Section 19.1: Interprofessional Communication Tools (SBAR, Huddles)

19.1.1 The “Why”: Communication is a Clinical Intervention

In your pharmacy education and practice, you have spent tens of thousands of hours mastering the intricate science of pharmacology. You can navigate the complexities of pharmacokinetics, pharmacodynamics, and biostatistics with expert precision. This expertise is the foundation of your value. However, in the complex, fast-paced ecosystem of a hospital, this expertise is only as effective as your ability to communicate it. The most brilliant clinical insight is useless if it is misunderstood, ignored, or never voiced. It is for this reason that we begin this critical module on communication with a profound and unshakeable principle: Structured communication is not a ‘soft skill’; it is a core clinical intervention with a direct, measurable impact on patient mortality and morbidity.

The Joint Commission, the primary accrediting body for U.S. healthcare organizations, has consistently identified communication failures as the root cause of the majority of sentinel events—unexpected occurrences involving death or serious physical or psychological injury. An ambiguous order, a delayed critical lab notification, a missed piece of patient history during a handoff—these are not minor administrative errors. They are preventable clinical failures. The traditional, hierarchical, and often unstructured way healthcare professionals have historically communicated is simply not safe enough for the complexity of modern medicine.

This is where standardized communication tools like SBAR and structured team meetings like Huddles come into play. These frameworks are not about creating robotic, impersonal interactions. They are about engineering reliability and safety into the high-stakes transfer of critical information. They are a universal language, a shared mental model that allows a pharmacist, a nurse, a respiratory therapist, and a physician to exchange complex information with clarity, conciseness, and a laser focus on patient safety, especially under pressure. Mastering these tools is a professional obligation. It is the act of translating your pharmacological expertise into effective, life-saving action at the bedside.

19.1.2 Deep Dive: SBAR – The Universal Language of Urgency

SBAR is an evidence-based communication framework originally developed by the U.S. Navy for use on nuclear submarines, where clear communication in high-stakes situations is a matter of national security. It was adapted for healthcare by institutions like Kaiser Permanente and has since become the gold standard for interprofessional communication about an acute patient event. Its power lies in its simplicity and its logical flow, which mirrors how physicians are trained to think, moving from data to diagnosis to plan.

SBAR is not a lengthy report. It is a concise, headline-driven briefing designed to be delivered in 60-90 seconds. It provides a structured way to present a complex situation, eliminating fluff and focusing all parties on the critical information needed to make a decision. For a pharmacist, mastering SBAR is the key to transforming a passive clarification call into an effective clinical intervention.

Mastering the “S”: Situation – Grab Their Attention

The ‘Situation’ is your headline. It must be concise, impactful, and immediately orient the listener to the purpose of your call and its urgency. It is not the time for a long story. Your goal is to convey the core issue in a single sentence. Before you pick up the phone, you should have this sentence formulated in your head.

Masterclass Table: Good vs. Ineffective “Situation” Statements

Clinical Scenario	Ineffective (Vague & Passive) “S”	Effective (Clear & Urgent) “S”
A patient’s potassium level comes back critically low at 2.4 mEq/L.	“Hi Dr. Jones, this is the pharmacist. I’m calling about a lab value for your patient, Mr. Chen.”	“Dr. Jones, this is the pharmacist calling with a critical potassium of 2.4 on your patient, Mr. Chen in room 402.”
You receive an order for ceftriaxone for a patient with a documented anaphylactic allergy to penicillin.	“Hi Dr. Smith, I have a question about a medication order for Jane Doe.”	“Dr. Smith, I’m calling to report a critical safety issue with a new ceftriaxone order for Jane Doe, who has a documented anaphylactic allergy to penicillin.”
An elderly patient on warfarin has an INR of 8.5.	“Hi, I’m calling about Mrs. Davis’s INR result.”	“Dr. Evans, this is the pharmacist calling about a critical INR of 8.5 on your patient, Mrs. Davis, who is currently on warfarin.”
A patient on a heparin drip has a PTT result that is subtherapeutic, requiring a rate increase per protocol.	“Hi, I’m just calling to let you know about a PTT.”	“Dr. Allen, I am calling to recommend a heparin dose adjustment per protocol for your patient, John Miller, due to a subtherapeutic PTT.”

Mastering the “B”: Background – Provide Relevant Context

The ‘Background’ section provides brief, highly relevant information that supports the ‘Situation’. This is not a full patient history. It is a curated set of data points that the listener needs to understand the context of the problem. For a pharmacist, this often includes the primary diagnosis, relevant medications, and recent pertinent lab values.

Case Study Application: Building the “Background”

Clinical Scenario	Situation (S)	Background (B)
Patient with heart failure exacerbation has a critically low potassium.	“Dr. Jones, this is the pharmacist calling with a critical potassium of 2.4 on your patient, Mr. Chen in room 402.”	“He was admitted for a heart failure exacerbation and has been receiving IV furosemide 80 mg twice daily for the past two days. His baseline potassium on admission was 3.6.”
Patient with a penicillin allergy receives a ceftriaxone order.	“Dr. Smith, I’m calling to report a critical safety issue with a new ceftriaxone order for Jane Doe, who has a documented anaphylactic allergy to penicillin.”	“She was admitted with community-acquired pneumonia. The allergy is listed in our system as ‘anaphylaxis’ with throat swelling, and she confirmed this history with me on admission.”
Patient on warfarin has a critically high INR.	“Dr. Evans, this is the pharmacist calling about a critical INR of 8.5 on your patient, Mrs. Davis.”	“She is an 82-year-old female admitted for a fall, on warfarin 5 mg daily for atrial fibrillation. She was also started on sulfamethoxazole/trimethoprim for a UTI yesterday.”

Mastering the “A”: Assessment – State Your Conclusion

The ‘Assessment’ is your professional judgment. This is where you connect the dots between the situation and the background and state what you believe the problem is. For a pharmacist, this is often the most challenging part of SBAR. It requires a shift from simply reporting data to interpreting it and forming a clinical conclusion. This is your opportunity to demonstrate your expertise and add significant value to the conversation. It’s the difference between being a reporter and being a consultant.

Your assessment should be a clear, concise statement of the medication-related problem. Phrases like, “My concern is…”, “The problem appears to be…”, or “This is likely a…” are excellent ways to frame your assessment.

Case Study Application: Forming the “Assessment”

Clinical Scenario	Situation (S) + Background (B)	Assessment (A)
Patient with heart failure exacerbation has a critically low potassium.	(S) “…critical potassium of 2.4…” (B) “…receiving IV furosemide 80 mg twice daily…”	“My assessment is that he has severe, symptomatic hypokalemia, likely induced by the high-dose loop diuretic, placing him at significant risk for a cardiac arrhythmia.”
Patient with a penicillin allergy receives a ceftriaxone order.	(S) “…critical safety issue with a new ceftriaxone order…” (B) “…documented anaphylactic allergy to penicillin…”	“My assessment is that ordering ceftriaxone for this patient is a major contraindication and places her at immediate risk for another anaphylactic reaction.”
Patient on warfarin has a critically high INR.	(S) “…critical INR of 8.5…” (B) “…on warfarin…started on sulfamethoxazole/trimethoprim yesterday.”	“My assessment is that this supratherapeutic INR is a direct result of a major drug-drug interaction between warfarin and Bactrim, placing the patient at high risk for a serious bleed.”

Mastering the “R”: Recommendation – Make a Clear Request

The ‘Recommendation’ is the entire point of the communication. It is your specific, actionable request. After presenting your clear case, you must now state exactly what you need the other person to do. A vague or passive recommendation undermines the entire SBAR. “What do you want to do?” is not a recommendation. It is a question that cedes your role as a medication expert. You must be prepared to propose a clear, evidence-based solution.

Your recommendation should be specific. It should include the drug, dose, route, and frequency. This makes it as easy as possible for the provider to agree. Your goal is to make “yes” the easiest possible answer. If you are unsure of the best course, it is acceptable to offer a couple of options, but you should still lead with your preferred plan.

Masterclass Table: Transforming Passive Questions into Professional Recommendations

Clinical Scenario	Passive & Weak “R”	Confident & Specific “R”
Severe hypokalemia (K=2.4)	“Do you want me to order some potassium for him?”	“I recommend we replete him aggressively per protocol, starting with 40 mEq of IV potassium chloride over 4 hours via peripheral line, and that we recheck his potassium level after the infusion is complete.”
Contraindicated antibiotic order	“So… we probably shouldn’t use ceftriaxone.”	“I recommend we immediately discontinue the ceftriaxone order and, given her allergy, switch to a safer alternative for CAP like levofloxacin 750 mg IV daily. Would you like me to enter that order for you?”
Supratherapeutic INR (INR=8.5)	“What should we do about her warfarin?”	“I recommend we hold the next two doses of warfarin, administer 2.5 mg of oral vitamin K now, and discontinue the Bactrim. We should also recheck her INR in the morning.”
Subtherapeutic heparin PTT	“Her PTT is low.”	“I recommend we administer a heparin bolus of 4000 units and increase the continuous infusion rate by 2 units/kg/hr, per the hospital’s approved nomogram. I can enter those orders now if you agree.”

19.1.3 Putting It All Together: SBAR Master Scripts for Pharmacists

Now let’s assemble the complete SBAR for our case studies. Notice how the entire communication flows logically and can be delivered in under 90 seconds, providing a complete clinical picture and a clear path forward.

19.1.4 Deep Dive: Huddles – The Engine of Proactive Team Care

If SBAR is the tool for focused, urgent, one-on-one communication, then the Huddle is the tool for proactive, routine, many-to-many communication. A huddle is a brief, stand-up meeting (typically 10-15 minutes) where the interprofessional team convenes to share critical information, anticipate risks, and coordinate the plan of care for the day. It is the antithesis of siloed care. It is a structured forum designed to create a shared mental model among all team members, ensuring everyone is on the same page.

For a pharmacist, the daily huddle is one of the most valuable and highest-impact activities you can participate in. It is your opportunity to move from being a reactive order verifier to a proactive clinical consultant. It allows you to identify and resolve medication-related problems before they happen, to provide pharmacotherapy recommendations in real-time, and to integrate your expertise directly into the team’s care plan. Consistent, effective participation in huddles is a hallmark of a high-functioning clinical pharmacist.

Anatomy of an Effective Daily Huddle

While the exact format can vary, effective huddles share common characteristics:

• Brief and Focused: 5-15 minutes, maximum. This is not a comprehensive review.
• Standing, Not Sitting: This encourages brevity and focus.
• Consistent Time and Place: Held at the same time and location every day to become a routine.
• Interprofessional: Includes the core team: nurse manager/charge nurse, physicians/residents, case manager, social worker, and the clinical pharmacist.
• Structured and Patient-Focused: The team rapidly discusses each patient on the unit, focusing on key safety and discharge issues.

The Pharmacist’s Huddle Preparation: The “3-Minute Scan”

You cannot walk into a huddle unprepared and expect to be effective. The key is a rapid, targeted review of your patient list just before the meeting. This isn’t a full workup; it’s a “3-minute scan” per patient to identify key medication-related talking points.

Category	Pharmacist’s Scan Question	Huddle Talking Point Example
Anticoagulation	Is the patient on therapeutic anticoagulation? Is their monitoring appropriate (INR, PTT, anti-Xa)? Is there a clear plan for bridging or transition?	“For Mrs. Jones in 301 on the heparin drip for her PE, her PTT this morning was therapeutic at 75. Warfarin was started yesterday; her first INR is pending.”
Antibiotic Stewardship	Is the patient on broad-spectrum antibiotics? Have cultures resulted? Is there an opportunity to de-escalate? Is the duration defined?	“For Mr. Smith in 302 on Vanc/Zosyn for pneumonia, his blood cultures are negative and sputum culture grew MSSA. I recommend we de-escalate to cefazolin today.”
Medication Monitoring	Is the patient on any high-risk drugs requiring lab monitoring? (e.g., vancomycin, digoxin, anticonvulsants). Are the levels therapeutic?	“For Mr. Davis in 303, his vancomycin trough this morning was high at 28. I’ve held his next dose and will be recommending a dose reduction.”
Discharge Planning	Are there any medication access barriers to discharge? (High cost, PA needed, non-formulary). Are complex medications (e.g., insulin, enoxaparin) being started that will require patient education?	“For Jane Doe in 304, she is planned for discharge tomorrow on Eliquis. I’ve checked her insurance, and it requires a prior authorization. I’ll get that process started today to avoid a delay.”
Pain/Sedation Management	Is the patient’s pain adequately controlled? Are they on multiple opioids or sedatives? Is there a plan to wean or transition to oral agents?	“For John Miller in 305, he has been requiring his IV hydromorphone PCA frequently overnight. We may need to consider adding a long-acting oral agent to improve his baseline control.”

19.1.5 Overcoming Barriers and Final Thoughts

Mastering structured communication is a journey. It requires practice, confidence, and a commitment to patient safety. You will encounter barriers, both internal and external. You may feel hesitant to challenge a physician, or you may work in an environment where structured communication is not yet the cultural norm. Your role is to be a champion for this process.

Ultimately, SBAR and Huddles are about creating a culture of safety. They foster an environment where every member of the team, regardless of their discipline, feels empowered and equipped to speak up for patient safety. As a pharmacist, you are uniquely positioned to be a leader in this culture. Your meticulous attention to detail, your deep knowledge of medication risks, and your systematic approach to problem-solving are perfectly suited to these structured frameworks. By mastering them, you will not only become a more effective clinician but also a vital and indispensable partner in the delivery of safe, high-quality patient care.