80 unit 2 | Working Within the Organization
then explains the goal of his or her discipline, the
interventions, and the outcome. Effectiveness of
treatment, development of new interventions, and
setting new goals are discussed. The key to a suc-
cessful interdisciplinary conference is presenting
information in a clear, concise manner and ensur-
ing input from all disciplines and levels of care
providers, from unlicensed assistive personnel to
physicians.
Communicating With Other Disciplines
Breakdowns in verbal and written communication
among health-care providers present a major concern
in the health-care delivery system. The Joint
Commission (www.jcaho.org) attributes a high per-
centage of sentinel events to be related to poor com-
munication among health-care providers. In many
settings, nurses act as patient care managers.
Integration, coordination, and communication
among all disciplines that are delivering care to a spe-
cific patient ultimately are the responsibility of the
nurse care manager. Nurses often find themselves in
the particularly advantageous position to observe the
patient’s responses to treatments. For example:
Mr. Richards is a 75-year-old man who was in a
motor vehicle accident with closed head trauma.
He had right-sided weakness and dysphagia. The
speech therapy, physical therapy, and social services
departments were called in to see Mr. Richards.
A speech therapist was working with Mr. Richards
to assist him with swallowing. He was to receive
pureed foods for the second day. The RN assigned
an LPN to feed Mr. Richards. The LPN reported
that although Mr. Richards had done well
the previous day, he had diff iculty swallowing
today. The RN immediately notif ied the speech
therapist, and a new treatment plan was
developed.Communicating With the Health-Care
Provider
The function of professional nurses in relation to
their patients’ health-care providers is to communi-
cate changes in the patient’s condition, share other
pertinent information, discuss modifications of the
treatment plan, and clarify orders. This can be
stressful for a new graduate who still has some role
insecurity. Using good communication skills and
having the necessary information at hand are help-
ful when discussing patient needs.
Before calling a health-care provider, make sure
that all the information you need is available. The
provider may want more clarification. If you are
calling to report a drop in a patient’s blood pres-
sure, be sure to have the list of the patient’s medica-
tions, laboratory results, vital signs, and blood pres-
sure trends, together with a general assessment of
the patient’s present status.
Sometimes when a nurse calls a physician or
health-care provider, the physician does not return
the call. It is important to document all health-care
provider contacts in the patient’s record. Many
units keep calling logs. In the log, enter the health-
care provider’s name, the date, the time, the reason
for the call, and the time the health-care provider
returns the call.SBAR
In response to the number of patients who die from
or confront a preventable adverse event during
hospitalization, health-care institutions have been
challenged to improve patient safety standards. This
challenge forced health-care institutions to look at
the causes of most sentinel events within their envi-
ronments. SBAR, developed by experts at Kaiser
Permanente, one of the largest health-care systems,
is an abbreviation for Situation, Background,
Assessment, and Recommendation (Haig, Sutton,
& Whittingdon, 2006). It provides a framework for
communicating critical patient information in a
systemized and organized fashion. The SBAR
method focuses on the immediate situation so that
decisions regarding patient care may be made
quickly and safely.
Although originally established to be used as an
“escalation tool,” to be implemented when a rapid
change in patient status occurs or is imminent, many
institutions have decided to implement the method
as a standard for shift report and other coordinating
communications (Haig, Sutton, & Whittingdon;
http://www.rwjf.org, 2008). The use of the SBAR format
helps to standardize a communication system to
effectively transmit needed information to provide
safe and effective patient care. Table 6-2 defines the
steps of the SBAR communication model.
The implementation of SBAR as a communica-
tion technique has demonstrated such success that
the Institute for Healthcare Improvement recom-
mends its use as a standard for communicating
between and among health-care providers. The Joint
Commission is now requiring it as a standard for