Effective communication is essential for all nurses, but especially for home health nurses, as we often become the eyes, ears and hands of our patients' physicians. And being the surrogate for the doctor means when we call to report patient issues or problems, we need to communicate clearly, effectively and quickly.
In one example of promoting effective communication techniques of healthcare staff, Kaiser Permanente of Colorado adapted a tool from the U.S. Navy called SBAR (situation, background, assessment, recommendation) which is a formalized method of communicating information between healthcare team members and is frequently used to report a situation that requires immediate action.1
According to the Institute for Healthcare Improvement, 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."2
When contacting the physician to report changes in a patient's status utilizing SBAR communication include: your name, designation/credentials (RN), the agency you work for, the patients' name and other statistics as needed, and the problem. Describe what is happening with the patient that warranted the call.
For example, you might say: "Dr. Jones, this is Linda Snyder, RN, of Keystone Home Health. I'm calling about your patient, Mrs. Smith, DOB of 5/5/45. She is reporting increased shortness of breath and feeling more fatigued the past 2 days.
Next, the home health nurse employing the SBAR communication technique should provide the physician with the patient's relevant back ground information, such as vital signs, diagnosis, other complaints, recent hospitalizations and any other pertinent physical assessment findings.
For example, you might say: "Mrs. Smith recently came home from the hospital after a 4-day stay for exacerbation of her COPD. However, at this time Mrs. Smith is presenting with +1-2 pitting edema of both legs below mid-shin and I noted scattered crackles at bilateral lung bases, neither of which were there on my last visit 2 days ago. Her BP is 138/78, her pulse is 84, and her respirations are 24 at rest. Also, she reports a weight gain of about 4 pounds since the beginning of the week."
The next step involves patient assessment, which presents the home health nurse the opportunity to offer your take on the situation.
For example, you might say: "As you know, Mrs. Smith has had problems with CHF in the past, and it appears she is moving toward an exacerbation of her heart failure. When prompted, Mrs. Smith admitted to having a can of soup yesterday for lunch and her son brought her some fast food for dinner, a burger and fries, which she says she ate most of. It seems her increased salt intake over the past few days is putting her into a fluid overload situation."
The "final" part of an SBAR conversation is where the nurse can make her recommendation for handling the situation, such as a change in medication, a visit to the doctor or emergency department as warranted, or other available treatment options. Forming this recommendation as a question sometimes encourages the physician to be more accepting of the suggestion.
For example, you might say: "Dr. Jones, since Mrs. Smith already has 40 mg of furosemide in the home, do you think we should have her take an extra dose for the next 2 days and see if it helps bring down the swelling and weight? We could have a nurse visit again after this increased dose is completed. I am also recommending to her to "lay off" the fast foods and canned soups, and to elevate her legs as often as possible for now."
Improving Communication & Outcomes
As you can see from the above scenario, using the SBAR communication tool can help improve nurse-physician communication. By following the outline, nurses can quickly update the doctor about changes in patient status.
Often, providing information quickly makes the difference in whether you get to talk to the physician. When physicians know the nurse will not take much of their time, they are more apt to take the call to discuss the patient situation and options.
Hopefully, using this method will increase your communications with physicians and improve patient outcomes.
1. Iyer, P. Medication errors. Retrieved Aug. 5, 2009, from the World Wide Web: www.medleague.com/Articles/medical_errors/sbar.htm
2. Institute for Healthcare Improvement. (2009). SBAR technique for communication: A situational briefing model. Retrieved Aug, 6, 2009, from the World Wide Web: http://www.ihi.org/IHI/Topics/PatientSafety/
Linda Snyder is a wound care nurse at Keystone Home Health Services in Wyndmoor, PA. She is currently completing her MSN through Walden University.