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Dealing With Doctors | Be Prepared & Use SBAR
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- Опубліковано 17 жов 2011
- The SBAR (Situation-Background-Assessment-Recommendation) technique provides a framework for communication between members of the health care team about a patient's condition. SBAR is an easy-to-remember, concrete mechanism useful for framing any conversation, especially critical ones, requiring a clinician's immediate attention and action. It allows for an easy and focused way to set expectations for what will be communicated and how between members of the team, which is essential for developing teamwork and fostering a culture of patient safety.
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The opinions expressed on this channel and/or in the videos on this channel are not necessarily of those of my employer or institution. The views expressed on this channel and/or in the videos on this channel do not represent medical advice. If you have specific medical concerns, please contact your physician. In order to protect patient privacy, all patient identifiers in all videos have been deleted and/or altered.
The views expressed on this channel and/or in the videos on this channel are personal opinions. I am not an expert nor do I dispense medical advice or procedural specifications. The information I present is for general knowledge purposes only. You need to refer to your own medical director, teachers and protocols for specific treatment information. It is your responsibility to know how best to treat your patient in your jurisdiction.
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I'm here watching this video trying to complete the SBAR section of my simchart like, "I wanna be like her when I grow up (graduate)" lol. Very informative. Thanks for this.
Haha, thank you so much for your support.
After six years experience in a variety of units increasing in acuity from LTC-med-surg-telemetry and post cardiac intervention-icu step-down-icu and finally CVICU, the following Ive learned to be helpful:
Don’t take it personally if the MD cuts you off or is rude. It’s not about you. Some physicians prefer simple direct and to the point in 15 seconds or less. An example of this type of MD is: he will interrupt you with something along the lines of ‘what is the patient needs’. This MD prefers something along the lines of: ‘hey, thanks for calling, our pt in 6512, here with sepsis, is now in afib at a rate in upwards of the 150s. It’s new onset/chronic. What would you like me to do?
The latter is the MD that wants the whole picture because maybe he is on call for his associate and isn’t familiar with the pt. This MD will likely listen to you without interrupting then proceeded ask a ton of questions. He prefers something like: “hi thanks for calling, our pt in 6512 was admitted for sepsis. We are treating her with vanco and fluids however she’s still febrile with a tmax of #101.9/24 hrs. In addition she’s being monitored for her diabete ulcer that has a history of MRSA but her ua was + and they suspect she’s uroseptic at this time. She is now in afib with a rate ranging from 100s-150s. It’s new onset/it’s chronic but she’s been controlled/converted with metoprolol. She’s symptomatic and slightly unstable with a bp of 94/46, experiencing chest pain dizziness and shortness of breath. Of note she is also a ESRD and dialyzes M-W-F, they pulled 2 L off last run but had to give fluids for hypotension. How do you wish to intervene?
(Disclaimer-the above is a generalized and slightly exaggerated example of a case and of course everyone will choose to present differently once they’ve ‘profiled’ so to speak, the preference type of the MD they’re speaking with.)
It also helps to learn what appropriate or expected orders to receive with the pts current situation. The md you’re speaking with might be answering your page with you on speaker because he’s multi tasking with his other super septic new admit and he’s gowned+sterile placing a central line. So he may miss something due to distraction or he’s on call between shift and it 0300 and you woke him up so he’s not thinking clearly. In this situation you might need to prompt. He may miss that if she continues to have chest pain after she’s controlled and/or converted he might choose to consider consider a cardiac work up. Or, that the patient might be non compliant with dialysis demand and the fluid volume excess/high + because the pts runs dialysis tomorrow and they likely ate everything they weren’t supposed to for dinner plus septic-stress triggered her afib flare up. He might forget he needs labs as well as an ekg. He may not recognize he could also be dry because she’s septic and needs a fluid bonus because it’s 0300 and his brain is still asleep so he forgot her lactic was still 7.1 that morning. Proceed to request these items by saying “would you also like a bmp and electrolytes? Do you feel she would benefit from a cardiology consult if she continues to be symptomatic once her rate is controlled”
Please don’t say “ok” and not ask for those, figure out you need them and call back. Please don’t say “well it’s new onset afib so doesn’t she need amiodarone not cardizem ggt?” Please don’t say “what about a bolus”. All of these think support and foster growth of respect and confidence in competency.
Hope this helps. I really love to coach.
Additional disclaimer: please understand throughout the above post appropriate pronouns are implied and gender of the patient and physician is not assumed. Please insert “he/she/him/her/they/them” above where “he” “she” “him” “her” is used to reference gender. Assumptions and stereotypes have not been applied but omitted due to long reply.
You’re amazing! Very thorough! I appreciate this explanation!
Thank you soo much for this!
Great example of SBAR technique! Love your videos!
Maureen Murray Thank you very much.
Totally subscribing to you. Cant believe i havent seen your videos before. Absolutely love them! Thank you so much! :)
Haha, you're too kind. Thank you for watching : )
Just finished my first week of my first nursing job!! I think out of everything contacting the Doc for the first time was the most scary for me haha
my wife is a RN, and sometimes when she calls the team doctor(s) for the patient, she is up front, and informs the doctor on what SHOULD be done, and sometimes; especially during night shifts, the doctor just goes with whatever she prescribes is the best course of action. Team doctors normally in her hospital have medi students, so she 'informs' them of what should be done, even though she still has to go through the resident to confirm the order.
Answered alotta my questions
JUST SUBSCRIBED! :) you are super informative! I love it!
+Alma G. G. Thank you for your support.
Thank you very much for making this SBAR video it is greatly appreciated! Thank you so much for all the information you share.
Anquinita Davis You are very welcome, thank you for watching.
This is GOLD. Thank you, Nacole
No problem, thank you for watching.
Great job on these videos, Nacole. Very helpful.
I am a new graduate and just got hired for my first RN job and will be working nights. I feel very nervous. What tips can you give about preparing myself? How does a new grad - lacking experience- go by calling physicians and recommending what to do?
This is awesome!!! Thank you!
Thank you for watching : )
Thank you very much you gave such good information.
+Jayshree Sharma You're very welcome.
How do you handle night shifts? What do you do to stay up during work dayss?
Great info!! Thanks. Just subscribed!
Thank you for your support.
Thank you so much!
darn girl, you rock!
really good information! thank you. I subscribed.
Thank you for watching.
THANKYOU. THANKYOU. And THANKYOU. x
You're welcome, thank you for watching.
You are honestly saving me. Haha.
Really informative! Do you have any videos on how to read the patient chart or write the chart accurately? My school teaches by self directed learning so its up to us the students how to figure out how to do things. I've mostly been figuring out how things work through youtube. Was your school like this? Also, any other helpful videos you can recommend?
+nearleaf22 Charts are institution based, going over that would only work if you and I worked in the same place. Hope you understand : )
Thank you you were awesome!
+Peter Lee Umm, you're awesome and thank you : )