SBAR (Situation-Background-Assessment-Recommendation) is the gold standard for urgent nursing-to-physician communication and any situation requiring a structured verbal report.
| Component | Content | Example |
|---|---|---|
| Situation | Who you are, who the patient is, what is happening RIGHT NOW | "This is RN Jessica on 5 West. I'm calling about Mr. Rivera in room 518 who is in acute respiratory distress." |
| Background | Relevant clinical history, reason for admission, pertinent past medical history | "He's a 72-year-old admitted yesterday for pneumonia, with a history of COPD and CHF." |
| Assessment | Your clinical judgment about what is happening; do not just report numbers — interpret them | "His SpO2 has dropped to 87% on 4L NC, RR is 28, he's using accessory muscles. I'm concerned he's tiring out and may need escalation." |
| Recommendation | What you are asking for or what you believe needs to happen | "I need you to assess him now and consider upgrading his oxygen. Should I call a rapid response?" |
I-PASS (Illness Severity, Patient Summary, Action List, Situation Awareness, Synthesis) is validated to reduce medical errors at handoff by 30% in multiple studies:
| Component | Content |
|---|---|
| I — Illness Severity | Stable / "watcher" (could deteriorate) / Unstable — one-word summary of overall patient trajectory |
| P — Patient Summary | One or two sentences: diagnosis, events during your shift, current clinical status |
| A — Action List | Pending tasks, labs to result, medications due, follow-up items for the incoming nurse |
| S — Situation Awareness | What to watch for; specific contingency plans ("if potassium comes back below 3.5, replace and recheck; call if below 3.0") |
| S — Synthesis by Receiver | Incoming nurse reads back key action items to confirm understanding (closed-loop) |
Bedside handoff (change-of-shift report at the patient's bedside) improves patient engagement, reduces errors, and decreases time spent on report.
| Category | Content |
|---|---|
| Identifying info | Patient name, age, room number, attending physician, code status (DNR/DNI/FULL CODE) |
| Diagnosis/reason for admission | Primary diagnosis; relevant significant PMH; allergies |
| Current vital signs | Trend (improving/stable/worsening); note deviations from baseline |
| Neuro status | Alert & oriented (×1/2/3/4); GCS if altered; seizure precautions |
| Respiratory | O2 delivery device and rate; breath sounds; recent SpO2 trend; ventilator settings if applicable |
| Cardiovascular | Rhythm (on telemetry?); recent EKG changes; edema; peripheral pulses |
| Fluids/renal | I&O for the shift; urine output; IV access (site, gauge, patent); drips running |
| Skin/wounds | Pressure injury risk; wounds and dressing status; skin assessment findings |
| Medications | PRN meds given this shift; timing of last scheduled meds; ongoing drips with current rates |
| Labs/diagnostics | Pending results; critical values from shift; upcoming procedures |
| Pain | Current pain level; what was given; patient's response |
| Safety | Fall risk (and score); restraints if applicable; isolation precautions; safety concerns |
| Psychosocial | Anxiety level; family involvement; discharge planning status; social work or chaplain involved |
| Action items | Pending tasks for the next nurse; anticipated events; contingency plans |
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