SBAR Tool Adds Structure to ICU Communication

A North Carolina hospital improved communication and collaboration between nurses and advanced practice providers (APPs) in an intensive care unit (ICU), with a template to convey important data in a clear, concise and logical way.

“Implementing a Standardized Communication Tool in an Intensive Care Unit” details how Duke University Medical Center, Durham, North Carolina, developed a quality improvement project to address the absence of a standardized method for nurses and APPs to share clinical data and patient updates. The article is published in the June issue of Critical Care Nurse (CCN).

Co-author Margaret Murphy, MSN, ACNP, CCNS, CCRN-CSC, is one of the team leaders for APPs in the hospital’s 32-bed adult ICU for patients recovering from a variety of cardiac, aortic, lung and esophageal surgical procedures. The ICU has a staff of approximately 180 direct care nurses, 20 intensivists, 20 APPs, 10 core team respiratory therapists and two primary pharmacists.

“Poor communication can have dire consequences in an ICU, putting patients’ safety at risk because of incomplete, inaccurate or delayed information about their condition,” Murphy said. “Effective communication is imperative to the delivery of high-quality care, especially in critical care settings.”

The team selected the SBAR (Situation, Background, Assessment, Recommendation) tool, which has been shown to reduce the incidence of adverse events in hospital settings. The SBAR communication framework is designed to facilitate the concise transfer of information and rapid decision-making that occur frequently in critical care.

The team used SBAR materials from the comprehensive patient safety essentials toolkit from the Institute for Healthcare Improvement, which is freely available online for public use.

The intervention began with educating the staff on the SBAR tool. Doing so required presentations at approximately 15 staff meetings for nurses and one staff meeting for APPs. The presentation was also provided electronically to all nursing and APP staff members.

Simple outlines of the tool were made into laminated signs, with smaller versions to wear on lanyards. Educational flyers with common SBAR patient scenarios were placed throughout the unit to further encourage use of the tool.

One of the ICU nurses was already familiar with the SBAR communication framework and became a designated project champion to reinforce the education and serve as a role model for using the SBAR tool in clinical practice. During implementation, other staff members became informal champions of the project, and members of the nursing leadership became actively engaged in sharing the resources to nurse preceptors, nurse orientees and staff nurses.

A 12-item survey measured staff perceptions of the quality of communication and collaboration between the two professional groups, before the intervention and again three months after implementation. The survey also collected demographic information, including years of experience, length of employment in the ICU and any prior experience with the SBAR tool.

A total of 24 APPs and 200 nurses participated in the project. The survey results found a significant increase in the percentage of nurses using the SBAR tool after the intervention (95%) compared with before the intervention (66%).

In addition, scores related to General Perceptions and Open Communication improved for both groups. Nurses and APPs alike reported a significant increase in their confidence in the accuracy and completeness of data being reported.

“Enhanced communication and collaboration contributed to an improved sense of teamwork within the unit and even enjoyment in working together,” Murphy said. “Participants were eager to improve their communication skills, and this project provided them with a standardized method that had been missing from their clinical practice.

Throughout the project, APPs role-played clinical scenarios with nurses and provided ongoing feedback and encouragement. Nurses and APPs were observed using the SBAR tool with physicians, which was an unexpected positive outcome beyond the goals of the project. In addition, respiratory therapists requested SBAR education for their team.

Based on the results of the project, the SBAR education is being embedded into orientation programs and materials for nurses and APPs and integrated into the culture of the ICU.  They are exploring expanding SBAR education and implementation to other members of the ICU team, including intensivists, fellows, respiratory therapists and pharmacists. The resources are also being shared with other units of the hospital and care settings.

As the American Association of Critical-Care Nurses’ bimonthly clinical practice journal for acute and critical care nurses, CCN is a trusted source of information related to the bedside care of critically and acutely ill patients.

Access the article abstract and full-text PDF by visiting the CCN website at http://ccn.aacnjournals.org.

About Critical Care Nurse: Critical Care Nurse (CCN), a bimonthly clinical practice journal published by the American Association of Critical-Care Nurses, provides current, relevant and useful information about the bedside care of critically and acutely ill patients. The award-winning journal also offers columns on traditional and emerging issues across the spectrum of critical care, keeping critical care nurses informed on topics that affect their practice in acute, progressive and critical care settings. CCN enjoys a circulation of more than 130,000 and can be accessed at http://ccn.aacnjournals.org/.

About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with more than 130,000 members and over 200 chapters in the United States.

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