PHYSICAL THERAPISTSTUDENTSBAR CARD
Instructions:
On INSERT DATE HERE you will discuss a case with other interprofessional students. Below is a description of the health care situation and background that has been prepared by faculty from your profession.
Learning Objective(s):
•Describe the value of interprofessional communication for your profession and your clients/patients
•Effectively communicate to another profession your professional insight (e.g. home risks, assistive devices, exercise programs) about this patient using SBAR
- You will be using the SBAR tool to communicate with your small group.
- Below you will find the situation and background of a medical case from the perspective of your profession.
• The case is presented using SBAR format.
S (Situation): how the patient presents
B (Background): what the initial professional evaluation shows
A (Assessment): what are the patient’s problems?
R (Recommendation): what we should consider doing for the patient
• Based on the information provided, and knowledge of your profession, please develop an assessment and specific recommendations for this patient’s treatment. Bring the completed worksheet to your assigned room for the INSERT DATE HERE activity. You will be asked to communicate concisely and effectively your assessment and recommendations to students from other professions in order to determine the patient’s relevant issues. The end result will be a team derived treatment plan. Hint: Abbreviating your knowledge of the patient in a concise SBAR format demonstrated in the IHI module will greatly facilitate your ability to communicate in the group.
• Please feel free to use any resources in preparation for this activity.
S (Situation):
An 82 year old woman is referred to your outpatient physical therapy by her physician for gait instability. The patient’s daughter, who is visiting from out of town, also attends the appointment. The daughter is concerned because upon her arrival, she noticed a contusion and laceration on the patient’s arm. The daughter says that her mother admitted to a fall the day before while emptying the dishwasher and reported experiencing other falls in the bathroom and garden within the last month. The patient is adamant that she wants to stay in her own home; the daughter is supportive of this goal as long as her mother is safe.
B (Background):
The patient lives in 2 story home with 5 steps with 1 rail to enter. The main floor contains a living room, bathroom, and kitchen. The bedroom is on the 2nd floor, though, the patient states that most nights she falls asleep in a recliner while reading. The washer and dryer are in the basement. The patient is not using an assistive device (cane, walker, etc.) because she doesn’t want to “look old.” She is vague when describing her falls, but believes they occur when bending down. She has been able to rise independently after each fall. She recently started doing sponge baths in the sink, rather than climbing in/out of the tub. The patient reports eating mostly cereal because of a lack of appetite and she doesn’t like to cook for just one person. She wears bifocals, but cannot recall her last visit to the optometrist. She rarely leaves home since she stopped driving. Most of her friends who lived nearby have either died or moved away. She reports the following meds: HCTZ, glipizide, metachlopramide. Her medical history includes high blood pressure, Type 2 diabetes, and gastroparesis. The patient states her goal is to continue living in her home, which is where she and her deceased husband raised their children.
The following is revealed during the physical examination:
Strength: weakness of hip abductors, hip extensors, plantarflexors, and dorsiflexors
Sensation: Light touch reduced in both feet
Posture: thoracic kyphosis
Flexibility: tightness in bilateral hamstrings and plantarflexors
Gait: Patient tends to reach out for furniture or walls when walking. Gait deviations include excessive lateral trunk sway, shortened step length, and decreased heel strike. Gait speed is measured at 0.5 m/s.
Standardized Balance Assessments:
- 30 second chair stand (number of sit ↔ stand repetitions completed in 30 sec without upper extremity assist): 4 repetitions but must use upper extremities to assist (The gender and age matched cut point for fall risk = 9 reps completed without upper extremities assist.)
- Berg Balance Test (14 item test with max score of 56 points): 30 points (45 is cut point for fall risk)
Blood pressure: Supine: 140/88. Immediately upon sitting from supine: 126/80, no symptoms; increases to 136/84 within a few minutes. Immediately upon standing from supine: 106/70 with report of lightheadedness; increases to 138/88 within a few minutes.
A (Assessment):
R (Recommendation):