A team of Kean University graduate nursing students has adapted and applied a communication tool initially developed by the military to standardize and streamline end-of-shift reporting.
The evidence-based method, SBAR, stands for Situation, Background, Assessment, and Recommendation. It was designed to provide the most critical information in the shortest amount of time. Although it is currently used in the healthcare industry, it has already been applied in other sectors, such as emergency services.
The students, all of whom are practicing nurses, would employ the method during end-of-shift reporting to target an all-too-familiar problem.
"Many times, nurses are challenged with the kind of information to tell and how to organize it during the end-of-shift report," said Juanita Ormilon, RNC, BSN, MSN, staff nurse in the neonatal ICU at the University of Medicine and Dentistry of New Jersey. "Personally, in my own experience, many times the reports are missing information. [For example,] I was supposed to be told about procedures that were supposed to be done or follow-up to lab work."
Oftentimes, communication breakdowns have dire consequences, added Bertha Uka, RN, MSN, BSN, clinical nurse coordinator in the med/surg unit at the East Orange Campus of the VA New Jersey Health Care System. "Gaps in communication can lead to serious breakdowns in the continuity of nursing care, inappropriate treatment, and potential harm to the patients."
Because of a lack of a standardized, end-of-shift reporting method in the healthcare industry, The Joint Commission identified the development of such a technique as a key process for assuring patient safety, the nurses explained.
The students' method, which was honed by Ormilon, Uka, and fellow students Marie Delva, RN, MSN, BSN, and Eileen Gabayeron, CCRN, MSN, BSN, during their final semester of master's level coursework, was piloted this past spring in the med/surg unit at East Orange.
"Initially, the 15 nurses at East Orange piloting the program did not like the students' technique," Ormilon said. "But as they went through the six-week period, the nurses who were involved said it was a much better system,? Ormilon says. ?They said they were not scouring for information to tell the next shift."
That's because the standardized form encompasses and categorizes each patient's vital information, said Delva, a triage nurse in East Orange's outpatient primary care group. "It does make nurses more accurate in their communication [and] more precise because you get straight to the point."
Furthermore, Delva added that since SBAR aims for brevity, nurses using the method spend less time creating and transmitting reports and more time caring for patients.
SBAR's organization scheme breaks down into sections:
SITUATION: Patient's name, age, diagnosis, chief complaint, medications and allergies
BACKGROUND: Medical history
ASSESSMENT: Observations, such as bowel sounds, lung clarity, current IV lines
RECOMMENDATION: The patient's care plan
"It's six lines, can be done at the door or bedside, [and is] quick and easy to understand," said Gabayeron, who works in the endoscopy unit at East Orange. "Before this, the report [was] long, and the nurse might not know which specific information to concentrate on, but this SBAR is unit specific. If you were to give information to the recovery room, there are specific areas to concentrate on than if you were to give information to the ICU."
That's a dramatic shift from current practice, which varies widely from unit to unit and nurse to nurse.
"[The practice] is highly individual between nurses," explained the students' instructor and project adviser, Constance Patten, RN, BSN, MA, MPA, EdD. "[SBAR] is a specific standard format to make sure all of the pertinent and the most accurate information is communicated from nurse to nurse. They have a format to follow and are more apt to communicating all of the necessary information. As you can imagine, change of shift reporting can be distracting."
"On a broader level, besides effective communication, if all of the right information is communicated, hopefully, medical errors are reduced, falls are reduced, [and] pressure ulcers are reduced," Patten added.
Because the students had less than three months to develop, implement, and assess the project, data on error reduction could not be gathered and analyzed.
The method also helped improve interpersonal relationships among the nurses who participated. "I feel the project not only helps nurses communicate, but it also improves co-worker relationships because you know you're being given accurate information and you know the patient was handled accurately," Delva said. For the newer nurses especially, it helped them better organize their information and follow up."
In addition, SBAR's designation of a specific place for the incoming nurse to ask questions of the outgoing nurse eliminates issues of competence that could come up. "Before when you asked questions, they might get angry or upset because they feel like you're questioning their integrity or knowledge," Uka said. "Using SBAR, everyone knows that when you're asking questions, it's not because you're trying to find out what they do or do not know. It's part of the process."
Although the students hope to see the process eventually instituted on a much grander scale, the acquiescence of their method by their colleagues is an important first step. "It's good to learn that with the help of your superiors, you're able to do things to improve practice," Gabayeron said. "As a student, I feel good knowing there is something I can do."
