Situation, Background, Assessment, Recommendation: A Communication Handbook For All Staff

[
SAMPLE
SBAR
Situation,
Background,
Assessment, ]
Recommendation
A Communication
Handbook
for All Staff
|
SAMPLE
SBAR
Situation,
Background,
Assessment,
Recommendation
A Communication
Handbook
for All Staff
SAMPLE
SBAR: Situation, Background, Assessment, Recommendation—
A Communication Handbook for All Staff is published by HCPro, Inc.
Copyright 2006 HCPro, Inc.
All rights reserved. Printed in the United States of America.
ISBN-13: 978-1-57839-813-3
ISBN-10: 1-57839-813-4
No part of this publication may be reproduced in any form or by any

means without prior written consent of HCPro, Inc., or the Copyright
Clearance Center (978/750-8400). Please notify us immediately if you have
received an unauthorized copy.
HCPro provides information resources to the healthcare industry.
HCPro, Inc. is not affiliated in any way with The Joint Commission, which
owns the JCAHO and Joint Commission trademarks.
Molly Hall, Executive Editor

John Novack, Group Publisher
Jean St. Pierre, Director of Operations
Mike Mirabello, Senior Graphic Artist
Shane Katz, Cover Designer
Advice given is general. Readers should consult professional counsel with

specific legal, ethical, or clinical questions.
Arrangements can be made for quantity discounts.
For more information, contact:
HCPro, Inc.
P.O. Box 1168
Marblehead, MA 01945
Telephone: 800/650-6787 or 781/639-1872
Fax: 781/639-2982
E-mail: customerservice@hcpro.com
Visit HCPro at its World Wide Web sites:

www.hcmarketplace.com and www.hcpro.com
Rev. 02/2007
21110
SAMPLE
SBAR: Situation, Background, Assessment, Recommendation
Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Where communication fails . . . . . . . . . . . . . . . . . . . . . . . 2

SBAR communication: Who? . . . . . . . . . . . . . . . . . . . . . . 3
What is SBAR? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Situation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
SBAR script: Situation . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
SBAR script: Background . . . . . . . . . . . . . . . . . . . . . . . . . 6
Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
SBAR script: Assessment . . . . . . . . . . . . . . . . . . . . . . . . . 8
Recommendation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
SBAR script: Recommendation . . . . . . . . . . . . . . . . . . . . . 9
“Critical” words . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Sample SBAR card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
SBAR in action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Using SBAR during patient hand-offs . . . . . . . . . . . . . . . . . . 14

Using SBAR during RN to MD communication . . . . . . . . . . . 15
Tips for calling a physician . . . . . . . . . . . . . . . . . . . . . . 16
Using SBAR with emergency response teams . . . . . . . . . . . . 16
Using SBAR when resolving a complaint . . . . . . . . . . . . . . . 17
SBAR practice and discussion . . . . . . . . . . . . . . . . . . . . 18
Certificate of completion . . . . . . . . . . . . . . . . . . . . . . 20
3
SAMPLE
SAMPLE
SBAR: Situation, Background,
Assessment, Recommendation
Introduction
Hospitals are centers of communication. Patients who

come into your facility will be treated by any number
of healthcare professionals. Each person who works
with a patient must provide accurate and updated infor-
mation to other caregivers. After a while, all of the
information about a patient’s condition can become
confusing and scattered.
Whether you’re a nurse, dietician, maintenance worker,

or surgeon, your ability to communicate information
effectively and efficiently greatly affects patient safety.
In fact, data shows that most medical errors occur as a
result of communication breakdowns.
1
SAMPLE
Where communication fails:
• Failure to get attention

• Failure to communicate level of concern
• Failure to communicate real problem
• Failure to communicate desired action
• Failure to reach decision together before
communication is cut off
SBAR (pronounced s-bar) is a communication tool that

can improve the way you communicate.
SBAR stands for
• Situation
• Background
• Assessment
• Recommendation
SBAR helps you outline the most important points of a

situation and remove irrelevant information. Regardless
of your job or role, this simple technique will help you
organize information and present it in a way that pro-
vides important facts in a quick, coherent way.
2
SAMPLE
SBAR communication: Who?
4 Nurse to physician
4 Physician to physician
4 Resident to attending
4 Nurse to nurse
4 Pharmacy to physician/nurse
4 Nurse to technician
4 Bed control to nurse
4 Administrator to physician
4 Office/dietary/housekeeping staff to patient
This training handbook will explain each step of SBAR,

provide examples of when SBAR might be used, and offer
opportunities for you to practice your SBAR skills.
What is SBAR?
SBAR was developed by the United States Navy for sub-

mariners, who often work in stressful, time-critical envi-
ronments. Sound familiar? Hospitals are often stressful
places with significant time constraints, especially in an
emergency.
3
SAMPLE
Each component of SBAR—situation, background, assess-

ment, recommendation—provides a format for which to
present information in a specific, organized way.
Situation
The first step of the SBAR tool is stating the situation.
In other words, what is the problem?
The situation should include:
• Your name and unit

• Patient’s name, physician, room number
• Brief statement of your concerns
SBAR Script: Situation
I am calling about
_____________________________________________________.
The patient’s code status is

_____________________________________________________.
The problem I am calling about is

_____________________________________________________.
4
SAMPLE
SBAR Script: Situation (cont.)
I have just assessed the patient personally:

• Vital signs are: Blood pressure _______ /_______,
pulse _______, and temperature _______.
I am concerned about the patient’s

– blood pressure because it is over 200 or less than 100
– pulse because it is over 140 or less than 50
– respiration because it is less than five or over 40
– temperature because it is less than 96 or over 104
Background
The second step of SBAR is background. Provide a brief
history on the patient or situation, making sure the infor-
mation is pertinent to the situation at hand.
The background may include:
• Admission diagnosis and date of admission

• Pertinent medical history
• Brief synopsis of the treatment to date
• Clinical assessment (neuro, resp, cardio, GI/GU/bowl,
integ, wound)
• Recent interventions given and effectiveness
5
SAMPLE
• Abnormal lab or imaging tests, telemetry

• Status of IV
• Gait/fall precautions
• Diet
• Living situation; discharge plan
• Vaccines, allergies
SBAR
Assessment script: Background
The patient’s mental status is _______________________
q alert and oriented to person, place, and time
q confused and cooperative or noncooperative
q agitated or combative
q lethargic but conversant and able to swallow
q stuporous, not talking clearly, and possibly unable

to swallow
q comatose, eyes closed, and not responding to

stimulation
6
SAMPLE
SBAR script: Background (cont.)
The skin is
q warm and dry q diaphoretic

q mottled q pale
q extremities are cold q extremities are warm
The patient is not or is on oxygen.
q The patient has been on _________ (l./min.) or (%)

oxygen for _________ minutes (hours)
q The oximeter reads _________%
q The oximeter does not detect a good pulse and

is giving erratic readings
The third part of the SBAR tool is making an assessment:
The assessment should include:
• Vital signs
• Oxygen status
• Any changes from prior assessments
7
SAMPLE
SBAR script: Assessment
I think the problem is _____________________________

___________________.
q The problem seems to be cardiac/infection/neu-

rologic/respiratory __________.
q I am not sure what the problem is, but the patient

is deteriorating.
q The patient seems to be unstable and may get

worse. We need to do something.
Recommendation
The final SBAR step is recommendation. Give a recom-
mendation (or a response) based on the situation, back-
ground, and assessment of the case. In other words,
what do you think needs to be done?
The recommendation should include:
• Anything that needs to be attended to immediately

• Details on what the patient’s physician has been told
• Anything that has been left undone
8
SAMPLE
• Information on anything that could not be finished

during your shift/time with the patient
For many people, the recommendation step of SBAR is

the most intimidating. You may feel unqualified to make
a recommendation or worry that the recommendation
you make is incorrect.
It’s natural to worry about making a recommendation—

especially if you are new or inexperienced. But, remember
you are not making the final decision. The purpose
of the recommendation stage is to outline your thoughts.
It’s up to the physician or responsible party to decide
how to act. Saying something as simple as, “I need you to
check on the patient now,” is a proper recommendation.
SBAR script: Recommendation
I suggest or request that you ______________________

___________________________.
q transfer the patient to critical care

q come to see the patient at this time
q talk to the patient or family about code status
9
SAMPLE
SBAR script: Recommendation (cont.)
q ask the on-call family practice resident to see the

patient now
q ask for a consultant to see the patient now
Are any tests needed?

Do you need any tests done (e.g., CXR, ABG, EKG, CBC,
or BMP)?
Others?
If a change in treatment is ordered, ask

q how often do you want vital signs?
q how long do you expect this problem will last?
q if the patient does not get better, when would you
want us to call
10
SAMPLE
Critical language
It is important that your recommendation be taken seri-
ously—regardless of who is receiving it. The use of
“critical” language can increase the intensity of your mes-
sage. Critical language uses words that convey a sense
of urgency.
“This patient needs medication now.”

“I need you to check on the patient immediately.”
“Critical” words:
• Now • At once
• Must • Instantly/this instant
• Need • Acute
• Immediately • Imperative
• Critical • Vital
• Priority • Crucial
• Important • Urgent
• Quickly • Essential
• Requires
To help you remember the SBAR steps, you may want to

carry a card like the one on the next two pages.
11
SAMPLE
Sample SBAR card
SBAR report about a critical situation
S Situation
<patient name and location>
I am calling about ____________________________________________.
<code status>
The patient’s code status is ______________________________________.
The problem I am calling about is ____________________________.
I have just assessed the patient personally:
• Vital signs are: Blood pressure _____ /_____, pulse ______, respiration _____,
and temperature ______.
• I am concerned about the patient’s
– blood pressure because it is over 200 or less than 100 or 30 mmHg below usual
– pulse because it is over 140 or less than 50
– respiration because it is less than five or over 40
– temperature because it is less than 96 or over 104
B Background
The patient’s mental status is
• alert and oriented to person, place, and time
• confused and cooperative or noncooperative
• agitated or combative
• lethargic but conversant and able to swallow
• stuporous, not talking clearly, and possibly unable to swallow
• comatose, eyes closed, and not responding to stimulation
The skin is
• warm and dry • diaphoretic • mottled
• pale • extremities are cold • extremities are warm

The patient is not or is on oxygen.
• The patient has been on ________ (l./min.) or (%) oxygen for ______ minutes (hours)
• The oximeter reads _______%
• The oximeter does not detect a good pulse and is giving erratic readings
12
SAMPLE
Sample SBAR card
A Assessment
<say what you think is the problem>
I think the problem is __________________________________________.
• The problem seems to be cardiac/infection/neurologic/respiratory__________.
• I am not sure what the problem is, but the patient is deteriorating.
• The patient seems to be unstable and may get worse. We need to
do something.
R Recommendation
<say what you would like to see done>
I suggest or request that you ___________________________________.
• transfer the patient to critical care
• come to see the patient at this time
• talk to the patient or family about code status
• ask the on-call family practice resident to see the patient now
• ask for a consultant to see the patient now
Are any tests needed?

Do you need any tests done (e.g., CXR, ABG, EKG, CBC, or BMP)?
Others?
If a change in treatment is ordered, ask

• how often do you want vital signs?
• how long do you expect this problem will last?
• if the patient does not get better, when would you want us to call again?
13
SAMPLE
SBAR in action
SBAR is a useful technique for all types of communica-

tion—not just emergencies. However, when you are
nervous, hurried, or under stress, your potential for
communication errors is heightened. At these times,
SBAR can be a life-saving communication tool.
When SBAR is a “must”:
• During a patient hand-off

• During RN to MD communication
• When calling a emergency response team
(e.g. RRT, MRT)
• When resolving a consumer (patient or family) issue
Let’s take a closer look at SBAR in these situations.
Using SBAR during patient hand-offs

SBAR is especially useful in hand-off situations where
the care of a patient is transferred between shifts, floors,
or staff members. The Joint Commission on the Accredi
tation of Healthcare Organizations has made patient
hand-offs a National Patient Safety Goal. Part of the
goal requires that patient hand-offs provide time for care-
givers to ask and answer questions. With SBAR, you may
14
SAMPLE
be able to answer most questions even before they are

asked.
Using SBAR during RN to MD communication

When nurses need to communicate with physicians,
especially if the physician is off duty, there is the poten-
tial for miscommunication. Nurses are trained to be nar-
rative and descriptive. Physicians, however, want to get
straight to the “meat” of the issue: What specifically is
wrong and what do you want me to do?
SBAR gives you the chance to organize your thoughts

and prioritize information before talking to a physician.
And it helps a physician get the facts she needs in a
clear and concise way.
Before talking to a physician, ask yourself (you may

even want to write down your answers!):
• Why I am calling this physician?

• What’s happening to the patient that makes this call
important?
• What information is relevant to the situation?
• What might it mean?
• What would I do if I had to make the decision?
15
SAMPLE
Tips for calling a physician
Before calling the physician:
q Assess the patient

q Review the chart for the appropriate physician
to call
q Know the admitting diagnosis
q Read the most recent progress notes and the
assessment from the nurse of the prior shift.
Have available when speaking to the physician:
q Chart, allergies, meds, IV fluids, labs/results
Using SBAR with emergency response teams

You may work in a facility that has an emergency
response team (often called a rapid response team). This
is a specific team designated to respond to patients
in trouble.
Depending on your hospital’s specific policy, you may

need to activate this emergency team at some point. SBAR
will help you present key information needed to help a
16
SAMPLE
patient whose condition is deteriorating. The team needs

critical information about the patient to assess the situation.
Using SBAR when resolving a complaint

Dealing with a dissatisfied patient or family member
can be a stressful situation. SBAR can help you organize
your response to the complaint and explain the situation
in a clear and concise manner. However, don’t become
so locked into the four steps of SBAR that you become
robotic. Remember that you want to remain caring and
compassionate while resolving the complaint.
Summary
Like any new technique, the best way to master SBAR

is to practice it. Use it in phone calls, e-mails, memos, or
any other time you have to communicate. Once you get
the hang of it, you’ll find that communicating in critical
situations will become easier and take less time. Clear,
effective communication will saves lives and makes all of
our jobs easier.
17
SAMPLE
SBAR practice and discussion
Use the following scenarios to practice your SBAR tech-

nique. Think about how you would communicate in these
situations. Discuss your ideas with your manager and
other staff members.
Scenario one
A patient arrived in your outpatient clinic today for an

evaluation and is seemingly intoxicated. She has missed
the last two appointments. She has a history of paranoid
schizophrenia and is on medication. She also has a his-
tory of rheumatic heart disease and atrial fibrillation. She
is scheduled for mitral valve replacement and cardiology
clinic has referred the patient to you. The clinic is extremely
busy today.
• What are you concerned about?
• How should the clinic handle this situation?
• Who do you need to call and how will you orga-

nize your thoughts before calling?
18
SAMPLE
SBAR practice and discussion (cont.)
Scenario two
You are taking care of a 72-year-old female for the first

time tonight. You’ve been told at shift report that the patient
is doing well but has had a rough day with lots of fam-
ily and visitors. She has not had much chance to rest. At
2:30 a.m., you enter the patient’s room to take vitals. She
is arousable but her heart rate is 42. Her blood pressure
is 98/40, and her pulse rate is regular. She was admit-
ted three days ago in rapid atrial fibrillation, diuresed, and
placed on a beta blocker. She is also on digoxin 0.25
mg p.o.q. AM. Her last potassium 2 days ago was 3.8.
The patient is scheduled to undergo a colonoscopy around
noon, since she was noted to have heme and stools. She is
NPO and has taken her bowel prep.
19
Certificate of completion
This is to certify that
has read and successfully passed the final exam of
SBAR: Situation, Background, Assessment, Recommendation—

A Communication Handbook for All Staff
SAMPLE Rob Stuart
Senior Vice President/Chief Operating Officer
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[

Copyright 2006 HCPro, Inc.

All rights reserved. Printed in the United States of America.

No part of this publication may be reproduced in any form or by any

HCPro provides information resources to the healthcare industry.

Molly Hall, Executive Editor

Advice given is general. Readers should consult professional counsel with

Arrangements can be made for quantity discounts.

For more information, contact:

Visit HCPro at its World Wide Web sites:

Where communication fails . . . . . . . . . . . . . . . . . . . . . . . 2

Using SBAR during patient hand-offs . . . . . . . . . . . . . . . . . . 14

Hospitals are centers of communication. Patients who

Whether you’re a nurse, dietician, maintenance worker,

Where communication fails:

• Failure to get attention

SBAR (pronounced s-bar) is a communication tool that

SBAR stands for

SBAR helps you outline the most important points of a

SBAR communication: Who?

This training handbook will explain each step of SBAR,

SBAR was developed by the United States Navy for sub-

Each component of SBAR—situation, background, assess-

The situation should include:

• Your name and unit

SBAR Script: Situation

The patient’s code status is

The problem I am calling about is

SBAR Script: Situation (cont.)

I have just assessed the patient personally:

I am concerned about the patient’s

The background may include:

• Admission diagnosis and date of admission

• Abnormal lab or imaging tests, telemetry

The patient’s mental status is _______________________

q alert and oriented to person, place, and time

q confused and cooperative or noncooperative

q lethargic but conversant and able to swallow

q stuporous, not talking clearly, and possibly unable

q comatose, eyes closed, and not responding to

SBAR script: Background (cont.)

q warm and dry q diaphoretic

The patient is not or is on oxygen.

q The patient has been on _________ (l./min.) or (%)

q The oximeter reads _________%

q The oximeter does not detect a good pulse and

The third part of the SBAR tool is making an assessment:

The assessment should include:

SBAR script: Assessment

I think the problem is _____________________________

q The problem seems to be cardiac/infection/neu-

q I am not sure what the problem is, but the patient

q The patient seems to be unstable and may get

The recommendation should include:

• Anything that needs to be attended to immediately

• Information on anything that could not be finished

For many people, the recommendation step of SBAR is

It’s natural to worry about making a recommendation—

SBAR script: Recommendation