Clinical
Implementation of the SBAR Communication Technique in a Tertiary Center

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National Patient Safety Goals

National Patient Safety Goals have been established to address issues such as decreasing medical errors, particularly by focusing on better communication between health care providers. The Joint Commission on Accreditation of Healthcare Organizations safety goal 2E3., 4. recommends a “standardized handoff communication between the healthcare team, as well as providing for an opportunity for questions and response.” One tool that has been found to assist with structuring and standardizing

Initial Survey

In the fall of 2006, Magee Womens Hospital of the University of Pittsburgh Medical Center (UPMC) teamed up with its sister facility, UPMC Shadyside Hospital, to standardize and improve communication between health care team members.

Prior to the fall of 2006, Magee Womens Hospital did not have a standardized way of communicating during critical events. Physicians and nursing staff were surveyed regarding effective communication with use of 5 “profession specific” questions (Figure 2). A 5-point

Gaining Support and Educating Staff

Based on the initial survey, the SBAR technique was introduced hospital wide in an effort to standardize the transfer of information.6 Nursing management led the charge by strategically garnering support from physician leaders. Implementation included educating all personnel in all the areas that participated in the initial survey, as well as through presentations at the Med Exec Committees, Patient Safety Committee, Nursing Grand Rounds, and new employee orientation for nursing and physicians.

Initial Resistance

The physician staff initially had some reservations regarding the Recommendation portion of the SBAR tool. They questioned whether a nurse should recommend a medication or procedure prior to the physician’s examination of the patient. This point was clarified to explain that nurses would use the R to communicate “exactly what you need from the physician at that moment.” Nurses were educated to use the R even if they were unsure about what was happening in a situation, did not know how to remedy

Results

Use of the SBAR technique was generally well received, especially because of its simplicity and ease of understanding. All of our nursing units now require shift report using this technique, including the emergency department and medical/surgical units. The vice president of nursing requires her nursing directors and managers to utilize the SBAR technique when communicating critical information among the management team.

In January 2007, we surveyed the same hospital areas again to evaluate the

Conclusion

Emergency nurses are one of the health care provider groups most in need of clear, concise handoffs and physician communication techniques because of the urgency of emergency health care. The SBAR tool provides the translation between narrative and “headline” communication, thus bridging differences in nursing and physician training. Consider the volume of persons an ED registered nurse (RN) communicates with during an average work day: multiple physicians, other nurses and health care

Lorna J. Woodhall, ENA Chapter 92, is Clinical Nurse Specialist, Magee Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, Pa.

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Lorna J. Woodhall, ENA Chapter 92, is Clinical Nurse Specialist, Magee Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, Pa.

Lisa Vertacnik is Unit Director, Magee Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, Pa.

Maribeth McLaughlin is Chief Nursing Officer, Vice President of Patient Care Services, Magee Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, Pa.

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