Unit Record No.
_____________________________________
Surname __________________________________________
SBAR
Given Names _______________________________________
COMMUNICATION TOOL
D.O.B. _______/__________/_________ Sex __________
Affix patient label
Time and Date : Problem ……………………………………………………………………..
S
………………………………… ………………………………………………………………………………..
• Identify yourself ………………………………………………………………………………..
Situation
• Identify your Unit State severity
• Give the patient’s name Severe Very concerned Concerned Controlled
• State current patient Name of professional being contacted
location ……………………………………………….…………………….…………
• Briefly state the problem Number called / contact reached (eg mobile / pager)
• Identify when it happened / …………………………………………....................................................
started Number and time of attempts made to reach person being called
……………………………………………………………………………….
Information could include:
B
Admitting diagnosis /operation …………………………………………………………………………...........
……………………………………………………………………………………………………………………...
Background
Date of admission ……………………………………………………………………………..…………………
Most recent vital signs BP ………………. HR ……….………Temp ……………………..
Pain Score …………… RR ……………… SaO2 …………… Urine output ……………..
Pt on oxygen? Yes No Litres / min…………. IV Fluid …………………………………………
Test Results ……………………………………………………………………………………………………..
………………………………………………………………………………………………………………..........
Pt mental state ……………………………………………………………………………………………..........
Assessment of skin / extremities ……………………………………………………………………………….
Your assessment should be concise, clear, assertive, and factual
A
………………………………………………………………………………………………………….................
Assessment
………………………………………………………………………………………………………….................
………………………………………………………………………………………………………….................
SBAR COMMUNICATION TOOL MR 126
………………………………………………………………………………………………………….................
……………………………………………………………………………………………………………………...
I suggest / request that:
R Examples of ……………………………………………………………………………….
recommendations may ……………………………………………………………………………….
Recommendations
include:
Does Dr want a response back – what parameters do they wish to be
• Pt needs to be seen now notified about – phone number to contact and time
• Order change ……………………………………………………………………………….
• Transfer to alternate facility …………………………………………………………..............................
• Request for tests needed Doctor’s Orders / comments …………………………………………….
• Talk to the patient and/or ………………………………………………………………………………..
family ………………………………………………………………………………..
………………………………………………………………………………..
………………………………………………………………………………..
Outcome: ……………………………….……………………………………………………………………….……...
……………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………..
Print Name: ………………………………….. Signature: ……………………… Designation: ………………….
