SBAR: A solution to shift report problems?

By Kadera Ferguson, Brittany Kurtz, Janae McGallicher and Aimie Terry

Mission Moment

In adult medical-surgical patients, does the use of SBAR by nurses in the shift change report improve communication between nurses and patient outcomes, compared to not using a shift change reporting tool?

PICO Question

Research information

● Search databases: EBSCOhost, Cochrane, Joanna Briggs Institute, Pubmed, JSTOR

● Search terms: nurse to nurse communication, SBAR, Communication tools, shift report, nursing shift report, handoff communication

● Number of articles accessed: 24

● Number of articles reviewed: 8

S - SituationB - BackgroundA - AssessmentR - Recommendation

Commonly used as a communication tool to report a change in patient status or other concern from nursing to other departments (physicians, pharmacy, etc.) (Cornell, Townsend-Gervis, Yates, & Vardaman, 2013).

SBAR

Other Definitions

shift report - the transfer of information from one nurse to another about patients at change of shift in order to provide safe, quality patient care (Poletick & Holly, 2010)

• Other names may include: handoff report, nurse to nurse report, handover report and sign-off

There are many ways in which the practice of shift report or handoff is performed in different settings. These include: (Staggers & Blaz, 2012)

● bed side handoff● taped verbal handoff● verbal handoff with print supplement● electronic templates with verbal handoff

Some of the common issues with handoff report include: (Cornell, Townsend-Gervis, Yates, & Vardaman, 2013)

● ambiguous information (unclear, unnecessary)● lack of key information (missing or forgotten)● unstructured ● time consuming

Current Practice and Common Complaints

● This method of handoff shift report has improved accountability and the critical thinking approach to events(Boaro et al., 2010).

● Use of the tool helps nurses to relay information in an objective and professional manner while increasing their ability to justify the recommendations chosen (Boaro et al., 2010).

○ Handoff communication becomes more comprehensive and decreases human error.

● Increased nurse confidence in relaying information (Ardoin & Broussard, 2011).

Research Findings

● The nurse spent less time writing information and more time providing patient care and critically thinking about the patient progression Cornell, Townsend-Gervis, Yates, & Vardaman, 2014).

● SBAR decreases the overall time nurses spent on shift report, indicating a more focused process of information transfer (Cornell, et al., 2014).

● SBAR levels the playing field for all nurses regardless of their level of experience (Cornell, et al., 2014).

Research Findings cont.

● Implementation of an SBAR shift report tool resulted in:○ greater focus and consistency of nursing shift reports (Cornell et al., 2013).○ increased nurse to nurse communication and decreased amount of transcribing

occurred when a print form of SBAR was provided.

● SBAR reduced adverse events and drug events (Haig, Sutton, & Whittington, 2006).

● SBAR decreases the amount of unexpected deaths (Meester, Verspuy, Monsieurs, & Van Bogaert, 2013).

Research Findings cont.

● In order to facilitate change within a unit, helpful encouragement and reminders should be placed throughout the unit. This could include:

○ Placing SBAR posters in the nursing station○ Adhering SBAR stickers on telephones○ Encouraging peer practice and observation with the use of SBAR (Ardoin &

Broussard, 2011).

● An electronic SBAR tool would help decrease the amount of transcribed information and allow for more verbal dialogue between nurses at shift report (Cornell et al., 2013).

● Before implementing change, a pilot study with a small group of nurses should be conducted in order to test the feasibility of using SBAR during shift handoffs (Ardoin & Broussard, 2011).

Recommendations .

● Expand the use of SBAR from simply a nurse-physician communication process to a tool for nursing shift report (Cornell et al., 2014)

○ helps to accomplish The Joint Commission communication goals, as process consistency and standardization are major pillars of the recommendations (Cornell et al., 2013).

● Physicians should be educated in the use of SBAR and critical thinking to promote better communication with nurses (Meester et al., 2013).

● Further higher level quantitative research should be conducted about using SBAR during nurse-to-nurse shift handoffs (Staggers & Blaz, 2012).

Recommendations cont.

SBAR TOOLS

From http://links.lww.com/JONA/A240

PICO: In adult medical-surgical patients, does the use of SBAR by nurses in the shift change report improve communication between nurses and improve patient outcomes as opposed to not using a shift change reporting tool?

• Current practice includes a variety of shift report tools and styles, with varying levels of effectiveness

• Research findings have supported the use of SBAR during shift handoff with the benefits of

• organized and consistent reports• effective use of report time• improved nurse to nurse communication

• Recommendations based on research are to advocate for the adoption of SBAR into clinical practice, taking into account the unique dynamics and function of each unit.

Conclusion

• Ardoin, K. B. & Broussard, L. (2011). Implementing handoff communication. Journal for Nurses in Staff Development, 27 (3). http://0-dx.doi.org/.alvin.iii.com/10.1097/NND.0b013e318217b3dd

• 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. http://dx.doi.org/10.3109/13561820902881601

• Cornell, P., Townsend Gervis, M., Yates, L., & Vardaman, J.M. (2013). Improving shift report focus and consistency with the situation, background, assessment and recommendation protocol. The Journal of Nursing Administration, 43(7/8), 422-428. http://dx.doi.org/10.1097/NNA.0b013e31829d6303

• Cornell, P., Townsend Gervis, M., Yates, L., & Vardaman, J. M. (2014). Impact of SBAR on nurse shift reports and staff rounding. MEDSURG Nursing, 23(5), 334-342. http://www.ajj.com/services/pblshng/msnj/default.htm

• De Meester, K., Verspuy, M., Monsieurs, K. G., & Van Bogaert, P. (2013). SBAR improves nurse–physician communication and reduces unexpected death: A pre and post intervention study. Resuscitation, 84(9), 1192-1196. doi:http://dx.doi.org.ezproxy.hacc.edu/10.1016/j.resuscitation.2013.03.016

References

• Haig, K. M., Sutton, S., & Whittington, J. (2006). National patient safety goals. SBAR: A shared mental model for improving communication between clinicians. Joint Commission Journal on Quality & Patient Safety, 32(3), 167-175. http://www.jcrinc.com/subscribers/journal.asp?durki=463

• Poletick, E. & Holly, C. (2010). A Systematic review of nurses’ inter-shift handoff reports in acute care hospitals. JBI Library of Systematic Reviews. 8(4), 121-172. http://0-ovidsp.tx.ovid.com.alvin.iii.com/

• Staggers, N. & Blaz, J.(2012). Research on nursing handoffs for medical and surgical settings: an integrative review. Journal of Advanced Nursing, 69(2), 247-262. http://dx.doi.org/10.1111/j.1365-2648.2012.06987.x.

References Cont.