SBARR information for staff

Hi, I'm Lin Marriott.

Lin Marriott

Lin Marriott

Late 2013 the decision was made to re-promote SBARR, an inter-professional and multi-professional communication tool to promote effective communication within the healthcare environment.
Inadequate and faulty communication has often been identified as the cause of adverse and 'near miss' event in the healthcare environment.
We will move to using SBARR in everyday clinical practice from June 2014 onwards (not just for urgent / escalation situations) across Waikato DHB.  
SBARR communications toolMy role is to help prepare and make the process happen.

This For Staff page provide updates on

Latest update - December 2014

First of all, It is time to say a big THANK YOU to the staff on the working group who worked so hard to ensure we improved our use of the SBARR communication tool across the organisation, in particular:  Helen Rountree, Stacey Brough, Jo Faulkner, Tricia Esselink, Perrin Aish, Gabby Reynolds, Jane Monsma, Sandra Cate, Meegan Farbeh-Tabrezi, Anne Watkins, Katherine Leamy, Mark Reynolds, Stacey Brough, Michelle Galbraith, Moira O’Shea, Bev Carney, Mary-Anne Spence. 

Also a THANK YOU to the staff and services who  are using SBARR in their day-to-day clinical communication.  

SBARR 2014 has been well received because it is practical and fits a whole range of scenarios from handover to team briefs to escalation situations.  It appears to be working really well, our staff have found it to be a useful tool to improve communication and lower risk of miscommunication as both the giver and receiver become familiar with its use and are each on “the same page” . 

It continues to gain momentum across the DHB, and services are using the documents that have been developed too, and there are now examples of areas adapting these to suit their service needs.  For example: Critical Care have recently downsized SBARR  telephone pads to a handy pocket-sized SBARR pad for clinical staff to use to make notes on as they go about their daily work.  

Since my last update SBARR is becoming more and more embedded in the organisation  and it is now part of clinical staff orientation.  We have presented SBARR within and outside our organisation – to Hospice Waikato, the Aged Residential Care sector, have supplied resources to the Red Cross in Wellington, within the DHB  at Allied Health forums, to Mental Health, at Tokoroa and Te Kuiti.  It is now included as part of clinical staff orientation, and just this week our 50 new Registrars were updated about using it on their arrival at the DHB. 

A user survey is planned for late January to get formal feedback from staff on how they are using SBARR so that we can share ideas, identify further opportunities and improvements.

SBARR information, resources and document examples can be accessed here (I have added a few more teaching resources and a new trial form for ward rounds), and a Midland Moodle SBARR training tool can be accessed via Moodle –Midland training resources.

- Lin Marriott

July 2014

 I’ve just got back from a visit to Thames Hospital where I presented to 56 staff, mainly nurses, doctors and HCAs.  The reaction was very positive, and they could immediately see how the tool could be practical and useful in situations such as handover and for post acute ward rounds. 

This visit to Thames was part of the concerted push on training and presentations to get the word out about SBARR. In the past month I’ve presented SBARR to oncology nurses and oncology trials nurse specialists, the senior nurse forum, the surgical clinical directors forum, Nursing and Midwifery Round Table, medical handover meeting, gerontology study day and a neonatal nurse specialist/practitioner study day, Thames Hospital, the paediatric home care team, and the community forensic psychiatry team.

They see the sense of SBARR and immediately come up with specific scenarios where it can improve their communications. 

You can contact me if your area or professional group would like a presentation, or talk to your nurse educator if you want some practical SBARR training.

The uptake of the SBARR resources has been very encouraging, especially the telephone pads which staff are finding a helpful tool. You can order them through the customer portal - Written and Visual Communications Request/Design and Print. 

The hospital transport service (non-urgent that attends and departs via Transit Lounge) have decided they will adopt the SBARR Transfer of Care form instead of their specific one - this is good news as it means one form process for staff.

- Lin Marriott, 4 July

June 2014

We have started short, practical training sessions around wards and departments (thanks to the educators!) and we have done a number of presentations e.g. to Grand Round, nursing forums.

The trial promotion and education resources are now available. Get the details here.  Wards and departments will get an initial supply in resource packs, and then you can order more using your local RC code and the Customer Portal request for Visual and Written Communications/ Design and Print.

- Lin Marriott, June 2014

SBARR's potential - May 2014

We don’t use SBARR to its potential - but we could. Most of us are aware that it is very useful in emergencies, it can be difficult to staff to relate to if only used in these stressful circumstances, lack of confidence means it is not consistently used.

To help make sure SBARR can be used by doctors, nurses and allied health every day, working groups have been developing documents, learning and promotional materials to help meet this aim.

Dr Wayne de Beer (Director, Clinical Training) and I are working on medical staff refresher training too, and the aim is to ultimately align with nursing staff. This all links very strongly with deteriorating patient education and training work.

Wayne De Beer

Wayne De Beer

Most of us know this tool, we just don’t always use it confidently, but we can practice using this framework more, as of NOW: in our day to day work e.g. briefing teams, handovers, ward rounds, patient transfers, incident reports (and emails!) – senior nurses and clinicians need to act as role models - use SBARR now and show your teams by example how it works.

Learning and promotional materials are now available to help support us to use SBARR for multiple communication purposes, and training/short update opportunities arranged on wards and at meetings to increase our confidence in using it.  I will update this section of the page each month to keep you informed. 

- Lin Marriott, May 2014


 

 

Why SBARR?

SBARR is an easy to remember acronym that stands for Situation; Background; Assessment; Recommendation and Response.

S - Situation (the situation at the present time, a succinct overview)Clinical staff member is required to identify themselves, the patient and the admitting diagnosis. They identify what the current problem is and when it started.

B - Background (circumstances leading up to this - what got us to this point?)
Clinical staff member should provide information about the admitting diagnosis and date of admission. They should provide the list of current medications, allergies and intravenous fluids received. The most recent vital signs, dates and times and results of lab tests should be included.  

A - Assessment (summarize the facts, what do you think is going on?)
Clinical staff member should provide an assessment of what the clinical problem is or provide clinical impressions or concerns e.g. what psychological processes may be contributing to the problems, what medications might be causing the problems. 

R - Recommendation  (what would you do to correct the situation? What needs to happen next?)
Based on the information in the assessment, clinical staff member is required to make recommendations to ensure that the patient receives safe and appropriate care, and steps are implemented to identify any future deterioration. This may include:

  • Transfer to a high level of care
  • A request for an SMO to evaluate the patient
  • Need for additional tests and investigations
  • Arranging for specific interventions which may include medication or dose changes. 

R - Response (has a decision been reached? Do you know what do you need to do?)
Clinical staff member is required to document any response (activity) and also monitor that recommendations and further monitoring occurs. 

What is SBARR?

  1. SBARR is a situational briefing model. It was first used in the US military and then adopted in the healthcare environment.
  2. It helps frame clinical conversations between healthcare professionals.
  3. It is standardised.
  4. Information is presented in an expected manner; the standardised presentation is predictable and expected and therefore helps staff anticipate the flow of information.
  5. It is a structured communication model that reduces the need for repetition.
  6. It is time saving in that it encourages clinical staff to provide succinct, filtered and relevant information.

SBARR promotes learning and strategic thinking in staff

  • To communicate using the SBARR strategy, the clinician will have taken a history, reviewed the existing clinical notes, spoken to family and caregivers, examined the patient and summarised important information.
  • They may need to have a list of medication, most recent vital signs and results of any preliminary investigations.
  • They are required to think about possible diagnosis and their clinical concerns.
  • It requires a formulation of the information and the clinical problems that is the assessment, and SBARR is therefore a tool that promotes critical and clinical reasoning abilities.
  • It promotes the synthesis of a recommended action plan.
  • SBARR is also a tool that promotes teamwork and ultimately encourages a better and safer environment for patient care. 

How is SBARR used in the clinical context?

  • Bedside case presentations.
  • Transfer of care from one department to another e.g. outpatient to inpatient.
  • Junior doctor's communications with a senior medical officer on call.
  • Changes in shift report, i.e. handover and escalating concern about a deteriorating patient.