We like what we are hearing about SBAR use in nursing homes.  INTERACT’s SBAR (stands for Situation, Background, Assessment, and Request) prompts nurses to collect comprehensive information about a resident’s change in condition in advance of calling a doctor to report the change.  With all the information handy on the SBAR, the nurse is prepared to make a comprehensive report, which in turns helps the doctor make informed clinical decisions.  This exchange can lead to better, more timely care for residents and sometimes prevent the need for hospital and emergency department transfers.

Nursing Homes and Physicians Like SBAR

During our October and November bootcamp calls, several nursing homes reported that the SBAR is working better than intended in their facilities.  While it does all of the above, it also empowers nurses by better preparing them for calls to the physicians.

“We love it,” reported one nurse supervisor, “and the doctors like it, too.”  She  noted that one physician commented that the facility’s nurses were communicating better since SBAR was adopted.

Other nursing homes report similar outcomes.  One director of nursing described the SBAR as “very user friendly.”  Previously, she said, her nursing home did not use anything like the SBAR, but the form is now being used throughout the facility.  “Things could not be going better,” she said, adding that her nurses now receive positive comments from physicians, who have thanked the staff for “making their jobs easier.”

Another nurse observed that when nurses complete an SBAR and communicate more knowledgably about residents in calls to physicians, then physicians gain confidence in the staff’s care management and are more willing to forego a transfer and instead let residents continue to receive care in the nursing home.  She cited this dynamic as one reason transfers have fallen in her nursing home since the SBAR was adopted.

SBAR Implementation Tips

What SBAR implementation strategies have nursing homes used?  In our coaching calls, nursing homes reported the following tips:

• Physician Buy-In: Introduce SBAR not only to nurses but also to the facility’s physicians.  Physicians can encourage nurse use of the SBAR by providing positive feedback, as described earlier.  They can also help hold nurses accountable for completing SBARs.  One nursing home instructed physicians to ask any nurse that called before completing an SBAR to hang-up, complete the SBAR, and then call back.  Nurses quickly learned to complete SBARs in advance to avoid delays in care.

•  Care Paths and Change-in-Condition Cards: Introduce INTERACT’s care paths and Change-in-Condition cards along with SBAR.  The care paths (for seven conditions that commonly lead to hospitalizations) can help nurses complete thorough resident assessments in advance of calling the doctor.  The Change-in-Condition cards are a handy reference tool for determining when to call the doctor (immediately, or can it wait a day?).

•  Case Study Practice: Create a resident case study and ask nurses to complete a practice SBAR.  Then offer feedback, calling attention to what was done well and constructively pointing out areas for improvement.

•  Accessible Forms: Make sure the SBAR forms are easily accessible.  Ditto for the care paths and Change-in-Condition cards.  Some nursing homes house the care paths and Change-in-Condition cards in binders at all units.  Some put on copy on the nurses’ carts.

•  Don’t Duplicate: If your nursing home already uses a form similar to SBAR, do notask nurses to complete INTERACT’s SBAR in addition.  Instead, your health-care team should decide whether it will continue to use its present form, discard that form and use the INTERACT SBAR instead, or revise the present form to include elements of INTERACT’s SBAR.

• Use SBAR in Quality Improvement: One nursing home uses the SBAR as the nurse’s note; as such, it is used when discussing resident care in interdisciplinary team meetings.  Another nursing home uses the SBAR as the starting point for completing a QI Review form when a resident’s change in condition leads to a hospital or emergency department transfer.

SBAR as Physician Order?

One nursing home worked with physicians to simplify the SBAR so that it now serves as a physician order as well as the nurse’s note.  This nursing home eliminated the final “request” section of the SBAR and replaced it with a “response” section, which serves as the physician order.  This strategy addresses concerns that “requested” SBAR items pose a liability: If a physician does not comply with a nurse’s request for a lab, or visit, or other service, he or she could be held liable if later that service is deemed critical.  Altering SBAR so that it records actual physician responses, rather than requests that may or may not be filled, may prevent liability problems from arising