Guidelines on the use of ISBAR in Clinical Conversations in OLCHC

Version Number V1

Date of Issue 13th August 2014

Reference Number GISBARCC-08-14-FONGRSWPMcGLB-V1

Review Interval 3 yearly

Approved By Signature Date

Name: Geraldine Regan
Title: Director of Nursing

Authorised By Signature Date

Name: Dr. Sean Walsh
Title: Chair of the Medical Board

Author/s Fionnuala O’ Neill, NPDC

Geraldine Regan, Director of Nursing
Sean Walsh, Medical Director
Paula McGrath, CNM 2
Lorcan Birthistle, CEO

Location of Copies On Hospital Intranet and locally in department

Document Review History

Review Date Reviewed By Signature

Document Change History

Change to Document Reason for Change

 Our Lady’s Children’s Hospital, Crumlin
Document Name: Guidelines on the Use of ISBAR in Clinical Conversation in OLCHC
Reference Number: GISBARCC-08-2014-FONGRSWPMcGLB-V1 Version Number: 1
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Date of Issue: 13 August 2014 Page 2 of 6

CONTENTS

Page Number

1.0 Introduction, Background and definition 3

2.0 Objective 4

3.0 The tool 5

4.0 Staff Inclusion Criteria 5

5.0 Staff Exclusion Criteria 5

6.0 References 6
 Our Lady’s Children’s Hospital, Crumlin
Document Name: Guidelines on the Use of ISBAR in Clinical Conversation in OLCHC
Reference Number: GISBARCC-08-2014-FONGRSWPMcGLB-V1 Version Number: 1
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Date of Issue: 13 August 2014 Page 3 of 6

1.0 Introduction, definition and background

Situation Background Assessment Recommendation (SBAR) is a structured manner by which

critical information is communicated from one healthcare professional to another. SBAR increases
patient safety and ensures the effective escalation of events or information which required
immediate attention or actions.

SBAR was developed first for healthcare by Dr Michael Leonard, Physician leader for Patient
Safety, in Kaiser Permanente, USA as a situational briefing model to assist with the communication
of essential patient information. SBAR, originated in the aviation and military, where it was used
specifically in the transfer of critical information to be passed on from one pilot to another.
Helmreich, R., (2000).

The NHS adopted a Patient Safety Culture with the introduction of the Institute for Innovation and
Improvement in 2008, with the responsibility of introducing the Safer Care Programme. Specifically
the role of this programme is to assist healthcare staff deliver care with a patient safety culture at its
core.

In the USA the Institute of Medicine, To Err is Human (1999) suggests that 70% of errors in
healthcare are ‘human error’ and relate specifically to communication or non/mis communication of
required detail in the handover of patient specific information. It has been calculated that 1 in 10
patients have been exposed to an adverse event during their exposure to the health system.

Of these events a large percent of the adverse events are reported as system failures. Included in
this category of system failures as detailed by a study by Folkman (1991) and again by the NHS in
2001, and once more by the Joint Commission’s Annual report on Quality and Safety in 2007,
system failures include:
1. Poor communication
2. Unclear lines of authority
3. Poor escalation of risk events
4. Increased patient to nurse staff ratio
5. Disconnected reporting systems
6. lack of coordination of errors and error reporting
7. Inadequate systems to share information on errors
8. Cost cutting measures in response to cutbacks
9. Infrastructure failure
 Our Lady’s Children’s Hospital, Crumlin
Document Name: Guidelines on the Use of ISBAR in Clinical Conversation in OLCHC
Reference Number: GISBARCC-08-2014-FONGRSWPMcGLB-V1 Version Number: 1
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Date of Issue: 13 August 2014 Page 4 of 6

The Joint Commission went so far as to suggest that ‘communication between Healthcare providers
and providers and the patient and family members was the root cause of over half the serious
adverse events in accredited hospitals’. Palmeri et al (2008) concurs with the view of the Joint
Commission and the WHO in their view that ‘patient safety is an endemic concern’.

The reports suggest a variety of factors which influence this failure in communication, namely:
• fatigue,
• workload,
• cognitive overload,
• poor interpersonal communications,
• imperfect information processing and
• flawed decision making.

Based on this information and accepting the inevitability of error, steps were taken to address the
‘Human’ aspects of error and put in place processes to address such error. ISBAR is one such
process which is designed to adapt well to healthcare and streamline the communication process
required of Healthcare staff in the verbal aspects of their work. (IOM, 1999).They have identified the
following as barriers to the effective and efficient transfer of information:
• Inadequate communication is recognised as being the most common root cause of serious
errors-both clinically and organizationally.
• Authority gradients can cause miscommunications
• Gender, assumptions, discipline differences, and ethnic background can all be barriers to
effective communications.

Modified with its use in healthcare SBAR was altered to include Identify (I) and became ISBAR.

The tool has been modified to standardize the detail which is communicated from one healthcare
professional to another. It enables where and how information should be communicated and what
level of detail is required. Using the prompts the tool allows for the assertive and effective delivery of
information and reduces the need for any repetition.

2.0 Objective

The objective of this document is to assist with the education process of the implementation of the
ISBAR in OLCHC. The guideline gives the context and background to the use of ISBAR nationally
and internationally. Objective of ISBAR implementation is to provide an easy-to-remember, concrete
mechanism useful for framing any conversation relating to a change in a patients clinical condition,
 Our Lady’s Children’s Hospital, Crumlin
Document Name: Guidelines on the Use of ISBAR in Clinical Conversation in OLCHC
Reference Number: GISBARCC-08-2014-FONGRSWPMcGLB-V1 Version Number: 1
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Date of Issue: 13 August 2014 Page 5 of 6

that is, a situation requiring a clinician’s immediate attention and action. In addition to facilitating the
transfer of patient information when an escalation of care is required, the SBAR tool may enhance
routine communication between carers, for example, at shift change. It allows for an easy and
focused way to set expectations for what will be communicated and how, between members of the
team, which is essential for developing teamwork and fostering a culture of patient safety.

3.0 The tool

Identify…. The first aspect of communication is to identify who you are, where you are, before you
commence any detail about the situation……..just mention the ‘situation’ you are calling about
Situation…
1. The patient name and reason for the detail is explained.
2. Diagnosis of the patient, consultant, ward and diagnosis.
3. Detail of resuscitation status if required is included
Background…
1. Give the patient reason for and date of admission
2. Explain significant medical history
3. Give an overview of patient background… diagnosis, procedures, medications, allergies,
results and any diagnosis. It may benefit to give the most recent vital signs if appropriate.
4. Any lab results which are important,
5. And any other clinical information which is important.
Assessment…
1. This includes detail of vital signs, clinical impressions and concerns. Detail such as ‘ this
child was admitted for asthma and is not responding to his medication………..
2. Or alternatively ‘I am not sure what the problem is but I am worried about him and would
like you to review him ASAP’…….
Recommendations…
1. Explain what you need to happen and in what time frame
2. Make some suggestions
3. State your recommendations. ‘ I wish you to come and review him immediately…….’

4.0 Staff Inclusion Criteria

All OLCHC staff

5.0 Staff Exclusion Criteria

None
 Our Lady’s Children’s Hospital, Crumlin
Document Name: Guidelines on the Use of ISBAR in Clinical Conversation in OLCHC
Reference Number: GISBARCC-08-2014-FONGRSWPMcGLB-V1 Version Number: 1
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Date of Issue: 13 August 2014 Page 6 of 6

6. 0 References

Folksman, S., Mc Phee, S.J. (1991) Do House Officers Learn from their mistakes, Journal of
American Medical Association, 265(16) 2089-94

Helmreich, R.L., (2000), On Error Management: Lessons from Aviation, BMJ 2000: 320 doi:
http//dx.doi.org/10.1136/bmj.320.7237.781

Henneman, E., (2007) Unreported errors in the Intensive Care: A case study of the way we
work. Critical Care Nurse http://ccn.aacnjournals.org/cgi/content/full/27/5/27

Institute of Medicine (1999), To Err is Human, IOM, USA

Joint Commission’s Annual Report on Quality and Safety (2007), Improving America’s
Hospitals; accessed 2013 http://www.jointcommissionreprot.org/

Lachman, P., (2011) Institute of Healthcare Improvement, SBAR, IHI, NHS, UK,

National Patient Safety Agency (2005)

Palmeri, P. et al (2008) ‘The Anatomy and Physiology of error in adverse healthcare events’,
Advances in health care management, 7:33-68.

World Health Organisation (2009) World Alliance for Patient Safety;

http://www.who.int/patientsafety/en/index.html/

©2014 OLCHC.