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Quickly identifying and communicating relevant changes of condition to clinicians (e.g., physicians, nurse practitioners, or physician assistants) has long been a challenge for many nursing homes. However, timely, efficient notifications are more critical than ever during the ongoing COVID-19 pandemic because directors of nursing services (DNSs) have to guard against potentially catastrophic COVID-19 spread in their buildings in addition to addressing each resident’s individual clinical concerns. The following steps can help DNSs ensure their teams stay on top of changes of condition:
Use a tool that structures the nurse-clinician conversation
Communication between nurses and clinicians can be difficult,” says Joseph Ouslander, MD, professor of geriatric medicine and senior advisor to the Dean for Geriatrics in the Schmidt College of Medicine at Florida Atlantic University in Boca Raton, FL; author of the editorial “Coronavirus Disease19 in Geriatrics and Long-Term Care: An Update” in the Journal of the American Geriatrics Society; and the primary creator of the free INTERACT (Interventions to Reduce Acute Care Transfers) quality improvement program. “Sometimes nurses don’t know the resident very well, and sometimes the physician is on call and doesn’t know the nurse, the facility, or the resident very well. There is also a struggle to determine what information is important to communicate to clinicians and what is not important. What are the pertinent negatives that should be communicated? What are the pertinent positives?”
To gather the necessary information, nurses should complete an assessment when staff identify a potential change of condition. In many facilities, this assessment is done using a tool that gathers information using the SBAR (Situation – Background – Assessment – Recommendation) format. The Agency for Healthcare Research and Quality (AHRQ) defines SBAR as follows:
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