There will always come a time when you have to relay critical patient information to an attending physician. Am I hearing pounding heart sounds? You don’t have to worry, because you will be experiencing nurse-physician encounters more often than you think, and doing it right the first time will surely impress your co-workers and physicians for doing it with confidence.
The NHS Institute for Innovation and Improvement has recommended a tool that helps health care workers to frame conversations, especially critical ones so that they can easily communicate with clinicians. This tool, as NHS describes it, makes use of assessment skills and prompts staff to formulate information with the right level of detail. It is dubbed as the SBAR Tool or the Situation-Background-Assessment-Recommendation Method which can be used during referrals and relaying patient updates.
Before approaching or calling the physician, you should have the chart and the kardex at hand and have all your assessment details available so you can relay complete information in case the doctor asks for it. In using the SBAR tool, you have to know the step by step process on how you can execute it flawlessly. Read on below for the specifics of this excellent communication tool:
Step 1: Situation – in starting a conversation, you must first introduce yourself, which unit you are from, the institution/hospital you are in, and most importantly, the patient you are about to refer to the physician. This will establish your conversation properly. Take a look at this example: “Good evening, this is Nurse Lily from Sacred Heart-Medical Unit and I’m calling regarding Ms. Lianne Jenkins at room 222.”
Step 2: Background – note that physicians don’t always remember their patients, especially when they have a lot of them admitted to different hospitals. So you might want to give the patient’s admitting diagnosis and recent diagnostic or surgical procedure. This is how would add this to your conversation:” She is your post cesarian section patient six hours ago; who has been ordered for transfusion of 3 units packed RBCs.”
Step 3: Assessment –patient assessment includes vital signs and other signs and symptoms pertinent to the situation you are referring to. You can add this by saying: “While on her first 15 minutes of blood transfusion for the first bag, she has developed transfusion reaction and presented with chills, nausea, and vomiting, and now her vital signs are as follows: Temp: 99 degrees F., BP: 90/60, RR: 24, 02 Sat: 96 and HR: 100. We’ve already stopped the transfusion and brought the blood back to the laboratory. We’ve also kept the IV line open, placed 3 liters of supplemental oxygen and applied a thermal blanket to the patient.”
Step 4: Recommendation – this last part in the SBAR Methodis where you make recommendations, based on your relayed circumstances. Being the eyes and ears of the attending physicians, you are the first person to see and understand what your patient has experienced, so you may suggest what she needs. You can say: ”Will you order an antihistamine or an antipyretic?”
After the doctor has given you his orders, make sure you jot it down and read it back to him for confirmation. Remember that you can never be too careful when it comes to patient care so it is imperative that you fully understand all the orders given to you. If it is a telephone order, you must transcribe it into the physician’s order sheet, which you should have the physician signed within 24 hours. That wasn’t too hard, was it? Why don’t you give the SBAR Tool a try on your next encounter with an attending physician? Just make sure that you are knowledgeable and confident with your suggestions and you’re on your way to success.