M.M.'s physician calls your unit to find out what is happening. Using SBAR, what information would you need to convey at this time?

Question

The hospital's staff physician is coming to the floor immediately to evaluate the patient. In
the meantime she orders furosemide (Lasix) 40 mg IV push STAT. You have only 20 mg in
stock. Should you give the 20 mg now, and then give the additional 20 mg when it comes up
from the pharmacy? Explain your answer.

Answer 1

Following SBAR (Situation, Background, Assessment, Recommendation), you would first identify
yourself, the patient, and her admitting diagnosis. For background, you would tell the physician that
the patient speaks Spanish only, and that she was admitted because of heaviness in her chest off
and on over the past few days and with signs of HF. Describe how she vomited once she was assisted
onto the bedpan and that her skin was clammy; report your assessment findings, VS, and what you
have done so far. The assessment of the situation is that M.M. might be experiencing an MI, and
you would anticipate a transfer to the coronary care unit and medications to maintain cardiac and
respiratory function.

Give the 20 mg furosemide to start treatment. However, you should know that response to
furosemide is dose related; 20 mg now plus 20 mg later does not equal the same response as
40 mg given at one time. You need to make the physician aware that you gave only 20 mg and ask
how much more the physician wants to give when it becomes available. The physician might say,
"Give another 20 later" or "Give 40 later when it gets here." Call the pharmacy and have furosemide
brought to the floor STAT or send someone to get it.