Situation. Background. Assessment. Recommendation. SBAR, it’s a tool that has found its way into the heart of most nursing classes. Almost from day one, nursing students are educated about this technique and informed they are to use it when communicating with physicians during clinical.
SBAR really is something that even nursing students need to know how to use. We don’t talk to physicians all that much right now, but SBAR is really far more encompassing than what nursing school has pigeonholed it to be. How many times in a day do nurses discuss care with other nurses? How many times do they quickly transfer care before going to lunch or leaving the floor for some other task? Now, how many times do those nurses transfer care by stating: the most pertinent problem, some background about that and/or the patient, what the nurse’s impression is at the present moment, and what the nurse needs to have done while she is away? Take this for example:
Mary: Hey, Mike, can you take care of my patient in room 3 while I go to lunch? [situation]
Mike: Sure, Mary.
Mary: Okay, now Mr. Smith is in room 3. He has a history of uncontrolled diabetes with PVD and had a stroke within the last year. He’s here because he’s developed skin breakdown around his ischium and has two infected diabetic ulcers on his right foot. I just gave him his IV pain medications, but he has a PRN if he needs more. [background] Otherwise, I would just keep checking on Mr. Smith. I think he’s working through some feelings of resentment and guilt about his current visit with us [assessment], and he may need some extra support and education if he seems ready for it. [recommendation]
Should this be heard at any point while at clinical, tell your nurses they are fantastic! Not using an SBAR format for discussing patients with all providers isn’t necessarily a bad thing, but it may not be the quickest way to present the most amount of information either. The conversation above could easily have looked like this:
Mary: Hey, Mike, can you take care of my patient in room 3 while I go to lunch.
Mike: Sure, Mary.
Mary: Okay, he’s here to be treated for three different skin breakdown areas. I just gave him some IV pain meds, but he has a PRN. Keep an eye on him, especially because he seems kind of down. Thanks!
You see, this didn’t exactly have the same type of detail as the last one. Now, poor Mike will be left to figure out the extent of the patient’s condition on his own and there is the possibility that he could be missing out on some very important information.
So the next time a brief transfer of care—or, really, any rapid patient discussion—needs to occur, try using SBAR. Not only does it encourage every nurse to package a complex person into the best description, but it also forces the nurse to really think about what needs to be shared for best patient continuity of care.