Case Study Scenario
SCENARIO: Mr. G. is a resident at the Excelsior Assisted Living Center.. He has lived here for the past three years in a single studio unit. His wife passed away 4 years ago. He is 83 years old. He is friendly and active in recreational activities in the facility and in the community. In addition, he sees his son and grandchildren every other week.
Members of Mr. G’s Excelsior care team:
• Assisted Living Administrator – Ms. Miller
• Resident (Mr. G.)
• Floor Supervisor (you)
• Nurse Manager
• Recreation Therapist. – Greg, CTRS
• Dietitian
• Social Worker
• Resident’s adult son – Ted
You are a Floor Supervisor at Excelsior Assisted Living Facility and are assigned to the floor where Mr. G.
resides. Greg, the Recreation Therapist, comes to talk to you about Mr. G. Greg has built a close relationship with Mr. G. He explains that Mr. G. appears unkempt, and sometimes smells of urine. Other residents have started to make remarks about Mr. G’s odor and staff is complaining as well. You review the situation by having a discussion with Mr. G. and several discussions with other staff on the floor.
It becomes clear to you that Mr. G. needs more personal hygiene care than he can provide for himself or that the facility can provide. You present this information to the administrator, Ms. Miller.
Ms. Miller contacts Mr. G’s son, Ted, and explains the situation. She offers the son the option to pay for extra services from the facility or to hire an external Personal Care Assistant. (PCA). She explains that it may be more cost effective to hire someone from an outside agency. He asks for a recommendation and Ms. Miller provides a list, highlighting an agency that the facility has worked with in the past. Ted contacts the agency and Gloria is hired as a PCA. Gloria begins visiting three times per week.
(Two months later) cut to your office!
Greg comes to your office. Over a cup of coffee, he explains that while Mr. G’s hygiene has significantly
improved he has new concerns he wants to run by you. He and Mr. G. were at the mall buying a birthday gift for one of the grandchildren. Mr. G. was expressing anger and confusion about the medications his doctor is prescribing.
As the conversation progressed Mr. G. confided the following to Greg. He is thinking of stopping his statin medication under the advice of his PCA, Gloria. Gloria was asking him about side effects from his medications.
Mr. G. thinks that he has been experiencing some of these side effects and wonders if his lack of bladder
control might be from his medications. He acknowledges feeling deeply embarrassed by having to wear adult “diapers.” Mr. G. told him that Gloria was also showing him news articles regarding potential dangers of taking statins long term.
Cut to Ms. Miller’s office
You and Greg ask to meet with Ms. Miller. You express your concerns about Gloria overstepping her role and the potential medical risks for Mr. G who has a significant history of cardiac disease. At the same time, you don’t want to impinge on the working relationship he has with Gloria as he is very fond of her and has improved since her hiring. Your charge: Ms. Miller decides to call a meeting of Mr. G’s entire care team (see team listed above). She asks
you to prepare an SBAR for the meeting.
SBAR (Situation-Background-Assessment-Recommendation) is a technique for communicating critical information that requires immediate attention and action concerning a patient’s condition. It is used as a communication technique, shift report hand-off, critical situation call to a provider, in specialty care areas, and as process/quality/improvement.
Situation – Briefly describe the current situation. Give a clear, succinct overview of pertinent issues.
Background – Briefly state the pertinent history. What got us to this point?
Assessment – Summarize the facts and give your best assessment. What is going on? Use your best judgment based on your knowledge of roles and responsibilities of health professionals.
Recommendations – What actions are you asking for? What do you want to happen next?
