Hey guys, so question here from Nancy talking about SBAR report. and physician interaction from a student's perspective. So I'm going to talk about that for a little bit. I'm going to start with the SBAR report, and then I'm going to talk about the physician interaction.
So I'm not a fan of any single report style. So I know there's the SBAR. I know there's the court reporting. There's various acronyms out there for different types of reports you can give.
Here's how I break it down when it comes to giving report. This is what I ask my students to do during report. This is what I listen for during report.
What you don't want in report is something like this. Okay. Hey, patient in bed 413. The last treatment was given at 1115. Their pre vitals were X, Y, Z. They did their treatment. They did good at it or they sucked.
at it and their post vitals were XYZ. Most respiratory therapists don't care about that. We don't care about pre vitals and post vitals.
We do care about abnormalities in pre and post vitals but we don't really care about the pre and post vitals if they didn't change. So stop giving a report over unchanged vital signs. What a quality report should look like is this.
and it should include all of these topics. Demographics for your patient. So I got a 67 year old Caucasian female. Okay. She was DOA, date of admission.
She was admitted on 8-9. What's the date today? 8-13. So she's been here for four days.
That tells you something, right? Immediately, you know something. What if I told you she was admitted on 6-13?
Then you go, she's been in for two months, right? So that's why date of admission is important. Probably the single most cut out piece of information during report is date of admission.
And it's so vitally important because it gives you a state of mind of, is this an acute situation that I'm dealing with? Or is this a chronic or a continuation of a problem that I'm dealing with? So date of admission is so incredibly important. Okay. What did they come in for?
Chief complaint. Came in for shortness of breath. How often do you see that?
Most of the time. Right? Most of the time patients come in, excessive shortness of breath, persistent cough, whatever it may be.
They don't ever come in and say, I feel pretty good. I just thought I'd come to the emergency room to get checked out. No. Chief complaint will tell you a lot about what brought them here.
History. Now, when I say history, most of our patients have hyperlipidemia. Okay? You can put that in there.
I don't really care. Okay? But if they have... coronary artery disease if they have congestive heart failure if they have COPD they have a history of asthma let's say they came in for a broken foot the chief complaint is right lower extremity pain because they broke their foot but they got a history of asthma you should probably know that right so when you talk about history include any relevant history diabetes in anything that gives you an indication of a situation that might become relevant while that patient is in the hospital. Now, the next thing I'd like to include is always your most recent chest x-ray and ABG.
And if they're not recent, like if they're more than 48 hours old, then you can still give those values, but just state that they were 48 hours ago. The last chest x-ray was done on 8-11, today's 8-13, 8-11, and it showed continuing atelectasis. ABG two days ago showed mild hypoxemia, normal acid-base balance.
That's information that I can use as an oncoming respiratory therapist. What if the most recent blood gas was 30 minutes ago? And then you should say...
We just did a blood gas on this patient and they have a CO2 of 46 and a pH of 7.34. then I know I need to keep a watch on this patient, right? Because this is looking like potentially impending ventilatory failure, and I need to know about that, right? So always talk about your chest x-ray and your ABGs when you give a report. The next thing you want to do is talk about your orders.
What are the current orders? And then the last thing is your response to therapy. Okay, so how do they do with their therapy? Maybe we're doing a Medineb. Q4 for a patient who has atlactasis on the chest x-ray.
Tell me are they doing Medinev with a mask or with a mouthpiece? Are they getting a pressure of 20 centimeters of water pressure? Or can they only tolerate 10 centimeters of water pressure?
Tell me what those pressures are. Tell me what I should expect. Tell me when I only get 10 but you got 20 then I know that's a problem. Okay, now the one thing you don't see on here that you see on the s bar Guideline is recommendations. Okay s is situation B is background a is assessment R is Recommendations now, I don't really talk about recommendations because here's my thoughts on Recommendations you ready?
You're probably not but especially For day shift respiratory therapists, you should probably not give off report and have any recommendations to changes. Because if you have recommendations, you probably should have already addressed those recommendations. Now I'm not saying that the physician or the medical team agreed with you.
I'm just saying that you probably shouldn't leave the next shift with, this is what you need to do. No, if this is what they need to do, then this is what you should have pursued during your shift. So I don't like talking about recommendations, because recommendations just become a recurring cycle. Nice Shift isn't going to call and get the recommendations acted on.
And I'm not saying they should. Maybe they should. Maybe they shouldn't.
I'm not saying they should or shouldn't. I'm just saying if day shift, when the physicians are present or at least actively working, don't pursue the recommendations, then you can expect night shift to follow up those recommendations when the physicians and overall Medicare team. have left for the evening.
So I'm not a big fan of recommendations in report because if you have a recommendation you should pick up the phone and call and act on that recommendation. Personal opinion, I'm not the medical community, nobody really other than just one person, just my personal views. So I would just like to talk about response to therapy.
If you feel like a patient is on Ibuterol Q4 and they have pneumonia and they don't need Ibuterol and they need more of a mucus clearance adjunct or they need Medineb, I'm not a fan of giving a report like, hey, you should call the doctor and get Medineb ordered. No, I should have called the doctor and gotten Medineb ordered. Right?
That makes sense. Hopefully. Maybe it doesn't. Maybe I'm going to present things like that.
I don't know. So I'm not a fan of recommendation in report. If you did call and make a recommendation, then you should pass that on.
But don't give the next person a recommendation of what you think they should do. If you think it should be done, then you make the recommendation. If the next person wants to make the recommendation, then let them come to that and make the recommendation.
So that's my thoughts on SBAR. That's my thoughts on what a report should look like. Okay.
Report is something that is not. generally naturally come to it doesn't it's not something I think you really get good at during the academic phase of your learning I think it's something that grows as you continue to give more and more reports okay but more details are better than fewer details Got it? Now, more details into what happened are not necessarily always good. So I've gotten reports before where it was like, the dude got shot, his girlfriend said that he cheated on her, and he said no, and then she came back and said, yes you did, and then the mother came in, and the mother said, did you cheat or not, and the mother, chop, I don't care about all that.
I just need to know what happened to the patient. What's the problem? Motorcycle accident. Motor vehicle collision.
Gunshot wound. I don't care about all that other stuff. I don't care if it was brother-in-law came in over a poker game and beat him over the head with a beer bottle because he had the ace of spades and he cheated. I don't care. So keep it to the relative matter, to what happened, the relevant history, the relevant chest X-ray and ABG, the current orders, and how they respond to those orders, and leave it at that.
Okay? short concise to the point and let me come on assess the patient and make my further recommendations to what needs to happen and i will talk to the care team from there ok now the second part of your question nancy was about physician interaction and how you go about that in the student role You know, everybody knows students have to get physician interactions as part of the co-arc requirements. And so co-arc is the governing body for all respiratory therapy schools. And the question is, I don't like talking to students.
I mean, not to students. As a student, I don't like talking to physicians. So, do you have any pointers? Yeah, I do.
Here you go. Relevant to the patient. Know your disease process, know your anatomical alterations, and ask yourself, is the therapy that's ordered correcting the anatomical alterations? If it's asthma and you're ordered Q4 albuterol, then yes, you're meeting the needs of the anatomical alterations.
Perfect. No questions asked. If it's asthma and they're on a ventilator and you're on a flow of 40 liters per minute, could you talk to the doctor about increasing the flow to decrease the I time, to increase the E time?
to allow for less air trapping? 100%. If it's pneumonia and they're ordered on Q4 hour albuterol, can I talk to the doctor about why are we on Q4 hour albuterol?
Yes, you can, but you should probably do it in a way that says, hey doc, can we, instead of doing Q4 hour albuterol, can we start a Medineb? so that we can re-recruit dysfunctional alveoli and increase functional alveoli in the area of the pneumonia. That's a discussion you could have 100%. Now, you could always go to a physician. Let's say you don't have a patient who has anything that has orders that should be questioned.
You can always approach a physician with simple questions such as, Hey, Doc, what do you think about IS versus Medinab? Like, what are your thoughts? You can always approach anybody, a doctor, a pharmacist, a physical therapist, another respiratory therapist, a nurse.
If you approach anybody with these words right here, you ready? Excuse me. Can I pick your brain for a second?
You just put that person on a pedestal and you want to know what they think. I'm a respiratory therapy student. I know virtually very little. Let me pick your brain for a moment. Talk to me about what you're concerned about with your post-op thoracic surgery patient.
You're going to get a wealth of information that you weren't even expecting. So remember those words. Excuse me, doctor, such and such, whatever his name is.
Can I pick your brain for a moment and see the response you get? It's going to be much greater than going up and saying, excuse me, why is the patient on a two liter nasal cannula? They're going to say. Because that's what I ordered.
Ask them to share their knowledge with you. Ask them to talk to you. Ask them to share the knowledge they have by, can I pick your brain for a minute?
Most people respond very positively. to that approach. I hope this helps.
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Good luck.