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Enhancing Communication

There are several techniques or tools that can help to strengthen team communication:

SBAR is a framework for team members to structure information exchanges when communicating
with one another.

It is meant to help make information clear, complete and concise.

When communicating using SBAR you should:

State the Situation of concern immediately and concisely so your listener understands the point of concern.

You should then place your concern in the context of relevant Background information.

You should then provide your listener with your Assessment of the situation, followed by your

Recommendation of what you believe needs to be done to address the situtation.

[For an example of SBAR, click the play button, then double click on the screen to enlarge the video]

Some other examples of SBAR communication that you can use to shape your communication skills:

Nurse (speaking on phone to physician):

S: I'm calling you about a patient, Mrs. S.B. whose mental status seems to have changed..

B: She's 75 years old and had a hip fracture repaired yesterday.She did well for the first 24 hours
but this evening she seems confused and a bit restless in bed. Her temperature is slightly elevated
at 99.5 degrees, her blood pressure is 114/69, her HR is 96 and her 02 sat is 90%.
Her incision does not reveal signs of infection, and other than her confusion her physical exam and
her neurological status is unchanged. She's been on Norco for the past 24 hours as her only new medication.

A:This might just be from the Norco she's receiving, or perhaps she could just be "sundowning," but I don't think
we can exclude early sepsis, or even a pulmonary embolism as the cause.

R:I'm concerned and would like you to come and assess her to make certain we don't ignore anything that could be serious.

ED Physician (speaking to respiratory therapist)

S:I need for you to help me with a dyspneic patient here in the Emergency Department.

B:The patient is a 74 y/o male with known COPD, and multiple hospitalizations for shortness of breath.
His 02 sat is 84% and his PCO2 is 52.
The last time he was in the hospital he required intubation for a prolonged period of time.
He now states that he no longer wishes to be intubated (DNI) as part of his treatment.

A: He has a right lower lobe pneumonia for which he has agreed to inpatient treatment with IV antibiotics

R: I need for you to come and set him up on BIPAP.

"The patient's blood pressure is dropping!"

"I am having difficulty getting a peripheral IV."

"I don't like the way the patient looks!"

"I'm seeing an increase in fetal decelerations!"

 

Effective team members feel empowered to call out whenever the need arises, recognizing that the ultimate goal
is the safety of the patient and the success of the team.

[For an example of a Call Out, click the play button, then double click on the screen to enlarge the video]

The sender initiates the message, the receiver accepts it and restates the message,
in return, the sender verifies that the re-statement of the original message is correct or
if not, amends it.

Leader: "Nurse Jones: I wan't you to administer one amp of 50% Dextrose IV.
Nurse Jones: "I am ready to give one amp of 50% Dextrose IV."

Leader: "Dr. Richards, when the patient is adequately sedated I want you to charge the defibrillator
and perform a synchronous cardioversion at a setting of 100 Joules."
Dr. Richards: "I will prepare the defibrillator to perform synchronized cardioversion at a setting of 100 Joules."

[For an example of a Check Back click the play button, then double click on the screen to enlarge the video]

 [Click the play button, then double click on the screen to enlarge the video]

Having explored strategies for enhancing communication, let us now turn to the third pillar of effective
team performance, Situation Monitoring.


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