycerin tabs in her pocket “just in case”. Mrs. S took a nitroglycerin tab and an aspirin and drove herself to the hospital. Mrs. S was admitted to the hospital on Monday afternoon with chest pain, rule out myocardial infarction.

She has been a patient on cardiology for 4 days now. She has had no chest pain since Monday and has been ruled out for a heart attack. She has a IV of .9NS at keep open and expects to go home in the morning. At 2200, Mrs. S put her call light on. Her nurse Sue, RN, answered the call light. Mrs. S stated that she was having chest pain and rated it a 9/10 on the pain scale. Sue, RN, had the PCA check her vitals and get an EKG. Sue, RN, went to get her a nitroglycerin tab. Mrs. S blood pressure was 90/52. Her EKG shows ST changes. Her HR was 120. Her breathing was labored at 36 and her pulse ox was 85% on room air. Sue gave Mrs. S a nitroglycerin tab sublingually. There was no relief to her chest pain and her blood pressure decreased to 80/52. Sue, RN, placed Mrs. S on oxygen at 2L and her pulse ox improved to 91%. Mrs. S is very anxious and states she feels terrible.

Sue, RN, increased her IV fluids to 100cc/hr and called the physician.

Scenario 3

Margie Colby, a 25-year-old primipara, is in the recovery room after a low forceps delivery of a nine pound, two ounce, term male. Although this was an unplanned pregnancy, Margie and her husband adjusted to the idea, and are now very excited parents. Margie plans to breast feed the baby.

Forty-five minutes after delivery, Margie’s vital signs are BP 100/60, pulse 88 and respirations 16. Her fundus is firm and is at level of umbilicus, no clots observed. She has continuous trickle of bright red lochia. No change in perineal edema, ice pack applied and peripads changed. Peripads and chux weight indicate 300cc of blood loss.

Fifteen minutes later the fundus is massaged and remains firm at umbilical level and midline. A constant trickle of bright red lochia persists with no clots expressed. Peripads and Chux weighed showing and additional 200 cc blood loss. Vital signs are now BP 90/52, pulse 110 and respirations 20.

SBAR Tool: Situation-Background-Assessment-Recommendat

​​Institute for Healthcare Improvement
Cambridge, Massachusetts, USA

The SBAR (Situation-Background-Assessment-Recommendation) technique provides a framework for communication between members of the health care team about a patient’s condition.

S = Situation (a concise statement of the problem)
B = Background (pertinent and brief information related to the situation)
A = Assessment (analysis and considerations of options — what you found/think)
R = Recommendation (action requested/recommended — what you want)

SBAR is an easy-to-remember, concrete mechanism useful for framing any conversation, especially critical ones, requiring a clinician’s immediate attention and action. It allows for an easy and focused way to set expectations for what will be communicated and how between members of the team, which is essential for developing teamwork and fostering a culture of patient safety
(Links to an external site.)
.

Background
Michael Leonard, MD, Physician Leader for Patient Safety, along with colleagues Doug Bonacum and Suzanne Graham at Kaiser Permanente of Colorado (Evergreen, Colorado, USA) developed this technique. The SBAR technique has been implemented widely at health systems such as Kaiser Permanente.

Directions
This tool has two components:

SBAR Guidelines (“Guidelines for Communicating with Physicians Using the SBAR Process”): Explains in detail how to implement the SBAR technique
SBAR Worksheet (“SBAR report to physician about a critical situation”): A worksheet/script that a provider can use to organize information in preparation for communicating with a physician about a critically ill patient
Both the worksheet and the guidelines use the physician team member as the example; however, they can be adapted for use with all other health professionals.
DOCUMENTS
SBAR Tool: Situation-Background-Assessment-Recommendation
(Links to an external site.)
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