Communication and Senior Colleague

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What is it and how can it help me?
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 tool consists of standardised prompt questions within four sections, to ensure that staff are sharing concise and focused information. It allows staff to communicate assertively and effectively, reducing the need for repetition. 

The tool helps staff anticipate the information needed by colleagues and encourages assessment skills. Using SBAR prompts staff to formulate information with the right level of detail. When does it work best?

The NHS is often criticised for poor communication, however, there are few tools around that actively focus on how to improve communication, in particular verbal communication. 

The tool can be used to shape communication at any stage of the patient's journey, from the content of a GP's referral letter, consultant to consultant referrals through to communicating discharge back to a GP.  

When staff use the tool in a clinical setting, they make a recommendation which ensures that the reason for the communication is clear. This is particularly important in situations where staff may be uncomfortable about making a recommendation i.e. those who are inexperienced or who need to communicate up the hierarchy. The use of SBAR prevents the hit and miss process of ‘hinting and hoping'. How to use it

A sample NHS SBAR template to show how to use SBAR in your hospital can be viewed in the following document: SBAR diagram. 

A detailed description of the steps involved: 

S Situation:
• Identify yourself the site/unit you are calling from
• Identify the patient by name and the reason for your report • Describe your concern
Firstly, describe the specific situation about which you are calling, including the patient's name, consultant, patient location, code status, and vital signs. An example of a script would be: "This is Lou, a registered nurse on Nightingale Ward. The reason I'm calling is that Mrs Taylor in room 225 has become suddenly short of breath, her oxygen saturation has dropped to 88 per cent on room air, her respiration rate is 24 per minute, her heart rate is 110 and her blood pressure is 85/50. We have placed her on 6 litres of oxygen and her saturation is 93 per cent, her work of breathing is increased, she is anxious, her breath sounds are clear throughout and her respiratory rate remains greater than 20. She has a full code status." B Background:

• Give the patient's reason for admission
• Explain significant medical history
• You then inform the consultant 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. For example: 

"Mrs. Smith is a 69-year-old woman who was admitted ten days ago, following a MVC, with a T 5 burst fracture and a T 6 ASIA B SCI. She had T 3-T 7 instrumentation and fusion nine days ago, her only complication was a right haemothorax for which a chest tube was put in place. The tube was removed five days ago and her CXR has shown significant improvement. She has been mobilising with physio and has been progressing well. Her haemoglobin is 100 gm/L; otherwise her blood work is within normal limits. She has been on Enoxaparin for DVT prophylaxis and Oxycodone for pain management." A  Assessment:

• Vital signs
• Contraction pattern
• Clinical impressions, concerns 

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...
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