Author: Wendeline Grbach, MSN, RN, CCRN, CLNC
Title: Curriculum Developer for Simulation Education
Institution: UPMC Shadyside School of Nursing
Coauthors: Lizbeth Vincent, RN, MSN, CEN; Deborah Struth, MSN, RN
(Slight modifications of QSEN Competencies) 1) Adopt and practice communication techniques focused on patient safety. 2) Use appropriate strategies to reduce reliance on memory. 3) Demonstrate effective use of strategies to reduce risk of harm to patients or self 4) Utilize standardized communication formats to minimize risk at care transitions/handoffs 5) Develop collaborative team communication practices which focus on patient safety 6) Examine nursing roles in assuring coordination, integration, and continuity of care.
SBAR is a standardized communication format widely used in education and healthcare arenas to enhance patient safety and quality care delivery. Recent adaptation of SBAR-R (Situation, Background, Assessment, Recommendation and Readback) has been utilized in the curriculum at UPMC Shadyside School of Nursing for the past year to reinforce Joint Commission on Accreditation of Hospitals (JCAHO) initiatives regarding safety practices; this includes the 2007 update to Patient Safety Goal #2, indicating “Implementation of a standardized approach to handoff communications, including the opportunity to ask and respond to questions”. Students participated in varied levels of simulation exercises in which they practice the SBAR-R communication techniques. However, in some instances we found that the most basic of communications when initiating care of a patient were being neglected…identification of the nurse/healthcare provider as well as the patient. Students were videotaped during simulation exercises and upon debriefing review recognized this error. To promote safe practice, we have adapted SBAR to the I-SBAR-R format, indicating Identification of yourself and your patient (2 identifiers to be used), standard SBAR and finally Readback. The strategy is introduced in fundamental nursing courses and is implemented throughout the curriculum and clinical experiences via faculty and student education for reinforcement. Students are provided laminated pocket cards with the SBAR format for ease of reference. Clinical communications related to shift report, condition changes, or physician requests are formulated using the I-SBAR-R format. Simulated and observational experiences will continue to enhance the correct procedures so that upon transition to employment, the use of the mnemonic will be ingrained in the student/graduate nurse care delivery processes.
We have implemented pocket reference SBAR cards which will be adapted to the new I-SBAR-R format. Handouts regarding this initiative are given in fundamental nursing courses.
Students are participating in continued scenario work and case study opportunities to refine the I-SBAR-R techniques in the fundamentals as well as Complex Health Nursing (Senior level Critical Care) courses. Through simulation and debfriefing sessions where the students reviewed their performances, they self-identified that the I-SBAR-R was deficient and they improved on this in successive scenarios. Students related more comfort with increased reinforcement of the mnemonic and being able to communicate with other health team providers by practice sessions in the simulator setting.