Say What?: Providing Accurate Information

Sunday, November 1, 2009

Christina L. Williamson, RN, MSN
Nursing Service, Veterans Health Care System of the Ozarks, Fayetteville, AR

Learning Objective 1: describe why the SBAR methodology is used as a standard form of communicaton for hand off.

Learning Objective 2: identify different uses for SBAR in the hospital setting and demonstrate in a variety of hand off situations.

The most frequently cited root cause of Sentinel Events evaluated by the Joint Commission is lack of effective communication. Statistics show that between 1995 and 2004 there were more than 3000 sentinel events. Further analysis reported that 65% were caused by communication problems. In 2005 these percentages increased to 70% with at least half of breakdowns in communication occurring during hand-off (Joint Commission, 2007). The National Patient Safety Goal 2E for 2008 states, “Implement a standardized approach to “hand off” communications, including an opportunity to ask and respond to questions.”  The purpose of this study was to establish policy, procedure, and responsibility for safe hand-off communication and define a minimum standard of practice within the Veterans Administration Medical Center (VAMC), Fayetteville, Arkansas.
Hand-off Communication is defined as an interactive process of passing current patient information from one care provider to another for the purpose of ensuring continuity of the patient’s care. The review of literature shows that “Communication handoff are critically important in creating a shared mental model around the patient’s condition,” (Haig, Sutton, & Whittington, 2006). Hohenhaus, Powell and Hohenhaus (2006) felt that “Nurses often lack or under utilize standardized methods that could assist the hand –off of patient information from one health care provider to another.” It is also felt that “Critically important pieces of information can be concisely communicated in a standard framework if one tool is used institution wide,” (Rouse, 2007).
Hand-off communication should occur during any situation where there are pending   specimens, patient care issues, or responsibility is handed off from one person to another. The medical center chose to use a standardized tool called S-B-A-R. Using a standardized approach would help to ensure the information provided was clear and consistently accurate and would facilitate a shared mental model. 
S=Situation. What is happening at the present time?
B=Background. What are the circumstances leading up to the situation?
A= Assessment. What do I think the problem is?
R=Recommendation. What should we do to correct the problem?
Several mechanisms were put into place. These included SBAR laminated pockets cards, development of electronic templates identifying the process, SBAR training for clinical and nonclinical staff, and training added to new employee orientation and annual staff education. In implementing the process several potential barriers were identified: lack of privacy, background noise, potential for interruption, language differences and the means of communication used.
Process improvement results were obtained through employee feedback. The use of the SBAR methodology improved patient centered communication, increased staff satisfaction regarding decisions that affect work life and increased continuity of care. Improving team communication helps to create an effective and efficient care environment. Developing, practicing and maintaining improved team communication skills may be the difference between an optimal outcome and an adverse event.
Joint Commission International Center for Patient Safety, (2007). Improving hand-off communications: Meeting National Patient Safety Goal 2E. Retrieved October 16, 2007 from http://www.jcipatietnsafety. org.
Haig, K. Sutton, S. & Whittington, J. (2006, March). SBAR: A shared mental model for improving communication between clinicians. Journal on Quality and Patient Safety, 32(3), p.1.
Hohenhaus, S., Powell, & S. Hohenhaus, J. (2006, August). Enhancing patient safety during hand-off: Standardized communication and teamwork.
Rouse, C. (2007, March/April). Speak SBAR to improve communication. OR Nurse, 1(2), p.1.