on the horizon
Add identity to SBAR
By Kim Giselle Cudjoe, BSN, RN
Were often confronted with communication
barriers due to the complexity and diversity
of our healthcare system. Communication
challenges can be a result of human factors,
such as poor communication skills; lack of
resources to support communication training;
lack of support for active communication in
the clinical setting; or an inappropriate envi-
ronment for handoff due to interruptions.
These barriers can threaten patient safety,
negatively affect clinical outcomes, and im-
pede the delivery of quality care.
Effective communication is essential
because it allows us to exchange patient infor-
mation among our colleagues, physicians,
and other members of the multidisciplinary
healthcare team. Successful communication
in the healthcare setting develops therapeutic
nurse-patient relationships, facilitates the
development of team collaboration, reduces
the risks of errors, promotes patient satisfac-
tion and positive clinical outcomes, and
increases the quality of care.
SBAR
One communication tool thats utilized in
the clinical setting is the situation, back-
ground, assessment, and recommendation
(SBAR) technique. Situation represents the
problem thats being reported to the physi-
cian; background is the brief history of the
patient that can help identify the cause of
the problem; assessment refers to the nurses
observations, including symptoms and vital
signs; and recommendation encompasses
the nurses requests of the physician or care
plan suggestions.
The Joint Commission describes SBAR as
the best practice for standardized commu-
nication in healthcare. Nurses use the SBAR
technique to report concise, pertinent, and
complete verbal information when commu-
nicating with physicians, engaging in hand-
offs, and giving nurse-to-nurse shift reports.
Nursing reports and handoffs need to be
performed efficiently because they provide
6 Nursing made Incredibly Easy! January/February 2016
Copyright 2016 Wolters Kluwer Health, Inc. All rights reserved.
us with the opportunity to ask questions,
seek clarification, and confirm information.
SBAR can be especially valuable when
were required to report a critical situation to
physicians in which effective communication
is vital to the patients clinical outcomes and
safety. The main objective of using SBAR is
to verbalize an emergent condition and
receive solution-oriented feedback.
+I
Adding identity to the SBAR acronym
allows you to identify yourself to the re-
ceiver of the information. The use of ISBAR
is impactful because it forms a systematic
framework for effective communication.
Lets take a look at an example.
Identity: Identify yourself, the physician,
and the patient.
Good morning, Dr. Smith. This is Nurse
Kim, RN. Im calling about your patient
Mrs. Jane on 6A, Room 601.
Situation: Clearly describe the current
situation, observations, and concerns.
The patient is complaining of shortness of
breath with worsening upon exertion. Her
oxygen saturation was 88% on room air. She
was placed on supplemental oxygen 2 L via
nasal cannula and her oxygen saturation is
now 92%. Her respirations are 26, pulse is 108,
BP is 95/64, and temperature is 101.2 F. She
has a cough with mucus production thats
green and tinged with blood. She reports chest
pain when coughing as a 7 out of 10 on the
pain scale and feelings of fatigue and anxiety.
Background: Provide a clear and brief pa-
tient background/history.
Mrs. Jane is a 65-year-old female who
was admitted with the diagnosis of
chronic obstructive pulmonary disease ex-
acerbation 4 days ago. Her initial clinical
presentation on admission included persis-
tent dyspnea and chest tightness. She also
had a cough that was producing clear spu-
tum and chest tightness. She was noted
for use of accessory respiratory muscles.
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She received orders for a bronchodilator
every 4 hours, oral corticosteroid, oxime-
try monitoring, and supplemental oxygen
for an oxygen saturation of less than 92%.
She has been on enoxaparin for deep vein
thrombosis prophylaxis.
Assessment: Whats your assessment?
I think Mrs. Jane is exhibiting symptoms
that may be associated with pneumonia.
Recommendation: Give your recommen-
dations and state any requests.
Dr. Smith, will you be coming to see the
patient? Would you like me to contact ra-
diology for a stat chest X-ray? Should I ini-
tiate an I.V. for antibiotic infusion?
The ISBAR technique is an important
practice that needs to be adopted within
the healthcare industry, as well as intro-
duced in nursing schools, to prevent
communication gaps, promote complete
communication through patient handoffs
and transitions of care, and maintain suc-
cessfully sustained communication through-
out the care continuum.
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Copyright 2016 Wolters Kluwer Health, Inc. All rights reserved.
Highest standards
Conversation thats standardized and struc-
tured can improve communication, build
collaboration and collegiality, improve clinical
outcomes and patient satisfaction, facilitate
the continuity of care, and promote patient
safety. Consider incorporating ISBAR into
your practice today.
REFERENCES
Agency for Healthcare Research and Quality. Pocket
guide: TeamSTEPPS. www.ahrq.gov/professionals/educa-
tion/curriculum-tools/teamstepps/instructor/essentials/
pocketguide.html#.
Cairns LL, Dudjak LA, Hoffmann RL, Lorenz HL.
Utilizing bedside shift report to improve the effectiveness
of shift handoff. J Nurs Adm. 2013;43(3):160-165.
Labson M. SBARa powerful tool to help improve com-
munication! www.jointcommission.org/At_home_with_
the_joint_commission/sbar_%E2%80%93_a_powerful_
tool_to_help_improve_communication/.
Ortega L, Parsh B. Improving change-of-shift report.
Nursing. 2013;43(2):68.
Kim Giselle Cudjoe is an RN, Utilization Management, at Tennessee Valley
Healthcare System Department of Veterans Affairs in Nashville, Tenn.
The author has disclosed no financial relationships related to this article.
DOI-10.1097/01.NME.0000475212.01090.46
January/February 2016 Nursing made Incredibly Easy! 7