Nurse Learning Hub
Communication failures are one of the most common contributors to patient harm. The Communicating for Safety Standard (Standard 6 of the National Safety and Quality Health Service Standards) requires health services to use structured clinical handover, and ISBAR is the tool most Australian hospitals use.
What ISBAR stands for
| Letter | Meaning | What to say |
|---|---|---|
| I | Identify | Yourself, your role and location; the patient (name, age, identifiers) and who you are speaking to. |
| S | Situation | Why you are calling or handing over – the main problem in one sentence. |
| B | Background | Relevant history: admission reason, diagnosis, procedures, medications, allergies, recent changes. |
| A | Assessment | Your findings: observations, examination, what you think is happening. |
| R | Recommendation / request | What you need and by when – then confirm the plan (read back). |
Example: escalating a deteriorating patient by phone
I: “Hi, this is Sam, RN on Ward 6B. I'm calling about Mr Jones, 72, bed 14, under the orthopaedic team.”
S: “I'm concerned he is deteriorating – his blood pressure has dropped to 104/62 and his heart rate is 112.”
B: “He's day two after a right hip replacement. He has type 2 diabetes and hypertension. He was confused overnight.”
A: “Resp rate 24, sats 93% on room air, temperature 38.4, urine output 20 mL an hour for three hours, BGL 14.2. He's drowsy. I think he may be septic.”
R: “I'd like you to review him within the next 30 minutes or sooner. Would you like me to take blood cultures and start oxygen in the meantime? … So to confirm, you'll be here in 15 minutes and I'll start oxygen at 2 litres via nasal prongs and repeat obs every 15 minutes.”
Tips for a better handover
- Prepare first. Have the chart, medication record and latest observations in front of you.
- Lead with the situation. Busy clinicians decide how urgent your call is in the first ten seconds.
- Make a clear request. “Please come and review” with a timeframe is better than “just letting you know”.
- Read back any orders and the agreed plan, then document the conversation.
- Escalate again if the response does not happen in the agreed time or you remain concerned.
- Bedside handover – where possible, involve the patient and family so they can correct and add information.
Sources and further reading
- ACSQHC – Communicating for Safety Standard
- Australian Commission on Safety and Quality in Health Care – NSQHS Standards
- ACSQHC – Recognising and Responding to Acute Deterioration Standard