help with ISBAR please?

  1. 0
    I am trying to understand how to utilize ISBAR with different scenarios. this is my first assignment related to this tool. i'm a bit confused and need help

    The first scenario involves a patient who is 80yrs old, who lives alone but has family nearby, and was diagnosed with diabetes 6 months ago. he has an injury on his toe and the home health nurse (me) is to assess it. after i do SPICES and ADL questions, I assess the wound and am supposed to call the doctor using ISBAR. I am not exactly sure how to word my statement and/or if i'm missing information. So far I have this: (after introducing self, stating i'm patients RN, and that I'm calling from his home) "patient currently has a wound on his right big toe. he said he injured it three weeks ago and has been soaking it in water. the patient has a history of diabetes - he was diagnosed six months ago. he takes 12 units of NPH insulin, tylenol, aspirin and a multivitamin every day. I assessed the ulcer and it appears to be infected. (then i will describe pain level, wound size, color of tissue, note drainage, odor, & edema but i wont find that out until tomorrow). My recommendation is to get him started on some antibiotics to help clear the infection." ..... I'm not sure what else to add to that. any suggestions? the treatment is also supposed to involve applying Neosporin to the wound and a damp saline soaked gauze, and also to have a home health nurse to monitor the wound 2 times a week, but I'm not sure if the doctor needs to okay applying neosporin or how that all works...

    The second scenario involves the same patient a couple weeks later who has't been taking care of himself. At the end of assessing him, administering meds, drawing labs and such, i'm supposed to request lab results - (do I just state that I would call the lab for that?) and after I request labs I am supposed to give report to the nurse in ICU using a standardized hand off tool... what does a report like that look like? just what has been done for the patient and his current condition? I am trying to find examples online but no luck
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  4. 1
    This is a school assignment, right? I can only speak to how I give a hand-off report, so it may not be what your instructors are looking for. We use SBAR at my job, is the "I" "introduction"? If this doc already cares for this patient, it would change how I request the order. "This is Nurse, Rosey, and I'm taking care of your 80-year-old diabetic patient, Mr. Smith. (that may be all it takes for the PCP to know who you're talking about). He's got a (size) ulceration on his (location) from a 3-week-old injury; he's been soaking it. The toe is edematous, erythemic, and oozing small/medium/large amounts of (color) exudate that (odor). The swelling and redness (travels up to ..... is isolated to toe....). I would like to culture the wound and start him on xyz abx because he is allergic to...or NKDA." I am not sure what your instructors expect; I generally don't give an entire Hx if the provider is already aware of the patient and is the prescriber of their meds. Your info sounds pretty good, I would try to make it as brief but thorough as possible.

    As far as the second question, you already are using a standardized hand-off tool - that's what the SBAR is. Just take your ICU patient and do what you did for your diabetic with the infx.

    A standard report from me would be something like this:

    Intro/Situation: "This is Nurse Rosey calling from the PACU, I have Ms. Brown ready for you."
    Background: "She is a 65 year old patient of Dr. Important's who had a lap chole today. She is allergic to PCN and has a history of htn, obesity, and a 50 year pack-history of smoking. She has been with me for 1.5 hours."
    Assessment: "She has 20 g iv in her RFA and 500 of LR up in bag #3. She has Teds, flow-trons and a Morphine PCA set at 1mg every 10 minutes with a 24 in 4 lock-out. She has four lap sites (give sites) that are steri-stripped and dry; Dr. Important injected Xcc's of 0.5% Marcaine w/Epi into the sites; her EBL was <20cc. I have given her a total of 200 mcg of Fentanyl, the last 50 mcg dose was at 1630; she also had some nausea, so I gave 4 mg of Zofran at 1615 and she states it is better. She has taken a few ice chips without any further nausea. She is currently rating her pain at 4/10, using her PCA appropriately, and resting in between doses. CMS checks are good, she is easily arousable to verbal stimulation. Her latest vitals are: T: 98.6 P: 65 in sinus rhythm R: 16 b/p 120/80, SpO2 97% on 2L by nasal cannula."
    Recommendations: I will be ready to bring her to you in about five minutes. She is on a cart, so if you could have her bed ready and we will need at least two more people to help with the transfer, that would be great. I will call the waiting room and let the family know we are moving her." (I would also let them know here if there is anything that needs to be done right on arrival - Dr. Important has ordered a test/abx/etc. as soon as she is in her room - this just gives them courtesy heads-up)
    Then you give the receiving nurse a chance to ask questions.

    I am sure that an instructor would probably rip this to shreds, but it works for me, and hopefully gives you a rough idea. You are a student, you are supposed to be learning how to do this, so hopefully your instructors will give you constructive feedback on this assignment that will help you in your real-world communications.
    Last edit by Roseyposey on Feb 5, '13 : Reason: happy fingers
    GrnTea likes this.
  5. 0
    ^^

    Excellent response
  6. 0
    thanks that definitely helps!!
  7. 1
    Quote from Roseyposey
    This is a school assignment, right? I can only speak to how I give a hand-off report, so it may not be what your instructors are looking for. We use SBAR at my job, is the "I" "introduction"? If this doc already cares for this patient, it would change how I request the order. "This is Nurse, Rosey, and I'm taking care of your 80-year-old diabetic patient, Mr. Smith. (that may be all it takes for the PCP to know who you're talking about). He's got a (size) ulceration on his (location) from a 3-week-old injury; he's been soaking it. The toe is edematous, erythemic, and oozing small/medium/large amounts of (color) exudate that (odor). The swelling and redness (travels up to ..... is isolated to toe....). I would like to culture the wound and start him on xyz abx because he is allergic to...or NKDA." I am not sure what your instructors expect; I generally don't give an entire Hx if the provider is already aware of the patient and is the prescriber of their meds. Your info sounds pretty good, I would try to make it as brief but thorough as possible.

    As far as the second question, you already are using a standardized hand-off tool - that's what the SBAR is. Just take your ICU patient and do what you did for your diabetic with the infx.

    A standard report from me would be something like this:

    Intro/Situation: "This is Nurse Rosey calling from the PACU, I have Ms. Brown ready for you."
    Background: "She is a 65 year old patient of Dr. Important's who had a lap chole today. She is allergic to PCN and has a history of htn, obesity, and a 50 year pack-history of smoking. She has been with me for 1.5 hours."
    Assessment: "She has 20 g iv in her RFA and 500 of LR up in bag #3. She has Teds, flow-trons and a Morphine PCA set at 1mg every 10 minutes with a 24 in 4 lock-out. She has four lap sites (give sites) that are steri-stripped and dry; Dr. Important injected Xcc's of 0.5% Marcaine w/Epi into the sites; her EBL was <20cc. I have given her a total of 200 mcg of Fentanyl, the last 50 mcg dose was at 1630; she also had some nausea, so I gave 4 mg of Zofran at 1615 and she states it is better. She has taken a few ice chips without any further nausea. She is currently rating her pain at 4/10, using her PCA appropriately, and resting in between doses. CMS checks are good, she is easily arousable to verbal stimulation. Her latest vitals are: T: 98.6 P: 65 in sinus rhythm R: 16 b/p 120/80, SpO2 97% on 2L by nasal cannula."
    Recommendations: I will be ready to bring her to you in about five minutes. She is on a cart, so if you could have her bed ready and we will need at least two more people to help with the transfer, that would be great. I will call the waiting room and let the family know we are moving her." (I would also let them know here if there is anything that needs to be done right on arrival - Dr. Important has ordered a test/abx/etc. as soon as she is in her room - this just gives them courtesy heads-up)
    Then you give the receiving nurse a chance to ask questions.

    I am sure that an instructor would probably rip this to shreds, but it works for me, and hopefully gives you a rough idea. You are a student, you are supposed to be learning how to do this, so hopefully your instructors will give you constructive feedback on this assignment that will help you in your real-world communications.
    This is a great example.......follow these steps

    ISBAR in action
    Introduction

    • Introduce yourself and your role in the patient’s care
    • State the unit you are calling from when speaking with a physician over the phone

    Situation

    • Specify the patient’s name and current condition or situation
    • Explain what has happened to trigger this conversation

    Background

    • State the admission date of the patient, his or her diagnosis, and pertinent medical history
    • Give a brief synopsis of what’s been done so far (e.g., lab test)

    Assessment

    • Give a summary of the patient’s condition or situation
    • Explain what you think the problem is or say, “I’m not sure what the problem is, but the patient is deteriorating”
    • Expand upon your statement with specific signs and symptoms

    Recommendation

    • Explain what you would like to see done (e.g., lab tests, treatments, or “I need you to see the patient now”)
    • State any new treatments or changes ordered (e.g., monitoring and frequency or when to re-notify the physician if there is no improvement in the patient)
    Roseyposey likes this.
  8. 0
    heyy..i reccomend this page on sbar samples..it has helpful links to a few essays and pdfs on handoff techniques!


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