Haig Kathleen M, Sutton Staci, Whittington John
OSF St Joseph Medical Center, Bloomington, Illinois, USA.
Jt Comm J Qual Patient Saf. 2006 Mar;32(3):167-75. doi: 10.1016/s1553-7250(06)32022-3.
The importance of sharing a common mental model in communication prompted efforts to spread the use of the SBAR (Situation, Background, Assessment, and Recommendation) tool at OSF St. Joseph Medical Center, Bloomington, Illinois.
An elderly patient was on warfarin sodium (Coumadin) 2.5 mg daily. The nurse received a call from the lab regarding an elevated international normalized ratio (INR) but did not write down the results (she was providing care to another patient). On the basis of the previous lab cumulative summary, the physician increased the warfarin dose for the patient; a dangerously high INR resulted.
The medical center initiated a collaborative to implement the use of the SBAR communication tool. Education was incorporated into team resource management training and general orientation. Tools included SBAR pocket cards for clinicians and laminated SBAR "cheat sheets" posted at each phone. SBAR became the communication methodology from leadership to the microsystem in all forms of reporting.
Staff adapted quickly to the use of SBAR, although hesitancy was noted in providing the "recommendation" to physicians. Medical staff were encouraged to listen for the SBAR components and encourage staff to share their recommendation if not initially provided.
在沟通中共享共同心智模型的重要性促使伊利诺伊州布卢明顿市的 OSF 圣约瑟夫医疗中心努力推广 SBAR（情况、背景、评估和建议）工具的使用。
一名老年患者每天服用 2.5 毫克华法林钠（香豆素）。护士接到实验室打来的关于国际标准化比值（INR）升高的电话，但没有记录结果（她当时正在照顾另一名患者）。根据之前的实验室累积总结，医生为该患者增加了华法林剂量；结果导致 INR 极高，十分危险。
医疗中心发起了一项合作，以实施 SBAR 沟通工具的使用。将相关培训纳入团队资源管理培训和一般入职培训。工具包括为临床医生准备的 SBAR 袖珍卡片以及张贴在每部电话旁的 SBAR 覆膜“备忘单”。在所有形式的报告中，SBAR 都成为了从领导层到微观系统的沟通方法。
工作人员很快适应了 SBAR 的使用，不过在向医生提供“建议”时存在犹豫。鼓励医务人员留意 SBAR 的各个组成部分，并鼓励工作人员如果最初未提供建议就分享自己的建议。
