Wessex PSC is helping organisations across Wessex to reduce harm related to communication failure by improving the use of safety communication techniques such as SBAR, SBARD and ATMIST.
SBARD communication tool (Situation, Background, Assessment, Recommendation, Decision)
SBARD is an easy to use, structured form of communication that enables information to be transferred accurately between individuals.
SBARD consists of standardised prompt questions in five sections to ensure that staff are sharing concise and focused information. It allows staff to communicate assertively and effectively, reducing the need for repetition and the likelihood for errors. As the structure is shared, it also helps staff anticipate the information needed by colleagues and encourages assessment skills. Using SBARD prompts staff to formulate information with the right level of detail.
SBAR was originally developed by the United States military for communication on nuclear submarines, but has been successfully used in many different healthcare settings, particularly relating to improving patient safety. Later versions used across the NHS included a 5th element "Decision", hence SBARD.
More information about SBARD can be found on the NHSE website and the ACT Academy SBAR tool can be downloaded from the resources area on the right hand side of this page.
Using SBARD in Care Settings (A Video by Wessex PSC, HIOW ICB and PHL)
When you’re worried about the person you’re looking after, in a Care Home or Care setting for example, it can sometimes be difficult getting people to understand what’s wrong and why you’re concerned. SBARD helps you to organise your thoughts before making a call so that you get the help you need.
The SBARD tool consists of standardised prompts to ensure that you share relevant information in a concise and focused way. It also helps you anticipate the information needed by colleagues and encourages assessment skills.
SBARD also helps when staff may be uncomfortable about making a recommendation i.e. those who are inexperienced or who need to communicate to senior staff. The use of SBARD prevents the hit and miss process of ‘hinting and hoping’.
This video, on the top right of the screen, demonstrates the use of SBARD in a care setting and was produced in collaboration between the Wessex Patient Safety Collaborative, Hampshire and Isle of Wight Integrated Care Board and the PHL Group, with input from the Wessex PSC Patient Partners.
SBARD Templates (WPSC)
SBARD is not copyrighted and Wessex PSC have developed two templates in Word format to assist people wanting either a generic form or a template that they can customise for local use. The WPSC template originated from the RESTORE2 SBARD template whilst the NPSC version was developed and shared by West Midlands PSC.
These templates can be downloaded from the Resources Zone on the right hand side of this webpage and may be adapted to meet local needs. (Acknowledgement of source would be appreciated.)
SBAR Communication in Care Homes (e-Learning for Healthcare)
Unplanned admissions to hospital result from a patient’s condition changing in such a way that they are no longer safe to be looked after in the care facility in which they live. Hospital often becomes the default location for their care to be transferred to. These patients are often elderly, frail and have complex medical comorbidities. If the deteriorating patient is highlighted earlier to other healthcare professionals, unplanned admissions to hospital can be reduced. Therefore, communicating the correct information about patients to the correct people is imperative and SBAR communication provides a standardized tool to aid this.
This training programme is a collaborative project between Sussex Community Trust and Surrey and Sussex Healthcare NHS Trust and is funded from a grant by Health Education Kent, Surrey and Sussex with the aim of reducing admissions from hospital and improving the quality of care of patients who become unwell in care homes (with and without nursing).
SBAR Training Guide (NHSIII)
This SBAR Training Guide has been developed by the NHS Institute for Innovation and Improvement in conjunction with clinicians and other frontline staff in the NHS.
The guide will help develop an understanding of the SBAR approach and support the planning and delivery of SBAR training events – either as a classroom event, in a clinical setting, as an informal session or as part of a more structured learning curriculum.
The NHSIII SBAR Training Guide can also be downloaded from the resource zone on the right hand side of this webpage.
SBARD Training videos
A number of healthcare providers have produced training videos that show the benefits of using SBARD in clinical settings. Please find a list below:
East Midlands Emergency Medicine Educational Media
Example 1 - Using SBAR to transfer patient into ED (Ambulance Crew)
Example 2 - Using SBAR in the Assessments Area (HCA)
Example 3 - Using SBAR in Majors (Nurse)
Example 4 - Using SBAR in Majors (SHO)
Example 5 - Using SBAR to admit the patient to the ward (ED Reg)
Ipswich Hospital NHS Foundation Trust
Royal Free Hampstead NHS Trust
Using SBARD (Derbyshire Healthcare NHS Foundation Trust and East Midlands AHSN)
When you’re worried about the person you’re looking after, it can sometimes be difficult making people understand what’s wrong and why you’re concerned. The SBARD structure helps you to organise your thoughts before you call so that you can get the help you need.
Impact of the communication and patient hand-off tool SBAR on patient safety: a systematic review (OpenBMJ)
This review found moderate evidence for improved patient safety through SBAR implementation, especially when used to structure communication over the phone. However, there is a lack of high-quality research on this widely used communication tool.
ATMIST communication tool (age, time, mechanism, injury, signs, and treatment)
Early recognition of life threatening sepsis is essential to enable the Ambulance Service to initiate life-saving therapy and issue a pre-arrival alert to the hospital’s emergency department.
Crews use a systematic handover tool called ATMIST (age, time, mechanism, injury, signs, and treatment) to convey details of septic symptoms to the receiving Emergency Department which will trigger the activation of Surviving Sepsis Clinical Care Pathway upon arrival at the Emergency Department. This pathway has been demonstrated to significantly improve patient survival.
Future opportunities and priorities to further improve patient care in the community - South Central Ambulance Service http://www.scas.nhs.uk/wp-content/uploads/Clinical-Strategy.pdf - accessed December 2018.
Make or Break: Incivility in the workplace (Epsom and St Helier University Hospital NHS Trust)
See how incivility affects all of us in the NHS and how that can impact patient safety. Join the staff of Epsom and St Helier University Hospitals NHS Trust in this video as they reflect on the real-life effects of both incivility and active kindness.
The response to patient deterioration in the UK National Health Service – a survey of acute hospital policies (Bournemouth University)
The assessment of acute-illness severity in adult non-pregnant patients in the United Kingdom is based on early warning score (EWS) values that determine the urgency and nature of the response to patient deterioration. This study aimed to describe, and identify variations in, the expected clinical response outlined in ‘deteriorating patient’ policies/guidelines in acute NHS hospitals.
If you have any questions about the Wessex Patient Safety Collaborative's Deterioration workstream or any other aspects of the Wessex PSC, please contact us via the link below: