SBAR Fail

We had a BIG lapse in communication on the floor recently. A vital patient assessment was communicated incorrectly and the effect was scary. As usual, the lapse was not just one person’s fault, and the whole unit was upset.

Ever played Gossip? It’s a game where a “secret” is whispered into the ear of one person, then that person whispers the info into another person’s ear, ad nauseum, until, at the end, the secret is said aloud and is unrecognizable from the gossip? Well, that’s how things got really messed up for us. The information was floating around but never landed on the right ears–and when it did, it wasn’t even correct!

The problem is that when patient information gets mangled and isn’t passed correctly, nurses and docs get extremely angry AND patient safety is compromised!

You and I don’t have to be extroverts to be good communicators. But as nurses we MUST have good communication skills. On a unit, communication occurs between doctors, nurses and patients all the time. And coming to the nurses station and announcing a piece of information to everyone then letting it just hang there is not considered adequate SBAR.

Oh yeah, so SBAR (Situation-Background-Assessment-Recommendation) is the right way to present patient information, but nurses need some other traits to communicate well–in and out of report. SBAR only works when the nurse:

1.) Sticks to the form and nixes the personal feelings about the patient (example: I really like Patient X. She seems like a good person.) I’d rather form my own opinion of the patient w/out an emotional bias. But please tell me if the patient cussed you out or bit you. That’s relevant to my care. Calling them “crazy” is not.

2.) Listens and answers questions about care. A full report means a nurse gives info and answers questions. It’s ok to say, “I don’t know.” And I want to know if you dropped the ball–i.e. forgot a med, etc. Let’s fix it together.

3.) Makes eye contact, speaks loudly enough and talks to the right person. Those are all without saying, but I have had some situations where a nurse or doc drops the ball in one of these areas and things get ugly, fast!

4.) Finishes the conversation. Dropping SBAR and running, or not finishing report because you’re busy charting, or hanging up the phone before getting/giving the complete story will ruin communication.

5.) Actually gives report to the right nurse at the right time. Have you noticed the trend where nurses don’t give an adequate report at all? I’ve seen nurses hand over their “brain” to another nurse and tell them to “just” read it, or pass report from one nurse to another, then another all within the same shift, but the nurse caring for the patient never gets the full story, or dropped a patient off and not communicate anything at all to anyone! What is up w/ that??

In the end, we nurses are human and screw up, yet we also have those moments where we learn from the mistakes around us or we keep nursing in error. Everything worked out the other night despite our huge snafu, but I hope to incorporate SBAR a little more effectively into my own nursing skills and hope to avoid moments like that in the future.