State Behavioral Scale (SBS)
Permission to use the SBS
You are free to reproduce and use the State Behavioral Scale (SBS) for research or clinical practice. The SBS may be reproduced on forms with hospital or clinical unit letterhead or logos, or used in electronic record systems. Please cite: Curley, M. A. Q., Harris, S. K., Fraser, K., Johnson, R., & Arnold, J. H. (2006). State behavioral scale: A sedation assessment instrument for infants and young children supported on mechanical ventilation. Pediatric Critical Care Medicine, 7(2), 107-114. If you would like to republish the tool in any form external to your organization you will have to obtain permission from the copyright holder - Pediatric Critical Care Medicine. Requests for any changes or alterations in the instrument or requests to translate it into another language should be made in writing to Dr Curley.
State Behavior Assessment Guidelines
Every intubated patient should have his/her state behavior assessed and documented at least every four hours.
Pediatric Assessment:
State behavior assessment, especially in preverbal or nonverbal children, is challenging. The nurse should tailor sedation assessment to the patient’s developmental level, medical status and temperament using the SBS.
Definition of State Behavior:
In pediatric patients supported on mechanical ventilation, state behavior is described as a summative characteristic of the following dimensions:
1. Respiratory Drive/ Response to ventilation
2. Coughing
3. Best Response to Stimulation
4. Attentiveness to Care Provider
5. Tolerance to Care
6. Consolability
7. Movement after Consoled
State behavior may range from anesthesia to agitation.
Assessment/Documentation:
Assess and document the patient’s state behavior in the designated column of the Patient Care Flowsheet:
· On admission
· Before and after sedative administration or any intervention to decrease or alleviate agitation
· At a minimum of every 4 hours with vital signs
Note: More frequent assessment is necessary in patients in whom agitation has not been well controlled. For example, state behavior assessment after a noxious procedure could occur as frequently as every 5-30 minutes. Use clinical judgment to disturb the sleeping patient.
Description:
The SBS is a 6-point scale that describes state behavior on a scale of -3 to +2.
Assessment Method:
1. Review the SBS, familiarizing yourself with the indicators and how they are scored.
2. Assess the patient during normal cares. Use progressive stimuli to elicit the patient’s response; specifically, using a calm voice call the patient’s name. If no response, call the patient’s name and gently touch the patient’s body. If no response, asses the patient’s response to a planned noxious procedure, e.g., planned endotracheal suctioning. If a noxious procedure is not planned and assessment is critically important then, using a pencil/pen, provide < 5 seconds of direct pressure to the patient’s nail bed.
Scoring Method:
Observe the patient’s respiratory drive/response to ventilation, coughing, best response to stimulation, attentiveness to care provider, tolerance to care, consolability and movement after consoled.
Interpretation:
More negative scores reflect a sedated state. More positive scores reflect a more agitated state. Zero scores reflect a patient who is awake and able to be calmed. Clinical judgment is used to interpret state behavior considering the context of the situation to differentiate behavioral distress from pain behavior.
Pediatric Assessment:
State behavior assessment, especially in preverbal or nonverbal children, is challenging. The nurse should tailor sedation assessment to the patient’s developmental level, medical status and temperament using the SBS.
Definition of State Behavior:
In pediatric patients supported on mechanical ventilation, state behavior is described as a summative characteristic of the following dimensions:
1. Respiratory Drive/ Response to ventilation
2. Coughing
3. Best Response to Stimulation
4. Attentiveness to Care Provider
5. Tolerance to Care
6. Consolability
7. Movement after Consoled
State behavior may range from anesthesia to agitation.
Assessment/Documentation:
Assess and document the patient’s state behavior in the designated column of the Patient Care Flowsheet:
· On admission
· Before and after sedative administration or any intervention to decrease or alleviate agitation
· At a minimum of every 4 hours with vital signs
Note: More frequent assessment is necessary in patients in whom agitation has not been well controlled. For example, state behavior assessment after a noxious procedure could occur as frequently as every 5-30 minutes. Use clinical judgment to disturb the sleeping patient.
Description:
The SBS is a 6-point scale that describes state behavior on a scale of -3 to +2.
Assessment Method:
1. Review the SBS, familiarizing yourself with the indicators and how they are scored.
2. Assess the patient during normal cares. Use progressive stimuli to elicit the patient’s response; specifically, using a calm voice call the patient’s name. If no response, call the patient’s name and gently touch the patient’s body. If no response, asses the patient’s response to a planned noxious procedure, e.g., planned endotracheal suctioning. If a noxious procedure is not planned and assessment is critically important then, using a pencil/pen, provide < 5 seconds of direct pressure to the patient’s nail bed.
Scoring Method:
Observe the patient’s respiratory drive/response to ventilation, coughing, best response to stimulation, attentiveness to care provider, tolerance to care, consolability and movement after consoled.
Interpretation:
More negative scores reflect a sedated state. More positive scores reflect a more agitated state. Zero scores reflect a patient who is awake and able to be calmed. Clinical judgment is used to interpret state behavior considering the context of the situation to differentiate behavioral distress from pain behavior.
Downloadable SBS
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English
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Chinese
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Japanese
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Article of Interest
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Curley, M. A. Q., Harris, S. K., Fraser, K., Johnson, R., & Arnold, J. H. (2006). State behavioral State Behavioral Scale (SBS): A sedation assessment instrument for infants and young children supported on mechanical ventilation. Pediatric Critical Care Medicine, 7(2), 107-114. (PMID: 16446601)
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