SBAR Communication Exercise Scenarios This handout accompanies the “SBAR Communication” presentation. Instructions: Read the scenario for your discipline, then complete the SBAR worksheet. STNAs STATE TESTED NURSE AIDE Mrs. Elmer — Stephanie Napier (STNA) Stephanie Napier, an STNA, is Mrs. Maureen Elmer’s primary aide. When Stephanie was assisting Mrs. Elmer to the bathroom today, she noticed that the resident was increasingly short of breath. When Helen asked Mrs. Elmer about her increase in shortness of breath, Mrs. Elmer responded by saying that it started last night. Because Mrs. Elmer has Congestive Heart Failure and has had problems recently, she is weighed by staff every morning. This morning’s weight was two lbs. more than it was yesterday. Helen sat Mrs. Elmer on the chair and called Tammy, her primary nurse, to find out what she should do. CLINICIANS NURSING Mr. Smith — Nancy Nottingham (Nurse) Mr. James Smith is a 78-year-old resident with CHF and HTN. Today’s vital signs were: T - 98.6, BP - 188/90, RR - 24. He is more SOB today, as evidenced by an increased respiration rate and now SOB ambulating 8 feet (baseline ability - ambulate 20 feet). Lung sounds were previously clear, but today he has crackles in the posterior bilateral lower bases (1/3rd lung fields). He usually has +1 edema, but today it is now +2 and slightly pitting. Mr. Smith’s monthly weight was taken four days ago, so Nursing decided to weigh him again to compare, and noted that he is six lbs. heavier. His current med regime includes: Digoxin, 0.125 mg, every day; Lasix, 20 mg, every day; Slow-K, 20 meq, every day; and Prinivil, 5 mg, every day. He has no standing/prn orders. It is noted that Mr. Smith has taken all of his medications as ordered. His diet in the nursing home is a normal 2 gm Na diet, but did have a ham dinner two days ago when he wife took him home. His wife is anxious over his change in status. Nurse Nancy Nottingham calls the resident’s primary physician, Dr. Gannon, with the update. OCCUPATIONAL THERAPY Mr. Wilson — Oliver Thorpe (OT) Mr. Frederick Wilson is a 69-year-old resident with CVA five years ago with right latent hemiplegia. Nurses are currently dressing an open wound on his right thumb from contracture of the right hand. Nursing also obtained an order for an OT evaluation. OT Oliver Thorpe, OT’s findings included: right- hand contracture, fist-like, with pressure being applied to mid-thumb joint from the index finger. Right wrist drop was also noted. The resident is unable to grip with his right hand. There is good circulation to the hand without other reddened areas at this time. The resident is at high risk for more breakdown. The primary CNA states there is no splint or cone for the resident. OT wants to fabricate a cock-up splint for the right hand and to see the resident according to the following schedule: 3x/week x 2 weeks; 2x/week x 2 weeks. The OT visits will involve teaching the CNA and Nursing staff a massage and exercise program to help prevent further muscle deterioration and skin breakdown. Oliver has contacted Dr. Gannon, the resident’s primary physician, regarding his plan for the resident. PHYSICAL THERAPY Mrs. Jones — Phillip Thomas (PT) Mrs. Helen Jones is a 78-year-old female. She lives in a one-story home with her elderly husband, where she is his primary caregiver. Mrs. Jones’s past medical diagnosis is HTN. She has become increasingly unsteady on her feet within the last several weeks, and has entered the rehabilitation unit for balance and gait training as well as strengthening. A referral was made to PT to evaluate lower extremity strengthening and gait training. PT Phillip Thomas’ findings include: ambulates 15 – 20 feet using furniture & walls. Both ambulation and standing balance fair (-). Strength BLE 3+/5 & BUE 3+/5. No other gait abnormalities exist. The resident showers alone in the home and there are no grab bars or any other shower equipment. A fall risk assessment evidences the resident scored as high risk. Phillip initiates a call to Dr. Gannon, the resident’s primary physician. MEDICAL SOCIAL WORKER Mrs. White — Melissa Stewart (MSW) Mrs. Janice White is a 72-year-old with CHF, diabetes, HTN and renal insufficiency. She is currently in the rehabilitation unit receiving therapy to return home. Mrs. White is currently on 10 different medications. After speaking with the resident, the nurse determines that the resident has not been taking her medication at home the way she should and hasn’t been eating well. MSW Melissa Stewart’s evaluation includes: Mrs. White is on a Medicare A stay in the rehabilitation unit, but is planning on returning home. She receives $XX a month from Social Security. Her expenses, which include rent, utilities, etc., and medication copayments, exceed her monthly income. Mrs. White admits that she has to skip medications because she cannot afford to get them refilled. The MSW finds the resident is eligible for some of the state and community programs, since her income is below poverty level. The resident is interested in applying for benefits. Appropriate referrals will be made, but it will take time to process them. Melissa calls a case conference with the primary nurse. Melissa also contacts the physician to ask for appropriate paperwork for the state referrals and reviews Mrs. White’s medication list for the purpose of reducing or consolidating any of her medications. Melissa will send the appropriate state paperwork to Dr. Gannon, the primary physician, for completion. A complete medication list and the SBAR communication will be faxed to Dr. Gannon. SPEECH THERAPY Mrs. Adams — Samantha Turner (ST) Mrs. Sarah Adams, a 74-year-old who had a CVA 7 weeks ago, has residual mild weakness of right side. She was in the rehabilitation unit for three weeks, but has spent the last four weeks on the skilled unit. Services include skilled nursing and PT. OT was previously discontinued. Mrs. Smith has now developed some swallowing difficulties, especially with solid foods. She complains that it is difficult to get the “food to go down at times,” but has no problem with liquids. ST Samantha Turner’s findings included: A, A, & oriented x 3. Speech is clear and non-slurred, and facial muscle tone is normal. She has good gag reflex and is able to swallow liquids without choking or difficulty. Mrs. Adams is able to swallow soft foods (i.e., mashed potatoes and applesauce), but is having difficulty with pieces of meat and some raw vegetables. The resident, family and staff were given instructions on proper feeding techniques as well as safety instructions on eating solid foods. Samantha has contacted Dr. Gannon, the resident’s primary physician, with the aforementioned findings. Rock Run Center, Suite 100 5700 Lombardo Center Drive Seven Hills, OH 44131 Ph: 216.447.9604 Fax: 216.447.7925 Ohio KePRO Provider QIC Line: 1.800.385.5080 www.ohiokepro.com All material presented or referenced herein is intended for general informational purposes and is not intended to provide or replace the independent judgment of a qualified healthcare provider treating a particular patient. Ohio KePRO disclaims any representation or warranty with respect to any treatments or course of treatment based upon information provided. Publication No. 922000-OH-189-05/2009. This material was prepared by Ohio KePRO, the Medicare Quality Improvement Organization for Ohio, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.
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