Guest Author - Julie Reeser, RN
The healthcare industry is complex and affects lives. What we say and how we say it can impact outcomes. This is true for all situations, and can be critical in emergencies. A tool that has been adapted from the aviation sector is the SBAR Communication Tool. Each letter stands for a piece of the puzzle in finding the right care for each patient and scenario.
Example 1: Your 50 year old patient has slowly developed a fever over the last hour while receiving blood products. They are in the hospital for pneumonia. They recently received a flu vaccine. They have a history of alcohol abuse and smoking. The patient is a full code with NKA.
When you call the physician, you will start with the patientís name and why they are a patient. Then, you should explain the reason you are calling. Follow this with pertinent information to the situation itself. The recommendation piece is the trickiest. Some physicians will jump straight to this component without your input, others will listen to your recommendation, and then there are the ones who would be insulted by your attempt to work as a team in this manner. Obviously, this is a judgment call on your part, but it is best to make the effort.
Situation - Dr. M, I am calling because Patient X has developed a fever over the last hour while getting blood products.
Background - Patient X is here for pneumonia, and recently received a flu vaccine.
Assessment - They arenít having any other symptoms.
Recommendations - Should I continue to give the blood product? Should I slow the infusion rate? Would you like to prescribe Tylenol for the fever?
In the above example, it is important to be clear that you require their input on the blood product continuing to infuse and at the same rate. This is something that you technically could do without a physician, but the outcome for the patient can be much better if you get collaborative communication, and that is really the key to making SBAR work.
Example 2: Your 81 year old patient appears cold, clammy, is tachypneic but shallow, and is less responsive than when you checked her an hour ago. She is here for atrial fibrillation with rapid ventricular response. She is on a Cardizem gtt at 10mg , started po Cardizem this morning, and has started Coumadin. Her last BP was 110/78. Her monitor was showing atrial fib with a rate of 120. She has a history of TIA, hypertension, and Lt hip fx with surgical repair last year. She is an intubation only code with allergies to Morphine and Codeine. Her Spo2 on RA is 86%. You call an RRT, and begin to place her on a nonrebreather (NRB) until help arrives. Youíll need to explain by SBAR to the team members as they arrive. Respiratory therapy arrives first.
Situation - She is becoming unresponsive and her breathing is shallow. Her Spo2 is 86%, so I am putting her on a NRB mask. She is an intubation code only.
Background - (The RN for the RRT arrives as you begin this piece.) She is here for atrial fibrillation. She is on IV Cardizem and started po today. She also started Coumadin today. She was fine an hour ago. She has a history of TIA and hypertension. (You pick up the phone to find out what her telemetry is now showing.)
Assessment - (The physician arrives for this part, so you start over at the beginning.) She is cold, clammy, and her breathing is ineffective. I am cycling a BP now. Her telemetry is showing atrial fibrillation with a rate of 130.
Recommendations - I am worried she is having a stroke. Should I call radiology? Would you like any lab work? Her BP is 88/54. I am going to turn off the Cardizem gtt now.
As you can see, you will need to be multitasking while you communicate with your team. It takes practice, but with time it becomes easier.