The Nursing Associate's Handbook of Clinical Skills. Группа авторов

not include neurological changes in observations. Be aware that new confusion, drowsiness or being unresponsive is indicative of patient deterioration and should be escalated quickly.

       The drug chart (prescription chart) – Review the medications that the patient has been receiving. Are any of these related to the concern you have about the patient? If so, this should be mentioned in the escalation.

       The nursing assessment – An essential source of information about the patient’s past medical history, current diagnosis, allergies, nursing requirements and often patient preferences or concerns.

       Your assessment of the patient – Think about not only the clinical observations but what the patient looks like, sounds like, feels like and smells like. Sometimes, a patient can appear well in terms of their clinical observations but look very unwell. Signs and symptoms can often be more telling of deterioration than the clinical observations on their own.

       Take Note

       Clinical observations refer to the recording of the patient respiratory rate, pulse rate, blood pressure, oxygen saturations, temperature, blood glucose and level of consciousness. These are colloquially known as ‘vital signs’.

       Resuscitation form/treatment escalation plan (TEP) – These documents will detail the decision‐making regarding the appropriateness of resuscitation for a patient or the maximum ceiling of intervention that a patient may receive and thus should be considered as a part of escalation and communicated to the recipient.

       Take Note

       Planning your escalation is important to ensure that the information given during escalation is relevant and concise and prompts the receiver of the escalation to act immediately.

SBAR – A Structured Communication Tool

      The SBAR method was originally designed as a communication tool by the US Navy, ensuring that important communications were concise and focused (Stonehouse 2019); this is the cornerstone of good patient escalation.

      Randmaa et al. (2014) and Müller et al. (2018) demonstrated that the use of the SBAR method for handover improved escalation communication and patient safety. The SBAR method is now a well‐known communication tool between healthcare professionals, ensuring that the person receiving the escalation is familiar with the structure of information being given; it improves accuracy and efficiency of handover which is important in cases of escalation of deteriorating patients.

      The SBAR tool increases confidence of the speaker which in turn obtains the confidence of the healthcare professional receiving the escalation in the person giving it (Stewart & Hand 2017).

      In Table 7.1, the elements of a complete handover are provided.

      With regards to Table 7.1, this must also be documented, and the nursing associate must adhere to local policy and procedure.

      Blue Flag

       The ‘Hello my name is….’ campaign, introduced by Dr Kate Grainger, encourages all staff, irrespective of their role, to introduce themselves when they are with patients and visitors. By simply introducing yourself with ‘Hello my name is ….’ is a simple gesture that can go a long way to helping reduce patient’s anxiety.

      Take Note

       It is important to remember that all elements of the SBAR must be communicated. Consequently, an assessment must have taken place, and the person escalating must have knowledge of the situation and background of the patient before calling.

      Touch Points

      The prevailing gold standard handover structure, Situation, Background, Assessment, Recommendation (SBAR), was originally developed and effectively used by the US Navy.

      The SBAR Communication Technique:

       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 healthcare setting, the SBAR protocol is used as a framework for structuring conversations between healthcare professionals with the intent of improving communication in various care situations.

The SBAR is a reliable and validated communication tool and has been implemented in a hospital‐based practice for sharing information among healthcare providers. For the tool to be used effectively, it does however require training (initial and ongoing) for all clinical staff to ensure that communication is well understood. There is a lack of high‐quality research on this widely used communication tool, and continued research is necessary to demonstrate the efficacy of applying SBAR in care areas.

Table 7.1 The elements of a complete handover.

SBAR ELEMENT	ACTIONS	EXAMPLE
Situation	Firstly identify yourself, your role and your location. Confirm the identity of the person you are handing over to. Explain the reason for your phone call and the immediate situation.	‘My name is Renu Gupta; I’m a nursing associate on Ward 1. I’m calling about a patient who is experiencing chest pain currently’.
Background	State who the patient is, their age and other relevant identity information. Describe the reasons for their admission, the current medical and treatment plans, relevant past medical history, relevant medications, allergies, if relevant, and any other medical or nursing information that you consider important.	‘I’m calling about Jane Doe, aged 85. She was admitted with chest pain two days ago and was diagnosed as having a non‐ST elevation myocardial infarction in the emergency department with a raised troponin test, and she is currently awaiting an inpatient angiogram. She has hypertension and angina’.
Assessment	Give the findings of your assessment of the patient. You may find it helpful to use the ABCDE structure (see Red Flag, p. 55). Include observations which are abnormal or trends that are concerning and give the overall NEWS score afterward describing the observations. Do not forget to give non‐numerical information such as the how the patient looks, how they feel and what they feel like to touch and other senses.	The chest pain started 10 minutes ago; she describes it as a crushing pain radiating to the left arm. She appears pale, and her skin is clammy. She is tachypnoeic with a respiration rate of 28, tachycardic with a heart rate of 112 and has a weak palpable radial pulse. She is hypotensive with a blood pressure of 92/56. Her total NEWS score is 7. We have performed a 12‐lead electrocardiogram (ECG) which needs assessment.
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