S.B.A.R.
S.B.A.R. stands for stands for Situation, Background, Assessment, Recommendation, and it is a communication technique we use for documentation and communication.
Situation:
What is it? This is the immediate issue or problem we identified.
Purpose: To provide a concise statement describing the current situation.
Examples:
- "The patient is experiencing difficulty in breathing."
- "Mr. Smith's blood pressure has dropped significantly since the last measurement."
Background:
What is it? This is the context or background information relevant to the situation.
Purpose: To give a brief overview of pertinent clinical information leading up to the current situation.
Examples:
- "The patient has a history of asthma and forgot to take their inhaler today."
- "Mr. Smith had surgery earlier this morning and was on antihypertensive medication."
Assessment:
What is it? This is the nurse's assessment of the situation.
Purpose: To present an analysis or synthesis of the problem based on the current data available.
Examples:
- "I believe the patient is having an asthma attack."
- "It seems like Mr. Smith's drop in blood pressure is related to a combination of his surgery and his medication."
Recommendation:
What is it? This is what the nurse recommends as the next steps.
Purpose: To provide guidance on how to manage the patient's situation or problem.
Examples:
- "I recommend giving the patient a bronchodilator immediately."
- "We might need to adjust Mr. Smith's antihypertensive dosage or administer a vasopressor."
SBAR Communication Exercise: Post-op Complications
Imagine you're a nurse on a medical-surgical floor. Think about how you would communicate the following situation to the prescribing doctor using the S.B.A.R. method. Uee the S.B.A.R. below and write your own in first person
Situation
You've just completed a routine assessment on Mr. Smith, a 65-year-old post-operative patient from a recent knee replacement surgery. You've noticed that he is increasingly short of breath and his oxygen saturation has dropped to 88% on room air (as a side note: 88% SpO2 would be scored as 3 points on the NEWS2 scale).
Background
Mr. Smith was admitted to the hospital two days ago after a successful knee replacement. His post-op period has been uneventful until now. He has a history of COPD but hasn't required supplemental oxygen during his stay.
Assessment
Upon your assessment, you found that he's using accessory muscles to breathe (this are the muscles situated between the ribs), has bilateral crackles on lung auscultation, and appears anxious. His vital signs are stable except for the decreased oxygen saturation.
Recommendation
You recommend that Mr. Smith be placed on supplemental oxygen and possibly have a chest X-ray ordered to rule out any post-operative complications like a pulmonary embolism or pneumonia. You'd also like the doctor to review his current medications and consider if any changes are required.
Sample S.B.A.R. Communication:
Situation: I've just assessed Mr. Smith, our post-op knee replacement patient in Room 5. He's increasingly short of breath and his O2 saturation has dropped to 88% on room air.
Background: He had his surgery two days ago and has been doing well. He has a history of COPD but hasn't needed any supplemental oxygen during this stay.
Assessment: He's using accessory muscles to breathe, has bilateral crackles in his lungs, and appears anxious. His other vital signs are stable.
Recommendation: I think we should place him on supplemental oxygen and consider a chest X-ray to check for post-op complications. A review of his current medications might also be beneficial.
SBAR Communication Exercise: Cardiac Concerns
Imagine you're a nurse in the cardiology department. Think about how you would communicate the following situation to the cardiologist using the S.B.A.R. method. Use the S.B.A.R. format below and draft write your own in first person.
Situation
You're caring for Mrs. Johnson, an 82-year-old female who was admitted for observation after a fainting episode at home. She has been complaining of intermittent chest pain since last night.
Background
Mrs. Johnson was admitted to the cardiology department 24 hours ago after she fainted while getting up from her bed. She has a history of hypertension and was diagnosed with atrial fibrillation (AFib) three years ago. She is on medication for both conditions. Her previous ECGs have shown non-sustained ventricular tachycardia.
Assessment
On your latest check, her blood pressure is lower than her baseline, and she describes her chest pain as a "tight squeezing" sensation that comes and goes. She also mentions feeling dizzy at times. An ECG taken an hour ago shows occasional premature ventricular contractions (PVCs).
Recommendation
Given her symptoms and history, you believe Mrs. Johnson might be experiencing a cardiac event or a side effect from her medications. You feel it's crucial for the cardiologist to assess her immediately, consider a medication review, and possibly order further diagnostic tests like an echocardiogram or a stress test.
Sample S.B.A.R. Communication:
Situation: I'm caring for Mrs. Johnson, an 82-year-old in the cardiology ward. She's been having intermittent chest pain since last night and had a fainting episode at home.
Background: She was admitted 24 hours ago after the fainting incident. She has a history of hypertension and AFib and is on medications for both. Previous ECGs showed non-sustained ventricular tachycardia.
Assessment: Her blood pressure is currently lower than her baseline. She describes her chest pain as a squeezing sensation and has mentioned feeling dizzy. The recent ECG shows occasional PVCs.
Recommendation: I believe she might be having a cardiac event or medication side effects. I recommend an immediate assessment by the cardiologist, a medication review, and possibly further diagnostic tests.
SBAR Handover Exercise: Neurological Changes
Imagine you're a nurse in the neurology department, and your shift is ending very soon, and all this is happening as you are about to give a handover. You need to hand over the care of Mr. Stormzy to the incoming nurse. Use the S.B.A.R. format below to draft your handover report.
Situation
Mr. Stormzy, a 28-year-old male, was admitted three days ago following a minor motor vehicle accident. Over the past 12 hours, he has shown subtle but progressive neurological changes, warranting a heightened level of care and observation.
Background
He was initially here for observation due to a minor concussion with CT scans that were clear. He was set for discharge today, but he began complaining of severe headaches, and there have been noticeable behavioural changes. Initial neurological checks were set at 4-hour intervals.
Assessment
He's become increasingly disoriented to time. His pupils are unequal with the left being larger, and they have a sluggish reaction to light. He struggles with instructions and shows signs of agitation. While his motor strength remains intact, there's a noticeable tremor in his left hand. His blood pressure is also rising. Given these findings, I've started doing the neurological checks every 30 minutes.
Recommendation
Given the significant changes in his neurological status, you think a repeat CT scan should be order as soon as possible to rule out potential complications, such as a slow bleed or swelling that wasn't evident on the initial scan. It's crucial to investigate the CT results closely and be ready for any interventions if needed. You concluded that it is necessary to decrease the intervals for neurological checks to every 15 minutes until the CT results are available and then adjust based on the findings. Perhaps find somebody to assist with the checks, as there are other patients to monitor as well.
Sample S.B.A.R. Handover:
Situation: Mr. Stormzy, our 28-year-old patient in Room 12, has shown significant neurological changes in the last 12 hours.
Background: He was admitted three days ago after a minor accident. Initial neurological checks were every 4 hours. He was due for discharge today, but he's started having severe headaches and behavioural changes.
Assessment: He's disoriented, has unequal pupils, struggles with instructions, and has a tremor in his left hand. I've increased the frequency of neurological checks to every 30 minutes due to these changes.
Recommendation: I strongly recommend an immediate repeat CT scan to rule out potential complications. I also recommend increasing the frequency of neurological checks to every 15 minutes until we have the CT results, and then adjust based on the findings. I also suggest enlisting the help of a health care assistance band 3, or perhaps a nurse student, who is trained to carry on Neurological Monitoring (Glasgow Coma Scale (GCS), Pupillary Response, Neurological Checks, Behavioural and Cognitive Monitoring).