1. Communication Strategies for Health Care Facilities: Use of SBAR Provided Courtesy of Nutrition411.com Contributed by Rachel Riddiford, MS, RD, LD Updated by Nutrition411.com staff G-1500 Review Date 1/14

2. What Is SBAR? SBAR stands for: Situation Background Assessment Recommendation/response

3. Discussions using SBAR (situation, background, assessment, and recommendation/response) can increase communication and facilitate improved patient care Why Use SBAR?

4. Good communication encourages collaboration, fosters teamwork, and prevents errors Good communication=patient safety Why Use SBAR? (cont’d)

5. Shift change Dietitian to nurse Unit-to-unit report Nurse to physician Physician to nurse/respiratory therapy Nurse to dietitian Social worker to nurse Nurse to clinical support staff/technicians Respiratory therapy to nurse Nurse to pharmacy Physician to nurse/ respiratory therapy Use SBAR during hand-off communication opportunities across a facility. Examples include: Build Better Communication

6. Situation: What’s going on with the patient right now? Identify yourself Identify the patient State the problems concisely SBAR: Step by Step

7. I’m Rachel, the registered dietitian covering 3E today. I have a concern about 363, Jones. He was supposed to count his carbs on his lunch tray, but said no one helped him with it. “S” Example (RD/RDN to RN)

8. I need help covering 3E when I am off tomorrow. I know 363, Jones, will need follow-up. He is learning carb counting and needs follow-up tomorrow. “S” Example (RD/RDN to RD/RDN)

9. Background: What is the background on this patient? How did we get to this point? Review the documentation Anticipate questions State the relevant medical issues SBAR: Step by Step

10. “B” Example (RD/RDN to RN) He and his parents did well in their diet education, but they need practice in carb counting to increase their confidence. I know you are busy, but hope you can help.

11. “B” Example (RD/RDN to RN) (cont’d) I would like to give them as much support and practical experience as possible to reduce anxiety and increase blood glucose control now and after discharge.

12. The patient told me that he did not get nursing assistance in carb counting at lunch today. I talked to the RN, who said she would make sure he gets help at dinner tonight. Please follow up tomorrow to find out what questions he may have and how the evening went. “B” Example (RD/RDN to RD/RDN)

13. I have educated the patient and both parents. They are able to read labels and write a menu together, complete with carbohydrate content. He came in with blood sugar of 650, but quickly normalized. “B” Example (RD/RDN to RD/RDN) (cont’d)

14. Assessment: What do I think the issues are? Provide your observations and evaluations of the patient’s current state and discuss pertinent issues/concerns SBAR: Step by Step

15. No family members have prior experience with type 1 diabetes. While they did well with their education, they still were weak in their confidence of putting it all together when I last talked with them. “A” Example (RD/RDN to RD or RD/RDN)

16. Recommendation/Response: How do we collaborate to form a plan of action? Discuss the plan of care to meet the patient’s immediate needs Listen for/seek feedback to ensure that responder understands the issues SBAR: Step by Step

17. It would help the patient/parents if they could count the carbs for the nurse, rather than the nurse doing the counting at dinner tonight. Do you think that is reasonable? Could you please make sure the nurse who is here during dinner knows the plan? “R” Example (RD/RDN to RN)

18. Ideally, try to arrive right after breakfast and have the patient/parents count the carbs to you, plus have them tell you how many units of insulin the patient will need. “R” Example (RD/RDN to RD/RDN)

19. Alternatively, try to follow up after breakfast and ask the patient and parents, plus the patient’s nurse, how the carb counting went. Ask them to give you details on how they determined the carb intake. Will this work into your current plans for the day? Anything else you need from me? “R” Example (RD/RDN to RD/RDN) (cont’d)

20. Depending on the purpose of the communication, the type and the amount of information will vary Communication Strategies

21. Situation: Identify the problem Communication Strategies (cont’d)

22. Background: Brief synopsis of patient (eg, diagnosis, date of admission, medical history) Communication Strategies (cont’d)

23. Assessment: Patient’s most recent data (eg, weight changes, supplement requirement, neurological status, oral intake) Include any changes from prior assessment Communication Strategies (cont’d)

24. Recommendation/Response: State what you would like to see happen Collaboration is very important here Communication Strategies (cont’d)

25. Positive outcomes of effective communication: More effective interventions Improved patient safety Enhanced employee morale Improved patient and family satisfaction Outcomes