SBAR and effective communication save the day!

SBAR and effective communication save the day!

Did you know that a high bilirubin can cause brain damage in an infant?

Kernicterus (high bilirubin) is a highly preventable condition of newborns that leads to severe brain damage or death when neonatal jaundice goes untreated.

Recently at AAMC, the lab reported a high bilirubin level for a newborn on the Mother/Baby Unit. It was well after midnight, but because the nurse was concerned she called the pediatrician to inform him of the level. After a brief conversation the plan was to check the level again in the morning.

After hanging up the phone the nurse was unsatisfied with the results of their conversation. Would morning be too long to wait? Had she communicated her concerns clearly? Should she call the physician back? Unsure, she consulted with the unit charge nurse and CPAC—they decided this situation warranted immediate action.

Before calling the pediatrician back, the team discussed how the nurse would communicate her concerns and what she believed was best for the patient. They even reviewed a few communication concepts, courtesy of TeamSTEPPS training.

After ensuring her report was in a clear and concise SBAR format, the nurse called the pediatrician back. Here, her report:

  • S (Situation): The bilirubin level is a very high result based on the newborn’s age.
  • B (Background): The newborn is 24-hours old and to be discharged today. She was delivered via an uncomplicated vaginal delivery.
  • A (Assessment): She is lethargic, feeding poorly and has signs of visible jaundice.
  • R (Recommendation): I recommend a NICU consult and possible transfer to NICU for phototherapy.

She concluded her report with her “CUS” words:

  • C: I am Concerned about this level, which is why I am calling back.
  • U: I am Uncomfortable not adjusting the plan of care for this baby.
  • S: I don’t think it is Safe to wait until morning.

After this conversation, the pediatrician called the NICU and the newborn was transferred for treatment. He was appreciative of the additional phone call. It included complete information which clearly reflected her level of concern, including additional signs and symptoms, beyond the lab results. It was a true collaboration resulting in excellent patient care. 

Thanks to all the staff involved in this real-life scenario, you saved the day! And thanks to all of the staff who use SBAR. Your clear communication enhances patient safety and quality of care.

-Lil Banchero, RN, Jan Clemons RN, BSN, OCN, Sandy Fox, MS, RN-BC, CCRN, Holly Greever, RN, and Barbara Saia, BSN, RN

1 comment

  1. Posted by Holly Greever RNII, at Reply

    I think this example is applicable to all disciplines. Every unit has patients with lab values, vital signs or other status changes that need to be reported in a structured format. Nurses are critical thinkers and we know what we want the change in the plan of care to be. This is the critical last piece of the SBAR format. Decision makers for the plan of care want to hear the recommendation from those of us that are continually at the bedside. (It even works with husbands and kids!! I have very clear recommendations at home and often get the change in the situation that I desire!!)

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