Question

Please create a SBAR HANDOFF Communication Tool based on on the case study below. thank you

Case Study Ms. Cis a 42-year-old black American woman with a 7-year history of hypertension first diagnosed during her last pregnancy. Her family history is positive for hypertension, with her mother dying at 56 years of age from hypertension-related cardiovascular disease (CVD). In addition, both her maternal and paternal grandparents had CVD. At physician visit one, Ms. Cpresented with complaints of headache and general weakness. She reported that she has been taking many medications for her hypertension in the past, but stopped taking them because of the side effects. She could not recall the names of the medications. Currently she is taking 100 mg/day atenolol and 12.5 mg/day hydrochlorothiazide (HCTZ), which she admits to taking irregularly because "... they bother me, and I forget to renew my prescription." Despite this antihypertensive regimen, her blood pressure remains elevated, ranging from 150 to 155/110 to 114 mm Hg. In addition, Ms. C admits that she has found it difficult to exercise, stop smoking, and change her eating habits. Findings from a complete history and physical assessment are unremarkable except for the presence of moderate obesity (5 6 in., 150 lbs), minimal retinopathy, and a 25-year history of smoking approximately one pack of cigarettes per day. Initial laboratory data revealed serum sodium 138 mg/L. (135 to 147 mEq/L.), potassium 3A mg/L (3.5 to 5 mEq/L.), blood urea nitrogen (BUN) 19 mg/dl. (10 to 20 mg/dL.), creatinine 0.9 mg/dL. (0.35 to 0.93 mg/dL): calcium 9.8 mg/dL (8.8 to 10 mg/dL.); total cholesterol 268 mg/dL (< 245 mg/dL), triglycerides 230 mg/dL (< 160 mg/dL), and fasting glucose 105 mg/dL (70 to 110 mg/dL). The patient refused a 24-h urine test.

Answer 1

SBAR defined

The prevailing gold standard handoff structure, Situation, Background, Assessment, Recommendation (SBAR), was originally developed and effectively used during submarine duty handoff by the US Navy. The Joint Commission [30] describes the SBAR communication technique as, Situation: what is the situation; why are you calling the physician? Background: what is the background information? Assessment: what is your assessment of the problem? Recommendation: how should the problem be corrected? In a health care setting, the SBAR protocol was first introduced at Kaiser Permanente in 2003 as a framework for structuring conversations between doctors and nurses about situations requiring immediate attention [31]. SBAR was originally implemented in health care settings with the intent of improving nurse-physician communication in acute care situations; however, it has also been shown to increase communication satisfaction among health care providers as well as their perceptions that communication is more precise . The role of the SBAR tool during handoff has been highlighted and supported by various specialties such as anesthesia . perioperative medicine .postoperative medicine. obstetrics .emergency medicine, acute care medicine .pediatrics ,and neonatology .

Situation.

Headache and general weakness

Background.

Hypertension

Assessment.

Taking into account the past history of compliance irregularities and the need to take immediate action to lower this patient’s blood pressure, Ms. C’s pharmacologic regimen was changed to a trial of the angiotensin-converting enzyme (ACE) inhibitor enalapril, 5 mg/day; her HCTZ was discontinued.

Recommendation.

recommendations for smoking cessation, weight reduction, and diet modification were reviewed as recommended by the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI).1

After a 3-month trial of this treatment plan with escalation of the enalapril dose to 20 mg/day, the patient’s blood pressure remained uncontrolled. The patient’s medical status was reviewed, without notation of significant changes, and her antihypertensive therapy was modified. The ACE inhibitor was discontinued, and the patient was started on the angiotensin-II receptor blocker (ARB) losartan, 50 mg/day.

After 2 months of therapy with the ARB the patient experienced a modest, yet encouraging, reduction in blood pressure (140/100 mm Hg). Serum electrolyte laboratory values were within normal limits, and the physical assessment remained unchanged. The treatment plan was to continue the ARB and reevaluate the patient in 1 month. At that time, if blood pressure control remained marginal, low-dose HCTZ (12.5 mg/day) was to be added to the regimen.