INVESTIGATE - SBAR tutorial presentation

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NHS Institute for Innovation and Improvement. © NHS Institute for Innovation and Improvement Safer Care.

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[Audio] SBAR is a structured method for communicating critical information that requires immediate attention and action SBAR improves communication, effective escalation and increased safety Its use is well established in many settings including the military, aviation and some acute medical environments.

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[Audio] SBAR has 4 steps. Situation, Background, Assessment and Recommendation.

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[Audio] There are some fundamental barriers to communication across different disciplines and levels of staff. These include hierarchy, gender, ethnic background and differences in communication styles between disciplines and individuals. Using it helps to prevent breakdowns in verbal and written communication, by creating a shared mental model around all patient handoffs and situations requiring escalation, or critical exchange of information ( handovers) SBAR is an effective mechanism to level the traditional hierarchy between physicians and other care givers by building a common language platform for communicating critical events, thereby reducing barriers to communication between healthcare professionals As a memory prompt, it is easy to remember and encourages prior preparation for communication SBAR reduces the incidence of missed communications that occur through the use of assumptions, hints, vagueness or reticence they may be caused by the authority gradient.

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[Audio] 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 use of SBAR prevents the hit and miss process of 'hinting and hoping'..

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[Audio] SBAR can be used in the majority of situations and is very transferable to all communication interactions between professionals 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 - e.g. Respiratory therapy and Physiotherapy Conversations with peers - e.g. Change of shift report Escalating a concern Handover from an ambulance crew to hospital staff.

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SBAR helps you think about what went well, what would you do differently and what are next steps?.

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[Audio] In terms of situation, Identify yourself the site/ unit you are calling from Identify the patient by name and the reason for your report Describe your concern.

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[Audio] For example. Firstly, describe the specific situation about which you are calling, including the patient's name, consultant, patient location, resuscitation status, and vital signs..

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[Audio] Next, give overview 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..

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NHS Institute for Innovation and Improvement. © NHS Institute for Innovation and Improvement Safer Care.

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[Audio] When you do the assessment, look out for vital signs and recognize clinical impressions and concerns..

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[Audio] You need to think critically when informing the doctor of your assessment of the situation. This means that you have considered what might be the underlying reason for your patient's condition. If you do not have an assessment, you may say: "I'm not sure what the problem is, but I am worried.".

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[Audio] When making the recommendation, Explain what you need - be specific about request and time frame Make suggestions Clarify expectations Finally, express what is your recommendation? 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..

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[Audio] 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..