This article will focus on using the SBAR handover as an effective communication tool. The SBAR (Situation, Background, Assessment, Recommendation) tool is used by all nursing fields within primary and secondary healthcare environments to aid patient safety (NHS Improvement, 2018).
Communication in nursing
Acts of communication through handovers, ward rounds, shift exchanges and team meetings are examples of when information is exchanged between nurses and between nurses and other health professionals. Communication is one of the 6Cs, and is recognised as a fundamental aspect of nursing practice and as an essential interprofessional skill that has the power to influence team interplay and patient safety (NHS England, 2016; Nursing and Midwifery Council, 2018; Herawati et al, 2018; Park et al, 2019).
An episode of communication, specifically in a patient handover, is the point where critical clinical information is passed between health professionals (Ballantyne, 2017; Park et al, 2019). Ineffective communication in nursing has been linked in research to clinical errors, delays in diagnosis and patient dissatisfaction (Frain, 2018; Royal College of Nursing, 2019).
Communication as a social activity, regardless of its context—whether face to face, over the phone or in writing—has two premises (Bach and Grant, 2011). The first premise is that communication involves a sender and a receiver, the second is that the sender and the receiver interact to exchange verbal and non-verbal information (Bach and Grant, 2011; Park et al, 2019). Although it may seem simple, communication in nursing is not, with multiple potential barriers to disrupt and interfere with the sender and the receiver (Box 1).
Box 1.Barriers to effective communication in nursing
- Accents/other languages
- Medical jargon/language
- Background noise
- Communication styles
- Distractions
- Time
- Poor telephone connection
- Not using a structured approach
- Lack of confidence
- Hierarchy
Source: Park et al, 2019
These communication barriers can be overcome and/or reduced by the use of a consistent structured communication tool (Abela-Dimech and Vuksic, 2018). Tools such as the SBAR tool improve the quality of episodes of communication, including handovers, as the tool enables thoughts to be standardised through applying a structured approach to sharing information (Renz et al, 2013; Dougherty and Lister, 2015). This process bridges the gap between different communication styles (Achrekar et al, 2016), allowing patient information to be delivered and received successfully (Ballantyne, 2017).
The SBAR handover
Using the SBAR communication tool is recommended practice in multiple professional contexts (including in healthcare, the military and aviation) (World Health Organization, 2007; van der Wulp et al, 2019). The tool was developed by the US navy and adapted for health care by Kaiser Permanente, a rapid-response team in the, USA (Achrekar et al, 2016; NHS Improvement, 2018). Evaluations have found it to be effective in reducing clinical errors (Ting et al, 2017; Yu and Kang, 2017; Abela-Dimech and Vuksic, 2018).
The SBAR handover tool can be used over the phone, face to face and through documentation. The SBAR tool consists of four sections, with each section made up of a set of predetermined structured parts (Park et al, 2019). This structured approach provides a process that is easy to follow and one that is designed to help nurses to prepare for episodes of communication. It acts as a checklist, reducing information overload and allowing the information shared to be focused, factual, clear and without repetition (Yu and Kang, 2017; Park et al, 2019). In addition, standardising handover practices provides nurses and other health professionals with confidence (van der Wulp et al, 2019) as it streamlines information exchange, and acts as a prompt for the patient information one should expect (NHS Institute for Innovation and Improvement, 2010).
Tips for using the SBAR handover
Tips for each of the four sections within the SBAR handover are outlined below (Park et al, 2019) and in Figure 1 and Box 2.
Box 2.Preparing for an SBAR handover
- Practise your SBAR handover beforehand
- Use the tool in order. Do not jump between sections (do not give information on assessment before the background information has been given, for example)
- Give yourself enough time
- Write down the information you want to include
- Check your environment is appropriate (ie free from disruptive noise and distractions)
- Do not be frightened to ask for information to be repeated or clarified
Source: Park et al, 2019
Situation
Clearly state the following:
- Your full name and profession. Multiple individuals from the same professional group working in the same setting may have the same or similar first name (such as Laura, Lauren, Lara, Lorna). Therefore, to reduce any potential confusion, ensure your full name and designation is given, for example, Laura Park, staff nurse
- If you are handing over/transferring a patient to a different location do not forget to give your current location—ward number/name and or department name
- Provide the patient's details, ensuring the patient's full name and age is given. The rationale for handing over information also needs to be given, for example because you are transferring the patient to another location or you are concerned about the patient's condition. For example, ‘I'm Laura Park, a staff nurse from ward 1 and I'm handing over Jill Smith, a 76-year-old female. I am concerned about her as she has a National Early Warning Score of 9.’
Background
You need to be clear and concise about the patient information that needs to be shared:
- Here you need to focus on what information is important and relevant for the current situation and thus requires sharing. Information overload can lead to fragmented handovers. Not all past medical history may be relevant. In the case of Mrs Smith, providing information on her broken arm when she was 60 may not be relevant to this admission. An example of information to provide for the background part would include ‘Mrs Smith was admitted today, she is normally fit and well. She saw her GP 2 weeks ago where she was diagnosed with a urinary tract infection and prescribed oral antibiotics.’
Assessment
The following needs to be clearly stated:
- The patient's current condition as well as their normal health status. If this includes their vital observations, ensure you include a full set and that you include both the patient's latest set and the ones documented before a change in their condition occurred. For example, ‘Mrs Smith was alert on admission 1 hour ago with all observations in the normal range except temperature at 37.1. She is now confused. Her observations are: BP: 90/58, pulse: 117, Sp02: 94%, temperature: 38.0, respirations: 22’
- Here you may also state what you think the problem is. However, do not feel pressured to provide this. If you do not know what is wrong with the patient, simply say that. For example, ‘Mrs Smith may be septic.’
Recommendation
For the final section, tips include:
- Be clear in what you want/need from the professional you are handing over to. For example ‘Mrs Smith needs to be reviewed in the next 15 minutes’
- If information or a request/recommendation is given to you, repeat the request back to the professional giving the recommendation. Ask them for their full name and professional designation
- Take notes if needed (Park et al, 2019).
LEARNING OUTCOMES
- Understand that there is a strong link between communication and clinical outcomes—ineffective communication during handovers is one of the leading causes of patient harm
- Know how to use the SBAR handover tool to reduce these risks by adding structure and consistency to the content of clinical nursing handovers