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Collaborating with HCP: ISBARR – COPD Nursing Care in ER

by Rhonda Lawes

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    00:00 Because now here's your chance.

    00:03 You get to practice using the I-SBAR-R method for organizing your information.

    00:09 Now, sometimes you might see just SBAR. Now, you've got some people add the I and the R.

    00:14 We'll show you multiple ways on how to do it in our series just because we want you to be open to that and find the best method that works for you.

    00:22 Now, we talked about the repeated vital signs on admit.

    00:26 Remember, she was 87%, 2 liters nasal cannula, it was her sat on 2 liters.

    00:31 Respirations were 28, pulse 113, you've got her blood pressure.

    00:35 But I'm not gonna keep repeating those for you because you have them written down.

    00:40 Now, identification is identifying yourself. S stands for situation, B stands for background, A stands for assessment, and R stands for recommendation.

    00:53 Now, the second R can often be read back if you get specific orders from the health care provider.

    00:57 That way you can read them back to them.

    00:59 So I've given you kind of a breakdown.

    01:02 I'm gonna introduce what types of things you would say in each one of these and then I want you to pause the video and quickly write out what you would say to the health care provider using this brief format.

    01:14 So the S is situation. So if you're in an ER, you've likely worked with this health care provider multiple times so you may or may not have to introduce yourself.

    01:23 Okay, so we're in the trauma emergency center.

    01:25 I could say, "Hi, hey, I'm Ronda," if I've not met the person before otherwise you can skip that point.

    01:31 Now, if I'm calling, I'll say I'm calling and say, "Hey, I wanted to talk to you about our new patient in bed number 4, Mrs. Taylor.

    01:38 I'm talking to you because I'm concerned about --" now you fill in abnormal assessment.

    01:44 So what are the -- all of the abnormal assessment that Mrs. Taylor has had.

    01:50 Well, the most pressing one is that pulse ox while she's on oxygen and her respiratory distress.

    01:57 So you wanna zero in when you talk to a health care provider.

    02:00 "Hey, this is what I need to communicate to you." The most important stuff so keep it short, succinct, and to the point.

    02:07 So take advantage of this.

    02:09 We're gonna learn together how you can establish a better professional relationship with health care providers by the way you communicate with them.

    02:18 We're gonna help you get your ducks in a row before you talk with them and you get the best care for you patient and you'll establish a great relationship that health care providers will respect your practice.

    02:29 So pause the video and you fill in the blanks.

    02:32 Write out the little script on what you would say for the situation part of the SBAR method.

    02:41 Okay, good. Now you've walked through the situation part.

    02:44 Now, I want you to talk about background.

    02:47 Okay, so here's where we talk about her history.

    02:50 So Mrs. Taylor came to the ER today.

    02:53 She was brought in by her daughter, right? So she was brought in through her daughter, triage noted she was in respiratory distress that's why she was brought back to the beds.

    03:02 Now, they have had what type of procedures? Well, the only procedures that she's had have been, right, a pulse ox and she's on nasal cannula. Haven't really done anything else for her.

    03:14 Now, the patient's condition has changed in the last blah, blah, blah.

    03:18 This is where we would use our information. She was this sat on room air.

    03:24 She's now this sat on 2 liters nasal cannula, okay? The list and sets of observation, we fill that out, we talked about cuz we're most concerned about oxygenation right now.

    03:35 I'm also gonna give them that information of what she's gone through, what her initial sets where, what we've done since she's been admitted, and what they are now.

    03:45 And then I'm gonna say her normal condition is what? So we're dealing with a respiratory distress like, she can talk to me but she gets very short of breath with short sentences.

    03:56 She does have COPD but she has told us that this is much different than her normal respiratory rate.

    04:03 Okay, now, you pause the video and use your words.

    04:06 I've given you clues but I want you to actually do the mental gymnastics it takes for you to walk through this and say if I was really the ER nurse, what would I say to the health care provider in the stuff? Okay, great. You've got the first 2 steps down. Now, assessment.

    04:27 You could say, I think the problem is that since she had that respiratory infection and her sat is still low, on 2 liters, and she's extremely short of breath, this is what you could say.

    04:41 I think the problem is the respiratory infection has just exacerbated her COPD.

    04:45 Now, it's also okay to say. "Hey, I'm not sure what the problem is but the patient is doing this, this, and this." That's what the X stands for. And is deteriorating.

    04:54 Or it's even okay to say and I've got to say this before, "I don't know what's wrong but I just have a gut feeling something is not right with this patient. I'm worried." And when you have established a professional relationship with a health care provider, they will listen to you and they will respond but that is on you to do the work of being organized in presenting information in a helpful manner for your patient.

    05:20 So pause the video. You practice -- actually speak it out, write it out, make your brain do the mental gymnastics because you're practicing for how you're gonna actually practice as a nurse.

    05:35 Now we're down to the R. What's your recommendation? What do you want done for the patient? Hey, that's not being bossy.

    05:43 That's being professional.

    05:44 Based on the situation, the background, and your assessment, what do you need for this patient? Well, in ER, you have lots of protocols, you also are very familiar with COPD patients so you know you're gonna start asking I need you to blank.

    05:59 So we know respiratory's the biggest problem.

    06:02 I need you to write some admit orders because this is exacerbation of COPD.

    06:06 You know, I need some orders for oxygen, what lab do you want.

    06:09 You can ask for all those things.

    06:11 If you know the physician really well, you may just say, "Hey, I need some admit orders.

    06:16 Would you mind writing those for me?" Or if you need the physician to come in and see the patient, you would say, "I need you to either come and see the patient in extra of minutes, and then I can follow up with, "Is there anything I need to do in the meantime?" See, that's open communication where you're letting them know.

    06:33 "Hey, this patient can wait and maybe doesn't need to be seen right away." Or, "No, no, I need you to come see this patient right away." In ER, you have that luxury.

    06:43 If you're on a floor in the hospital, the doctors are not right there.

    06:46 It's a different type of system. But this is your recommendation.

    06:49 Based on your current knowledge, what you know about Mrs. Taylor, what would you recommend to the physician? Pause the video, write it out, speak it out but practice while you do it.

    07:06 Okay, good work.

    07:07 I know this feels weird like you're talking to yourself or you're hearing voices in your head but this is the best way, is to practice, practice, practice so you'll be better at this when you're in real life situations.

    07:19 Now, the last R at the end, that's the read back.

    07:22 If the physician gives you an order, make sure you speak that back to them to make sure you're very clear on what they ask you to do.

    07:30 Sometimes in hospitals, if a physician is not gonna enter the order electronically, maybe a good idea to have someone else listen to the order with you and listen to you read it back to the physician.

    07:41 It just depends on how the system works in the hospital where you are.


    About the Lecture

    The lecture Collaborating with HCP: ISBARR – COPD Nursing Care in ER by Rhonda Lawes is from the course Respiratory Case Study: Nursing Care of COPD Patient.


    Included Quiz Questions

    1. Identification, situation, background, assessment, recommendation, read back
    2. Identification, situation, background, acknowledgment, requesting provider, read back
    3. Identification, summary, background, acknowledgment, recommendation, read back
    4. Identification, summary, background, assessment, requesting provider, read back
    1. "I have Ms. Smith, 62F, with CC of SOB that started this morning. She has a history of COPD and CHF. Her lung sounds are diminished, with crackles posterior. Would you like a breathing treatment started?"
    2. "I have a guy here today who has a history of CHF. Would you like me to listen to his lung sounds? He says he has difficulty sleeping at night."
    3. "My lady I just brought back could really benefit from some furosemide. She's 59 years old and has a lot of bilateral lower extremity swelling. She says she has a history of CHF."
    4. "Mr. Jones is here and I'm not sure but he's very anxious. He might be SOB. He can't tell me what is wrong. His oxygen saturation on room air is 90% but he's working pretty hard to breathe. I think he might have COPD. What would you like me to do?"
    1. Read or repeat back the orders to the health care provider.
    2. Write them down and instruct another nurse to complete the orders.
    3. Ask the nurse nearby what the orders were.
    4. Ask the other provider working with the ordering physician what he thought he would have ordered in this situation.
    1. "I need you to come see the client in 15 minutes."
    2. "I need you to put the order in for the Lasix you ordered verbally."
    3. "I saw you ordered Zofran for the patient's nausea, but he has an allergy to Zofran. Would you like to order something else?"
    4. "You ordered Lasix, and I really don't think that's appropriate. You should order something else."
    5. "If you don't come to see the client right now, she might die."

    Author of lecture Collaborating with HCP: ISBARR – COPD Nursing Care in ER

     Rhonda Lawes

    Rhonda Lawes


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