Red Flags, Skin Tone, Charting, SBAR and Delegation
A chest exam that ends in your head instead of in an SBAR call helps no one. Triage real findings into routine, provider notification or rapid response; choose colour-assessment sites that work in every skin tone; rewrite a vague lung note into one the next shift can compare; build a handoff that gets a decision; and draw the line between what you may hand off and what stays in your hands.
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Which colour change are you screening for?
Cyanosis, pallor and erythema are unreliable when assessed only on the outer skin of patients with richly pigmented skin. The fix is not to look harder — it is to move the assessment to sites where pigmentation is minimal and vascularity is high.
Choose every site you would actually assess
Pick a note that should never have been written
Choose the elements a usable entry needs
Could a colleague who has never seen this patient reconstruct what you found and detect a change tomorrow?
ScenarioMrs. Alvarez in room 412 is a 74-year-old, two days post right hip arthroplasty. She has new shortness of breath and her saturation has fallen to 88% on room air from an admission baseline of 95%. History of heart failure and COPD, home oxygen 2 L at night. She has been on bed rest since surgery and has not ambulated today. Respirations 30 and shallow, heart rate 118, blood pressure 104/62, temperature 37.9 °C. Accessory muscle use, speaking in short phrases, more confused than this morning. Fine crackles at both bases that do not clear with cough, decreased breath sounds and dullness at the right base. No stridor, trachea midline. You have her upright on 2 L nasal cannula under the standing hypoxia protocol, which brought her to 92%.
Assign each line to S, B, A or R
Leave out anything that does not belong in the call. Then score it.
Who may do this?
This is a rule of scope, not of workload.
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Escalate on the trendRestlessness and a rising respiratory rate precede a falling saturation.