Effective SBAR Communication for Nurses

Hey everyone, it's Sarah with RegisteredNurseAriane.com and in this video I'm going to be talking about SBAR, specifically for nurse to physician communication. So let's get started. SBAR is a communication method that we can use to help us simplify communicating patient information to other members of the healthcare team. And SBAR is actually an acronym and it stands for situation Background, assessment, and recommendation. And the whole goal of the SBAR 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 SBAR 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 SBAR is going to help you stay organized. Now what are some examples of how the nurse would use the SBAR to communicate? Well, one way would be whenever a nurse needs to communicate with a healthcare 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 SBAR. Now you can also use the SBAR 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 SBAR 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 wanna make sure you have like a little system of how you compile your S-Bar. And over time, it's gonna 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 wanna 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 note and know who's on board taking care of that patient so you have an idea of what 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 SBAR. And remember the SBAR 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 SBAR 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 why we are 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 date the date of admission and then you're going to tailor and include important patient information based on why you are 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, etc.? 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&H you want to make sure you're looking at the previous H&Hs 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 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 what 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, GI issue, etc. And then provide those assessment findings and current vital signs to back up 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 why 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 SBAR 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. 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 are 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 dyspnea 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 mg PO daily, and furosemide, 20 mg PO BID. 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% to 87% on two liters 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 attack 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, ABGs, 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 are 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

So the SBAR 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 SBAR is going to help you stay organized. Now what are some examples of how the nurse would use the SBAR to communicate? Well, one way would be whenever a nurse needs to communicate with a healthcare 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 SBAR. Now you can also use the SBAR 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 SBAR 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 wanna make sure you have like a little system of how you compile your S-Bar.

And over time, it's gonna 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 wanna 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 note and know who's on board taking care of that patient so you have an idea of what 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 SBAR.

And remember the SBAR 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 SBAR 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 why we are 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 date the date of admission and then you're going to tailor and include important patient information based on why you are 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, etc.? 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&H you want to make sure you're looking at the previous H&Hs 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 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 what 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, GI issue, etc.

And then provide those assessment findings and current vital signs to back up 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 why 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 SBAR 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. 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 are 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 dyspnea 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 mg PO daily, and furosemide, 20 mg PO BID. 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% to 87% on two liters 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 attack 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, ABGs, 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 are 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

Transcript for:Effective SBAR Communication for Nurses

Transcript for:
Effective SBAR Communication for Nurses