SBAR in long-term care: a quality improvement initiative

Abstract

Background: The Situation-Background-Assessment-Recommendation (SBAR) tool was adapted by hospitals from the United States Navy in the late 1990s to improve communication during critical situations. SBAR is regularly used in the hospital setting, but its applicability to long-term care is often underutilized. Local Problem: At a 135-bed long-term care facility, there is no institutionally endorsed standard of communication between nurses and providers. Providers receive instant-messaging style communications from nursing staff that often lack structure and pertinent clinical information. An incomplete clinical picture increases the need for clarification, causing delays to patient care. Communication barriers serve as a source of frustration for nurses and providers. Methods: An interdisciplinary approach was used to develop an educational template that was incorporated into the facility's nursing orientation material. Attendance at staff huddles and face-to-face discussions with floor nurses provided education and introduced SBAR as the standard for nurse-provider communication. The Jefferson Scale of Attitudes Towards Nurse and Physician Collaboration (JSAPNC) measured staff satisfaction regarding interdisciplinary collaboration. SBAR utilization was monitored through regular audits of patient progress notes. Results: No statistically significant change was found in JSAPNC scores pre- and post-intervention; post-intervention rates did not meet the long-term goal of 75% utilization of SBAR for nurse-provider communication. Conclusion: Introductory and regularly interval education fosters high-fidelity use of SBAR, but the impact of SBAR utilization on nurse and provider satisfaction with interdisciplinary communication was indeterminate and requires further study.