Last month we learned all about the implementation of the Stop and Watch tool from the INTERACT program. This month we will focus on the implement of the SBAR (Situation, Background, Assessment, Result).
Staff members from all departments should now be trained on the Stop and Watch and be using this form when they see a change in a resident. The completion of the Stop and Watch will lead the nurses to do an assessment. The SBAR is the tool used for this assessment. The Stop and Watch is a worksheet; however, the SBAR becomes part of the resident’s permanent record. If a resident is transferred to the hospital, a copy of the SBAR should accompany them.
The SBAR is an assessment tool used by nurses to gather essential information needed by the physician to make a clinical decision on the care needs of the individual. This information becomes extremely important on how to care for the individual in question and if a transfer to the hospital is necessary. The use of this tool can prevent an on-call physician from saying “just send them to the ER for evaluation” because you have gathered the necessary information a physician needs to make a sound clinical decision.
Physicians in medical groups, private practice and those working exclusively in the hospital are beginning to ask nurses at the time of call, if they have completed an SBAR? If it has not been done, they may ask the nurse to complete the form and then call them back.
Strategies for implementation and sustainability:
- At the morning standup meeting, ask if the SBAR was completed on situations that required a call to the Physician or a potential transfer out of the facility.
- A facility may want to implement this tool one unit at a time. Working out the bugs first before taking it facility-wide.
- Good initial education on this document is key in making sure all nurses understand the purpose of the document. The SBAR substitutes for a progress note in the medical record; therefore, an additional progress note is not necessary.
Strategies for ongoing implementation and monitoring:
- Review SBAR’S weekly.
- Compare the SBAR with your 24 hour report to identify possible missed opportunities in using the form and potentially avoiding an unnecessary readmission. This will help validate staff success at understanding and the completion of the document.
The form can be found at www.Interact2.net or by purchase from Medpass in tablet form.
Next month we will look at Medication Reconciliation.