Free Comprehensive SBAR Nurse Report Sheet

Patient Name:

[PATIENT NAME]

Room No.:

[ROOM NUMBER]

Age/Sex:

[AGE/SEX]

Admission Date:

[ADMISSION DATE]

Primary Diagnosis:

[PRIMARY DIAGNOSIS]

Consulting Physician:

[CONSULTING PHYSICIAN]

Code Status:

[CODE STATUS]

Reason for Report:

[REASON FOR REPORT]

Example:

"Reporting on patient [PATIENT NAME] due to a significant change in respiratory status, now requiring oxygen supplementation."

Medications:

[CURRENT MEDICATIONS]

Allergies:

[ALLERGIES]

Recent Procedures:

[RECENT PROCEDURES]

Example:

"Patient [PATIENT NAME] has a history of COPD, on medication including [SPECIFIC MEDICATIONS], recently underwent [SPECIFIC PROCEDURE]."

Physical Assessment Findings:

[PHYSICAL ASSESSMENT FINDINGS]

Patient's Current Status:

[PATIENT'S CURRENT STATUS]

Example:

"As of the last assessment, [PATIENT NAME]'s oxygen saturation decreased to [OXYGEN SATURATION]%, indicating potential respiratory distress."

Suggested Interventions:

[SUGGESTED INTERVENTIONS]

Follow-Up Care:

[FOLLOW-UP CARE]

Example:

"Recommend evaluation by the respiratory therapist for [PATIENT NAME] and possible escalation of care if no improvement in respiratory status."