hey everyone it's sarah register nurse rn.com and in this video i'm going to be talking about sbar specifically for nurse to physician communication so let's get started esbar is a communication method that we can use to help us simplify communicating patient information to other members of the healthcare team and esbar is actually an acronym and it stands for situation background assessment and recommendation and the whole goal of the s bar is to help us strategically and systematically communicate like a patient situation along with the background of that patient the assessment findings that we have found and recommendations that we recommend to that listener so they can easily understand what we need what we want and what is actually going on with that patient in a very clear and focused way so the esbar method can help the nurse stay organized whenever they're having to communicate and cut out that fluff that may be in the conversation that wastes time or may confuse the listener and just help prevent those moments where you may get questions from the person you're talking to and you may not know you know that whole dreaded like uh i don't know let me check so the s bar is going to help you stay organized now what are some examples of how the nurse would use the s bar to communicate well one way would be whenever a nurse needs to communicate with a health care provider like a physician a nurse practitioner or a pa let's say the patient's condition is deteriorating and they need to call and report that or they simply just need something for that patient the nurse can follow this tool which will help them clearly and concisely communicate that issue to the listener and that's what we're going to be concentrating on in this video how a nurse would communicate specifically let's say with a physician about a patient issue and i'm going to walk you through how you would apply that with the s bar now you can also use the s bar as a nurse to communicate with other nurses like during report where we hand off the patient or transferring a patient to a different unit also it can be used with other members of the healthcare team like speech therapy occupational therapy physical therapy it just helps and guides you with what information you need to provide to that person so they can understand what is going on with your patient so whenever you're creating your s bar in order to communicate with someone you want to make sure that you are fully prepared before you actually initiate that conversation so whenever you're new to this you really want to make sure you have like a little system of how you compile your s bar and over time it's going to get really quick and you can probably do a lot of this in your head or just jot down and make notes so the first thing what you want to do is you want to get a layout of an s bar a lot of units will have these created for you and you just fill them in and just put all the information you need whenever you're going to call that person or talk to that person also you want to make sure you have thoroughly reviewed that patient's chart and you know what's going on with that patient so you physically have went in there looked at that patient assess that patient you've collected their vital signs and you've looked in the chart you've looked at the latest progress snow and know who's on board taking care of that patient so you have an idea of what is going on with that patient for when those questions come up plus you have looked at the latest lab results you know what medications they're taking because those questions will probably come up and you'll definitely want to include that in your sbar if it's important for why you're calling this person and then whenever you have gathered all of that information and you're comfortable and ready to initiate that conversation you want to make sure that you have all of that stuff within reach so have your computer on on that specific patient so you can easily look at something in case the person asks you a question and have your papers in front of you so you can get to that information quickly now let's talk about the information that is included in each of these sections of the s bar and remember the s bar again is very focused and concise with its communication and remember there's no fluff in it so the first thing you're going to start out with whenever you're communicating using the s bar method is with the situation so with the situation just as it says our whole goal is we're going to communicate why we are calling that's our purpose so to help start things off it's good to have a little introduction by saying hello to whoever you're calling if you're calling the physician say hello doctor whatever that person's name is or hello to the nurse practitioner or the pa and then identify yourself and the unit that you're on so they can be familiar with okay this is the cardiac pcu or this is the cardiac icu that's who's calling me and then state the patient's name who you're calling about and the room number and then a short sentence for why you are calling then after that we're going to go straight into the patient's background and this part of the communication is again going to be very focused and what its goal is going to do is it's going to paint a picture for that listener for while we're calling so it's going to provide a brief description on what has occurred with that patient up to this current situation and how you would transition from situation to background is you can go into the patient's diagnosis so the patient was admitted with whatever diagnosis on such and such day the date of admission and then you're going to tailor and include important patient information based on why you're calling so it can really vary but here are some things that you can include you can include the patient's code status you can talk about any other significant health problems that goes along with the patient's current situation so if they're having cardiac problems talk about some of their health history with cardiac issues like have they had heart caths what were the results of that have they had a history of certain rhythms et cetera then talk about medications if you need to fluids they have running any allergies because that will tell them okay i can't prescribe this because they're allergic to this and give them any test results you can include blood work you can include any procedures what the results of those procedures were and then if you are reporting blood work let's say you're calling about an h you want to make sure you're looking at the previous h h's and see how are they trending have they been gradually going down and now we're critically low so know how that is going and along with consults what other doctor groups are on board with this patient and any pending procedures that the patient may be having as well that just lets them know okay i don't need to order this because they're going to be having this procedure so at the end of this video we're going to be going over a scenario and you're going to see how you tailor this background section whenever you are communicating a patient's history the next one is communicated is the assessment part and this is where the nurse is going to tell the listener what they have assessed so what they have found in that patient and what they think is going on based on what they have found so the nurse will explain you know i think that this is possibly a respiratory issue cardiac issue gisu etc and then provide those assessment findings and current vital signs to back up their what they think is going on but let's say that the nurse doesn't know they know that something's wrong with the patient they know the patient needs something but they don't know exactly what it is well it's okay the nurse can just say that they are worried or that the patient is deteriorating they're unstable and they have changed from when they previously saw them and then lastly we're going to wrap up the conversation with recommendations so this is the part where you're going to communicate to the listener what you specifically want or need for that patient so you've laid the framework for everything with your assessment background and situation while you're calling and this is where you specifically communicate what you need or what you need done for this patient so this can really be anything it can be you want more orders for the patient let's say that they need some more lab work you think you can ask for that or testing or you need a clarification on something maybe a medication order didn't seem quite right you need some more clarification on it or you need them to see the patient or transfer the patient to receive a higher level of care or let's say you don't know what to ask for you can ask them for what they recommend or what they want you to do based on everything you have told them now let's go over an example with how a nurse would use the esbar method to communicate with a physician about a patient that was just admitted and they're starting to deteriorate so we have this patient who was admitted to your cardiac pcu floor and they have a diagnosis of cardiomyopathy and about mid-noon the patient started having extreme difficulty breathing and their blood pressure has become elevated and you look through the patient's medications you don't really have anything that could help you decrease that blood pressure or help with the respiratory status of the patient so you're notifying the physician to let them know that the patient's status has changed and you need further medication orders or a change in their medications and further testing to investigate what is going on with this patient so you have compiled all the information you need to make this phone call and you're ready to call them so now the physician has called you back and this is how you're going to start the conversation you're going to start with the s part the situation so you're going to say hello dr ross this is sarah from 1800 the cardiac pcu floor i'm taking care of mr morris in room 1802 and i'm concerned about the patient's recent development of dysmia and hypertension then you're going to flip into the background part and paint that picture for dr ross for why you're really calling what's going on with this patient up to this point he was admitted early this morning and has a diagnosis of cardiomyopathy he has a history of coronary artery disease hypertension and aortic valve disease the medications he's currently ordered are lisinopril 10 milligrams po daily and furosemide 20 milligrams pobid then you want to go into the assessment part what you have found and what you think is going on with the patient so he's developed crackles throughout his lung fields especially in the right and left lower lobes his oxygen saturation has dropped from 95 percent to 87 percent onto leader's nasal cannula and his respiratory rate is 28 and when he speaks or performs any type of physical exertion he becomes extremely short of breath also he has three plus pitting edema in his lower extremities and a current blood pressure of 200 over 120 and his heart rate is 102 it's regular sinus tac i think he's experiencing fluid volume overload which may be contributing to his respiratory status and current cardiac issues and then lastly you want to wrap up the conversation with what you recommend or what you want to see done with the patient so i think the patient may need an adjustment in medications and further diagnostic testing how would you like me to proceed with this patient do you want me to order a change in medications or diagnostic testing like a chest x-ray abg's cardiac series echo to further investigate the patient's condition and then whenever you are done with that you want to listen to the provider and if they give you any orders or anything like that you want to read back that information to make sure that you have correctly understood what they have said and then whenever you get off the phone you want to be sure that you complete whatever orders you were given and document okay so that wraps up this video over the s bar and if you would like to watch more videos in this series you can access the videos in the youtube description below