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SBAR Report
Transcriptions
Situation
Start Date *
Condition Status *
Worse
Better
Stayed the same
Unable to determine
Has this occurred before?
Yes
No
Unknown
Change in Condition Description *
Things that make condition worse *
Things that make condition better
Background
Resident Type *
Long-Term Care
Post-Acute Care
Other
Does the resident have pain? *
Yes
No
Is the pain?
New
Worsening of chronic pain
Pain Intensity (0-10)
Code Status *
Primary Diagnoses *
Other Pertinent History
Allergies *
Medication Alerts
Changes in last week
On Warfarin/Coumadin
On other anticoagulant
On Hypoglycemic medication/Insulin
On Digoxin
Vital Signs *
Mental Status Evaluation *
Decreased level of consciousness
Increased confusion or disorientation
Memory loss
New/worsened delusions or hallucinations
Other symptoms of delirium
Unresponsiveness
No changes observed
Describe symptoms or signs (if mental status changes observed)
Functional Status Evaluation *
Decreased mobility
Needs more assistance with ADLs
Falls
Swallowing difficulty
Weakness
No changes observed
Describe symptoms or signs (if functional status changes observed)
Behavioral Evaluation *
Danger to self or others
Depression
Social withdrawal
Suicide potential
Verbal aggression
Physical aggression
No changes observed
Describe symptoms or signs (if behavioral status changes observed)
Respiratory Evaluation *
Abnormal lung sounds
Asthma
Cough
SOB
Labored breathing
No changes observed
Describe symptoms or signs (if respiratory status changes observed)
Cardiovascular Evaluation *
Chest pain/tightness
Edema
Dizziness/lightheadedness
Irregular pulse
No changes observed
Describe symptoms or signs (if cardiovascular status changes observed)
GI Evaluation *
Abdominal pain
Constipation
Decreased bowel sounds
Distention
Decreased appetite
No changes observed
Describe symptoms or signs (if gastrointestinal status changes observed)
Skin Evaluation *
Abrasion
Blister
Burn
Discoloration
Itching
Laceration
Tear
No changes observed
Describe symptoms or signs (if skin status changes observed)
Description/location of pain
Neurological Evaluation *
Abnormal Speech
Decreased level of consciousness
Dizziness or unsteadiness
Seizure
Weakness or hemiparesis
Other neurological symptoms (describe)
No changes observed
Describe symptoms or signs (if neurological status changes observed)
Symptoms or signs are NOT clinically applicable to the change in condition being reported
Yes
Advance Care Planning Information (the resident has orders for the following advanced care planning)
Other resident or family preferences for care
Appearance
Summarize your observations and evaluation *
Review and Notify
Primary Care Clinician Notified *
Notification Date *
Notification Time *
Family Notified *
Family Notified Date *
Family Notified Time *
Recommended Interventions
New medications
IV fluids
Oxygen
Other
Transfer Required
Transfer to hospital
Call 911
Emergency transport
Primary Care Recommendations (if any)
Recommended Tests
Blood tests
EKG
Urinalysis
Venous doppler
X-ray
Other
Nursing Notes (for additional information on the Change in Condition)
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