Author: Elizabeth C. Kudzma, DNSc, MPH, RNC
Title: Professor, Division of Nursing
Institution: Curry College
Coauthors: Maureen L. Murphy Phd edM CNM, Cathleen C. Santos MSN RN, Linda M. Caldwell DNSc APRN BC
Safety, Teamwork and Collaboration
Clinical Setting, Skills or Simulation Laboratories
Learning Objectives (modified from QSEN):
- Identify effective strategies to reduce reliance on memory
- Initiate requests for help when appropriate to situation
- Develop own communication style
- Examine strategies to support team functioning
- Follow communication practices that minimize risks associated with handoffs among providers and across transitions in care
- Choose communication styles that minimize the risks associated with authority gradients among team members.
Standardized methods of communicating between nurses, physicians and other health care givers promote patient quality and safety. Standardized communication also furthers optimal teamwork among health care providers, reduces human error, and institutes a form of high reliability system. Nurses (and nursing students) should use standardized methods to share what is important about a patient. Nursing students need to be introduced to specialized communication methods early in their nursing program.
Standardized communication improves efficiency because patient information can be discussed in a concise, complete and fairly rapid manner. SBAR stands for Situation, Background, Assessment and Recommendation.
Standardized communication bridges the gap in hand-off communication during changes in shift, patient transfers, and when changes in patient status occur. The Joint Commission on Accreditation of Hospitals has added a statement to Goal 2 in the Patient Safety Goals (2007) that states “implement a standardized approach to hand-off communications, including an opportunity to ask and respond to questions”. Patient transfers and hand-offs are areas of communication/teamwork where less than adequate communication has led to preventable harm to patients. The Institute for Healthcare Improvement has an extensive web site (http://www.ihi.org/IHI/Topics/PatientSafety/SafetyGeneral/Tools/) which contains Techniques for SBAR Communication, Sample SBAR Communication Tools, SBAR Toolkit, and Safety Briefings (an IHI tool). There are case studies and patient scenarios which can be adopted to practice SBAR with students.
The memory cards which we created for student use include SBAR, rights of medication administration and an edited form of rapid response team patient status triggers. At present we begin distribution of the cards in the second semester clinical courses. There is also media for the students to view which illustrates the use of SBAR. The cards have been fashioned for the students as neck tags on breakaway cords, but they can also be prepared as pocket cards. Lanyards with school/ college identification can be used. Many of our collaborating clinical agencies use similar neck tags and pocket cards for graduates and resident physicians. Students will be educated to use the cards to report off, during the clinical day when changes in status are noted, and at every opportunity where concise communication is needed with team members.
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The strategy is discussed in class when the cards are distributed. Students like the neck tag format and the similarity to tags worn by graduate nurses. Students ask many questions about the use of standardized communication, when it is appropriate, and how to use it when there is a change in patient status and in reporting off. The use of the cards emphasizes the importance of concise communication and planning (along with documentation) during “hand-offs” in patient care. The student is required to focus the information they communicate to others and to include all relevant facts which could lead to clinical recommendations. Faculty in various nursing courses have added their comments and modified the information placed on the cards. In the senior clinical practicum, nursing students prior to graduation have the experience of discussing discharge plans with physicians and more opportunities to use the cards. Clinical experiences where the students have used the memory cards in post conferences form a focus for discussion. Test questions, both multiple choice and essay, can be constructed around the use of SBAR in specific clinical scenarios.