NURSING Communication: Using the SBAR Technique

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What Is Communication Using the SBAR Technique?

› The Situation-Background-Assessment-Recommendation (SBAR) protocol is a technique
that provides a structure for communication among healthcare clinicians by organizing
the delivery of relevant patient information in subheadings of Situation, Background,
Assessment, and Recommendation. SBAR was designed for use when communicating
patient needs, but has come to be used in all forms of communication among members of
the healthcare team
• What: SBAR was designed primarily to promote patient safety during urgent patient care
situations by structuring healthcare information in a logical sequence, but the technique
also benefits clinicians in that it makes communication more readily understood and
more efficient. The information that follows focuses on a description of how to use the
SBAR technique to communicate a patient’s healthcare needs, although SBAR can be
used to communicate regarding other healthcare issues (e.g., bed or room assignments,
pharmacy concerns, equipment and supply issues)
• How: Nurses often utilize SBAR when communicating patient needs to the treating
clinician by telephone, and for communicating during patient handoff to other clinicians
or departments. To use SBAR, key information is documented on an SBAR worksheet
or script, and the script is followed when communicating with other clinicians
• Where:Although SBAR is primarily used in the acute care setting, it may also be used
in all inpatient and outpatient areas of health care, including primary care, home care,
rehabilitation, and hospice
• Who:Nurses and physicians primarily use SBAR, but SBAR can also be used by other
healthcare professionals (e.g., physical therapists, social workers)

What is the Desired Outcome of Using the SBAR

Communication Technique?
› The desired outcome of using the SBAR communication technique is to structure
Author healthcare information in a logical sequence, making communication between healthcare
Carita Caple, RN, BSN, MSHS professionals more readily understood and more efficient.
Cinahl Information Systems, Glendale, CA

Why Is Communication Using the SBAR Technique Important?

Reviewers
Kathleen Walsh, RN, MSN, CCRN › Communication patterns among clinicians vary according to clinician gender, education
Cinahl Information Systems, Glendale, CA level, cultural background, personal experience, stress level, environmental distractions,
Nursing Practice Council and individual communication style. Using a standardized framework such as the SBAR
Glendale Adventist Medical Center,
Glendale, CA
technique can eliminate communication failure due to differences in communication
patterns among clinicians
Editor › Poor communication among clinicians has been linked with sentinel events (i.e., an
Diane Pravikoff, RN, PhD, FAAN unanticipated patient safety incident that results in death or severe injury or the risk
Cinahl Information Systems, Glendale, CA of death or severe injury). In the acute care setting, risk for communication failure
is increased due to noise and other environmental distractions. Use of standardized
communication methods like the SBAR technique can help streamline information and
March 11, 2016

Published by Cinahl Information Systems, a division of EBSCO Information Services. Copyright©2016, Cinahl Information Systems. All rights
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any information storage and retrieval system, without permission in writing from the publisher. Cinahl Information Systems accepts no liability for advice
or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare
professional. Cinahl Information Systems, 1509 Wilson Terrace, Glendale, CA 91206
 verify that key patient information (e.g., urgent medications or treatments and important
assessment findings) is communicated clearly and efficiently
› Use of SBAR complies with The Joint Commission (TJC) and Institute for Healthcare Improvement (IHI) mandates for
improvement in healthcare communication

Facts and Figures

› Communication errors lead to an estimated 98,000 deaths and $17 billion in healthcare costs annually (Vardaman et al.,
2012)
› Barriers to effective communication during patient handoffs include interruptions (e.g., by family members, staff members,
or patients), distracting lighting, background noise, crowding (e.g., in nursing stations), and technology. SBAR was
initially designed by the military to create a process of communication and structure. The SBAR method assists healthcare
providers in overcoming barriers to effective communication, remaining focused on communication during patient handoffs,
improving interpersonal dynamics, and improving communication as patients move within hierarchical structures (Daniel et
al., 2014)
› Researchers who employed SBAR to improve communication during nursing shift report in 4 medical-surgical units reported
that although the average time for shift report did not decrease, nurses spent more time discussing key patient information
rather than transcribing information. The investigators concluded that SBAR made shift report more structured, consistent,
and patient-centered (Cornell et al., 2013)
› SBAR can be used to structure and communicate nonclinical information. When adopted by a rehabilitation team,
SBAR was used to express concern about workload and staffing levels in a nonpersonal and objective manner to the
management team. In this application, SBAR permitted the clinicians to justify their concerns with objective data and their
recommendations for improvement were considered and adopted (Boaro et al., 2010)
› Researchers evaluating the usefulness of SBAR in promoting appropriate clinical judgment in 80 undergraduate nursing
students noted that the majority of the students in the study (77%) were unable to independentlycompletethe steps of the
SBAR model that require clinical judgment (e.g., noticing, interpreting, responding to, and reflecting about patient care
issues). The investigators concluded that although SBAR is an important tool for communicating clinical information, its use
does not effectively promote development of independent clinical judgment in undergraduate nursing students (Lancaster et
al., 2015)

What You Need to Know Before Communicating Using the SBAR Technique
› Knowledge of the importance of effective communication among clinicians for the promotion of patient safety is important
› Understanding of ways in which the SBAR technique improves communication among members of the healthcare team is
important. SBAR improves communication by
• reducing patient safety errors related to miscommunication
• providing clinicians with a script to follow when communicating important patient information (e.g., patient age, weight,
medical history, current signs and symptoms) to be sure it is accurately and appropriately conveyed
• allowing for the communication of information that is easy to follow and provided in a logical sequence
• making communication more efficient
• reducing confusion that results from differences in clinician communication patterns
• standardizing communication in accordance with TJC and IHI standards
› Prior to communicating using the SBAR technique, the nurse should
• review standards for clinician communication as described by TJC, IHI, and facility protocol
–See http://www.jointcommission.org/ for standards related to communication in the healthcare setting
–See http://www.ihi.org/Topics/SBARCommunicationTechnique/Pages/default.aspx for information related to patient
safety and use of the SBAR technique
› Gather needed supplies as follows:
• Patient’s medical record
• SBAR worksheet (if available)
• Ink pen
How To Communicate Using the SBAR Technique
› Obtain an SBAR worksheet or create a worksheet using the SBAR template. Insert key information beneath each subheading
of Situation, Background, Assessment, and Recommendation. This may include information such as the patient’s name,
room number, vital signs, medications, and urgent medical concerns
› Begin communicating by introducing yourself and briefly stating information that is necessary to describe the information
from the Situation subheading
• If making a telephone call, consider stating “Good morning, my name is Nurse Smith from Temple Beth Zion Hospital, and
I am calling regarding your patient Mr. Jones in room number 227…”
• State the situation succinctly (e.g., in less than 10 seconds), for example say
–“The patient has elevated blood pressure and chest pain”
–“The patient refuses a blood transfusion”
–“The patient wishes to be transferred to another room”
› Communicate information from the Background subheading, which consists of background clinical information that
provides context to the rest of the conversation. Include pertinent information about
• the patient’s age, diagnosis, current medical status, and medical history
• the patient’s admission date and treatment received to date
• scheduled laboratory or other diagnostic tests
› Communicate information from the Assessment subheading, which refers to both physical assessment data and your
professional assessment of the situation (i.e., your clinical impression of patient status)
• Communicate the following physical assessment data:
–If the patient has fallen, state whether or not the patient appears injured or complains of pain, and provide information
regarding his/her neurologic status
–If the patient complains of nausea or vomiting, state whether or not he/she has undergone a change in diet or medications
• Communicate details regarding your clinical impression as follows:
–“I believe the patient’s dizziness is related to the recent increase in pain medication”
–“It appears that the nausea is related to the change from a liquid to solid diet”
–“I’m not sure what caused the problem and I would appreciate your input”
› Communicating regarding the Recommendation subheading involves making a recommendation for how the situation
may be addressed. This may include recommending a medication or diet change, diagnostic or laboratory test, referral to
a specialty clinician for consultation, or change in an intervention. Include information related to interventions you have
already performed as follows:
• If the patient complains of inability to sleep, you might request a prescription for a sleep aid and a change in the medication
administration schedule in order to avoid interrupting the patient’s sleep during the night
• If the patient’s CBC is abnormal, you may state that you have already drawn a repeat CBC, and you would like to know if
there are further physician orders
• If a postoperative patient is tolerating a liquid diet with no nausea or vomiting, you might request that his/her diet be
advanced
• If the patient has chest pain, you might state that you have already administered three nitroglycerin tablets with no effect,
and that you recommend a direct patient evaluation
• If the situation is urgent, be clear about what you need (e.g., state “The patient is unstable and I need you to come and
evaluate him now”)
› Document the outcome of the conversation with the clinician, and document information regarding new orders in the portion
of the patient’s medical record that is dedicated to nursing notes. For example, you might document the following:
• “Physician was made aware that the patient has refused a chest X-ray.No new orders were given.”
• “Report given to oncoming nurse. Nurse verbalized understanding of all patient concerns and treatments.”

Other Tests, Treatments, or Procedures That May be Necessary Before or After

Communication Using the SBAR Technique
› Facilitate completion of new interventions that were ordered during the conversation, and confirm that verbal orders are
properly read back to the prescriber and documented in the section of the medical record dedicated to clinician orders (for
details, see Red Flags , below)
What to Expect After Communication Using the SBAR Technique
› The SBAR technique will be used to provide structure for communication among clinicians
› The patient’s healthcare needs will be appropriately addressed and appropriate interventions implemented
› Patient injury related to poor communication will be avoided

Red Flags
› Documenting your communication with other clinicians at the time it occurs is important because discussions about patients
or interventions can quickly be forgotten in a busy clinical environment
› It is essential to clearly document, read back, and sign verbal orders. Inadequate documentation can place the nurse clinician
and healthcare facility at risk for legal liability

What Do I Need to Tell the Patient/Patient’s Family?

› Obtain information from the patient/family members regarding their healthcare expectations. Educate patients regarding how
you will meet their unique healthcare needs and promote their safety

References
1. Andreoli, A., Fancott, C., Velji, K., Baker, G. R., Solway, S., Aimone, E., & Tardif, G. (2010). Using SBAR to communicate falls risk and management in inter-professional
rehabilitation teams. Healthcare Quarterly (Toronto, Ont.), 13, 94-101.
2. Boaro, N., Fancott, C., Baker, R., Velji, K., & Andreoli, A. (2010). Using SBAR to improve communication in interprofessional rehabilitation teams. Journal of Interprofessional
Care, 24(1), 111-114. doi:10.3109/13561820902881601
3. Cornell, P., Gervis, M. T., Yates, L., & Vardaman, J. M. (2013). Improving shift report focus and consistency with the situation, background, assessment, recommendation
protocol. Journal of Nursing Administration, 43(7/8), 422-428. doi:10.1097/NNA.0b013e31829d6303
4. Daniel, L., & N-Wilfong, D. (2014). Empowering interpersonal teams to perform effective handoffs through online simulation education. Critical Care Nursing Quarterly, 37(2),
225-229. doi:10.1097/CNQ.0000000000000023
5. Dunsford, J. (2009). Structured communication: Improving patient safety with SBAR. Nursing for Women's Health, 13(5), 384-390. doi:10.1111/j.1751-486X.2009.01456.x
6. Lancaster, R. J., Westphal, J., & Jambunathan, J. (2015). Using SBAR to promote clinical judgment in undergraduate nursing students. Journal of Nursing Education, 54(3
Suppl), S31-S34. doi:10.3928/01484834-20150218-08
7. Vardaman, J. M., Cornell, P., Gondo, M. B., Amis, J. M., Townsend-Gervis, M., & Thetford, C. (2012). Beyond communication: The role of standardized protocols in a changing
health care environment. Health Care Management Review, 37(1), 88-97. doi:10.1097/HMR.0b013e31821fa503
8. Wacogne, I., & Diwakar, V. (2010). Handover and note-keeping: The SBAR approach. Clinical Risk, 16(5), 173-175. doi:10.1258/cr.2010.010043