section 23: safety: addendum a: sbar scriptsbar 799 last update 9/12. home health package...
TRANSCRIPT
A Home Health Package
This material was prepared by Quality Insights of Pennsylvania, the Medicare Quality Improvement Organization Support Center for Home Health, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health
and Human Services. The contents presented do not necessarily reflect CMS policy. Publication number 8SOW-PA-HHQ06.176.
SBAR
Last Update 9/12799
Home Health Package Introduction
SBAR Purpose:The SBAR tool is a strategy to improve communication from clinician to physician, clinician-to-clinician and/or staff to manager. SBAR was adapted from the US Navy Nuclear Submarine Service. Submarine officers and crew needed a situational briefing model to communicate clearly, effectively and efficiently. SBAR organizes the message in a consistent and concise manner. SBAR has been adapted successfully into health care.
S = Situation What is going on with the patient? A concise statement of the problem. B = Background What is the clinical background information that is pertinent to the situation? A = Assessment What did you find? Analysis and considerations of options. R = Recommendation What action/recommendation is needed to correct the problem? What do you want?
SBAR, the Home Health Connection: SBAR is perfect for improving communications in a home health agency (HHA). This simple tool condenses messages so they contain only concise and significant information about the patient and allows for the clinician to verbalize their assessment of the situation - what they think is happening and what recommendations/actions the clinician feels are needed to correct the problem. SBAR can be a strategy used with physicians to improve communications and outcomes, including reducing avoidable acute care hospitalizations.SBAR can also be used between staff and/or management. This tool can help HHAs clearly, effectively and efficiently express the real message of the patient situation. SBAR works well for home health aides to communicate to their supervisors or to the nurse as well as in interdisciplinary communication.
Sequencing & Reinforcing SBAR:SBAR is a standardized communication tool that is very easy and simple to use. It is recommended that you start with a small group or office and pilot this method prior to rolling it out to the entire workforce. During the pilot you can make necessary changes without any problems. Once you have successfully implemented it on a small scale you can spread it throughout your organization. SBAR works well in more complex situations such as designing it to meet the specifications of a disease management program (refer to COPD example in package). Always remember to reinforce the new concept to gain behavioral changes and staff buy-in. This package includes several tools/resources to help you. These tools should be modified to your agency’s specifications.
Last Update 9/12800
SBAR – Home Health Package Contents & Description: SBAR - An Opportunity to Improve Communication within the Home Health Arena Educational Session
o A XX minute Webex and audio recording on what SBAR is and how to use SBAR in home health. WebEx or audio can be used as part of staff education on SBAR and for leadership education.
SBAR Toolo A simple one page SBAR tool designed for home health. This document is in
Microsoft Word and can be modified by your agency to meet your needs. The agency logo or name can also be added.
COPD SBARo This COPD SBAR tool was designed using current standards of practice per
the Global Initiative for Chronic Obstructive Lung Disease (GOLD), www.goldcopd.com.
SBAR Postero This poster was designed by Kaiser Permanente to be utilized as a visual
reminder for staff throughout the organization.SBAR Interdisciplinary Communication
o Sample SBAR sheets for each discipline (nursing, physical therapy, occupational therapy, speech therapy, medical social worker and home health aide). Print the sheets and cut in half to use in your learning sessions.
SBAR Pocket Card templateo Print these cards on heavier paper and laminate for each staff member when
introducing the SBAR concept. Include this pocket card in your orientation process.
SBAR Phone Sticker template o Print stickers and place on or near phones as a visual reminder for staff on
how to use SBAR. SBAR Discipline worksheets
o Exercise worksheets developed for each discipline (nursing, physical therapy, occupational therapy, speech therapy, medical social worker and home health aide) to be used in either small group setting or individually. Print the worksheets and fold back the answer section.
SBAR Reference/Resource list o Available resources related to SBAR
SBAR – Home Health Package is located on MedQIC at www.medqic.org/hh, Care Transitions, Tools.
Last Update 9/12801
This educational session covers the following areas related to SBAR:
How can an agency transform communication? What is SBAR? Where did SBAR come from? How does SBAR impact health care? Is SBAR only for improving communication to physicians?
What SBAR resources are available for home care?
This WebEx, audio recording and handouts are located at: www.medqic.org under Care Transitions, Presentations.
Last Update 9/12802
[Agency Logo] Patient Name: Record #:
Staff Name Date & Time
Physician’s Name
(Physician Communication)
Have ALL information AVAILABLE when reporting:chart, allergies, medication list, pharmacy number, pertinent lab results
SITUATIONI am calling about: (patient’s name)
The problem I am calling about is:
BACKGROUNDState the primary diagnosis & reason patient is being seen for home care:
State the pertinent medical history:
Most recent findings:
Mental status Neuro changes Temp
BP Pulse rate/quality/rhythm Resp rate/quality
Lung sounds Pulse Oximetery % Oxygen L/min via
GI/GU changes (nausea/vomiting/diarrhea/impaction/hydration)
Weight (actual) Loss or Gain Skin color Blood Glucose
Wound status (drainage, wound bed, treatment)
Pain level/location/status
Musculoskeletal changes (weakness)
DNR Status
Other
ASSESSMENT(What do you think is going on with the patient?)
I think that the patient is:
or
I am not sure of what the problem is, but the patient’s status is deteriorating.
RECOMMENDATIONI suggest or request:
PRN visit or referral: Nurse PT ST OT HH Aide MSW Dietician
Visits frequency change
Schedule for a physician office visit
Physician, Nurse Practitioner or Physician Assistant home visit
Pulse Oximetery Lab work
Urinalysis, C & S X-rays EKG
Medication changes
Wound care changes
Nutrition or fluid restriction changes
Other
Call physician with:
SB
A
R
Last Update 9/12803
[Agency Logo] Patient Name: Record #:
Staff Name Date & Time
Physician’s Name
(Physician Communication)
Have ALL information AVAILABLE when reporting:chart, allergies, medication list, pharmacy number, pertinent lab results
SITUATIONIdentify self <name, title and agency> I am calling about <patient name and location>. The patient's code status is The problem I am calling about is: I am concerned that <patient name> has worsening of their respiratory symptoms.
BACKGROUNDI have just assessed the patient personally: Vital signs are: Blood pressure _____/_____ Pulse ______ Temperature ______ Respiratory:
Respiration rate _____ Pulse oximetry_____ Spirometry ____ FEV1 (indicate pre or post bronchodilator) Peak expiratory flow (PEF)______ (< 100 L/min. indicates a severe exacerbation) Lung sounds: ___ wheezing, ___ ralesEdema: ___ LE, ___ abdominal
Dyspnea: ___ increased ___ Rate on modified dyspnea scale (0-10, 0 nothing at all to 10 max.) ___Worse at night?
Sputum: __ increased amount, ___ thicker/stickier, ___ change in color <note color> Cough: ___ increased Evidence of pleuritic chest pain ___ yes ___ no Accessory muscle retraction: __ yes __ no Altered mental status: ___ sleepiness ___ confusion __ increased anxiety
The last hospital admission occurred on <date and time> & the reason for admission was <diagnosis>
Respiratory medications include: Short-acting bronchodilator: <name and dose> Long-acting bronchodilator (anticholinergic and/or B2-agonist): <name and dose> Theophylline: <name and dose> Bronochodilator/glucocorticosteroid combination: <name and dose> Systemic glucocorticosteroids: <name and dose> Antibiotic: <name and dose>
Today <patient name> took the following medications: <name and dosages>
The patient is not or is on oxygen. The patient has been on ________ (l/min) or (%) oxygen for ______ minutes (hours) The oximeter is reading _______% The oximeter does not detect a good pulse and is giving erratic readings.
Other comorbidity <name of cormorbid states> and medications for these comorbid conditions include: <name and dosages>
The most recent lab results are: <note date and time test was done and results of previous tests for comparison>
S
B
Last Update 9/12804
[Agency Logo] Patient Name: Record #:
Staff Name Date & Time
Physician’s Name
ASSESSMENT(What do you think is going on with the patient?)
I think that the patient is:
I think this patient is having an exacerbation of their COPD due to: Infection TriggerStress
RECOMMENDATIONI suggest or request that you:
Intensify bronchodilator treatment Add: __ antibiotic and/or __ steroid Adjust O2 rateTransfer the patient to emergency room Reposition patient and continue pursed lip breathing Talk to the patient or family about code status Other
Are any tests needed in the home? Do you need any tests like: Spirometry (indicate pre- or post-bronchodilator)
__ PEF__ Pulse Oximettry __ ABG __ Others?
If a change in treatment is ordered then ask: How often do you want vital signs? How long to you expect this problem will last? If the patient does not get better what medicine should be given and for how long? When would you want us to call again?
A
R
Last Update 9/12805
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se th
e fo
llow
ing
SBA
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teps
to c
omm
unic
ate
issu
es,
prob
lem
s or
opp
ortu
nitie
s fo
r im
prov
emen
t to
cow
orke
rs o
r su
perv
isor
s. S
BA
R c
an b
e ap
plie
d to
bot
h w
ritte
n an
d ve
rbal
co
mm
unic
atio
ns.
SITU
ATI
ON
–St
ate
wha
t is
happ
enin
g at
the
pres
ent t
ime
that
has
war
rant
ed th
e SB
AR
com
mun
icat
ion.
Exa
mpl
e:H
iB
erth
a (n
ursi
ng s
uper
viso
r) th
is is
Nan
cy N
urse
cal
ling
to re
port
that
my
patie
nt, L
ois
Lane
, has
an
elev
ated
blo
od p
ress
ure
this
mor
ning
. She
al
so v
erba
lized
that
she
had
a n
oseb
leed
this
a.m
.
BA
CK
GR
OU
ND
– E
xpla
in c
ircum
stan
ces
lead
ing
up to
this
si
tuat
ion.
Put
the
situ
atio
n in
to c
onte
xt fo
r the
read
er/li
sten
er.
Exa
mpl
e: M
iss
Lane
’s b
lood
pre
ssur
e is
188
/92
(R) u
p fro
m 1
26/8
0,
186/
90 (L
). H
er p
ulse
has
incr
ease
d fro
m 6
4 bp
m (r
egul
ar ra
te a
nd
rhyt
hm) t
o 98
bpm
(reg
ular
rate
and
rhyt
hm).
Mis
s La
ne re
porte
d on
e no
sebl
eed
this
a.m
. tha
t was
sto
pped
whe
n ic
e w
as a
pplie
d to
the
back
of
her
nec
k. N
o ot
her a
bnor
mal
CP
V s
ympt
omat
olog
y ev
iden
t dur
ing
my
asse
ssm
ent.
The
patie
nt h
as v
erba
lized
that
she
is s
light
ly n
ervo
us a
nd
jum
py b
ut d
enie
s an
y un
usua
l act
ivity
or s
tress
.
ASS
ESSM
ENT
– W
hat d
o yo
u th
ink
the
prob
lem
is?
Exa
mpl
e: I
t is
diffi
cult
to d
eter
min
e w
hat i
s go
ing
on w
ith th
e pa
tient
w
hen
the
only
cha
nge
in h
er c
ondi
tion
is a
n el
evat
ed b
lood
pre
ssur
e an
d w
hat a
ppea
rs to
be
a pa
nic
atta
ck.
REC
OM
MEN
DA
TIO
N –
Wha
t wou
ld y
ou d
o to
cor
rect
the
prob
lem
?E
xam
ple:
I w
ould
like
you
to n
otify
the
phys
icia
n of
thes
e fin
ding
s an
d as
k if
we
can
have
a M
SW
refe
rral
for a
n ev
alua
tion.
The
re
may
be
som
ethi
ng g
oing
on
in M
iss
Lane
’s li
fe th
at s
he h
as n
ot
reco
gniz
ed a
s ca
usin
g th
e po
ssib
le a
nxie
ty a
ttack
s. I
wou
ld a
lso
like
you
to v
isit
the
patie
nt in
the
a.m
. to
asse
ss h
er b
lood
pre
ssur
e. W
e w
ill ca
ll th
e ph
ysic
ian
tom
orro
w w
ith o
ur fi
ndin
gs to
see
if h
e w
ould
like
to
sche
dule
Mis
s La
ne fo
r an
offic
e vi
sit.
SS BBAA
RRII nn
tt eerr dd
ii sscc ii
pp llii nn
aa rryy
CCoo mm
mmuu nn
ii ccaa tt
ii oonn
SS kkii ll ll
ee ddNN
uu rrss ii
nn ggU
se th
e fo
llow
ing
SBA
R s
teps
to c
omm
unic
ate
issu
es,
prob
lem
s or
opp
ortu
nitie
s fo
r im
prov
emen
t to
cow
orke
rs o
r su
perv
isor
s. S
BA
R c
an b
e ap
plie
d to
bot
h w
ritte
n an
d ve
rbal
co
mm
unic
atio
ns.
SITU
ATI
ON
–St
ate
wha
t is
happ
enin
g at
the
pres
ent t
ime
that
has
war
rant
ed th
e SB
AR
com
mun
icat
ion.
Exa
mpl
e:H
iB
erth
a (n
ursi
ng s
uper
viso
r) th
is is
Nan
cy N
urse
cal
ling
to re
port
that
my
patie
nt, L
ois
Lane
, has
an
elev
ated
blo
od p
ress
ure
this
mor
ning
. She
al
so v
erba
lized
that
she
had
a n
oseb
leed
this
a.m
.
BA
CK
GR
OU
ND
– E
xpla
in c
ircum
stan
ces
lead
ing
up to
this
si
tuat
ion.
Put
the
situ
atio
n in
to c
onte
xt fo
r the
read
er/li
sten
er.
Exa
mpl
e: M
iss
Lane
’s b
lood
pre
ssur
e is
188
/92
(R) u
p fro
m 1
26/8
0,
186/
90 (L
). H
er p
ulse
has
incr
ease
d fro
m 6
4 bp
m (r
egul
ar ra
te a
nd
rhyt
hm) t
o 98
bpm
(reg
ular
rate
and
rhyt
hm).
Mis
s La
ne re
porte
d on
e no
sebl
eed
this
a.m
. tha
t was
sto
pped
whe
n ic
e w
as a
pplie
d to
the
back
of
her
nec
k. N
o ot
her a
bnor
mal
CP
V s
ympt
omat
olog
y ev
iden
t dur
ing
my
asse
ssm
ent.
The
patie
nt h
as v
erba
lized
that
she
is s
light
ly n
ervo
us a
nd
jum
py b
ut d
enie
s an
y un
usua
l act
ivity
or s
tress
.
ASS
ESSM
ENT
– W
hat d
o yo
u th
ink
the
prob
lem
is?
Exa
mpl
e: I
t is
diffi
cult
to d
eter
min
e w
hat i
s go
ing
on w
ith th
e pa
tient
w
hen
the
only
cha
nge
in h
er c
ondi
tion
is a
n el
evat
ed b
lood
pre
ssur
e an
d w
hat a
ppea
rs to
be
a pa
nic
atta
ck.
REC
OM
MEN
DA
TIO
N –
Wha
t wou
ld y
ou d
o to
cor
rect
the
prob
lem
?E
xam
ple:
I w
ould
like
you
to n
otify
the
phys
icia
n of
thes
e fin
ding
s an
d as
k if
we
can
have
a M
SW
refe
rral
for a
n ev
alua
tion.
The
re
may
be
som
ethi
ng g
oing
on
in M
iss
Lane
’s li
fe th
at s
he h
as n
ot
reco
gniz
ed a
s ca
usin
g th
e po
ssib
le a
nxie
ty a
ttack
s. I
wou
ld a
lso
like
you
to v
isit
the
patie
nt in
the
a.m
. to
asse
ss h
er b
lood
pre
ssur
e. W
e w
ill ca
ll th
e ph
ysic
ian
tom
orro
w w
ith o
ur fi
ndin
gs to
see
if h
e w
ould
like
to
sche
dule
Mis
s La
ne fo
r an
offic
e vi
sit.
Last Update 9/12806
SS BBAA
RRII nn
tt eerr dd
ii sscc ii
pp llii nn
aa rryy
CCoo mm
mmuu nn
ii ccaa tt
ii oonn
PP hhyy ss
ii ccaa ll
TThh ee
rr aapp yy
Use
the
follo
win
g SB
AR
ste
ps to
com
mun
icat
e is
sues
, pr
oble
ms
or o
ppor
tuni
ties
for i
mpr
ovem
ent t
o co
wor
kers
or
sup
ervi
sors
. SB
AR
can
be
appl
ied
to b
oth
writ
ten
and
verb
al c
omm
unic
atio
ns.
SITU
ATI
ON
–St
ate
wha
t is
happ
enin
g at
the
pres
ent t
ime
that
has
war
rant
ed th
e SB
AR
com
mun
icat
ion.
Exa
mpl
e: H
i Ja
mes
(reh
ab m
anag
er).
This
is P
hil T
hom
pson
, the
phy
sica
l the
rapi
st. I
am
cal
ling
abou
t my
patie
nt, M
r. C
lark
Ken
t, w
ho is
com
plai
ning
of
incr
ease
d pa
in a
nd re
dnes
s of
the
right
kne
e.
BA
CK
GR
OU
ND
– E
xpla
in c
ircum
stan
ces
lead
ing
up to
this
si
tuat
ion.
Put
the
situ
atio
n in
to c
onte
xt fo
r the
read
er/li
sten
er.
Exa
mpl
e: M
r. K
ent h
ad a
righ
t tot
al k
nee
repl
acem
ent (
TKR
) 10
days
ag
o. S
utur
es w
ere
rem
oved
by
nurs
e 3
days
ago
and
the
clos
ed in
cisi
on
is o
pen
to a
ir. C
areg
iver
has
not
cle
aned
inci
sion
as
dire
cted
by
the
nurs
e an
d th
erap
ist.
Pai
n le
vel h
as in
crea
sed
from
a 3
to a
n 8
over
the
last
24
hour
s. P
atie
nt is
usi
ng ic
e to
kne
e ap
prop
riate
ly a
nd ta
king
pai
n m
edic
atio
ns a
s or
dere
d. T
here
is a
n in
crea
sed
amou
nt o
f ede
ma
in ri
ght
knee
from
1+
to a
2+,
and
inci
sion
is re
dden
ed a
nd te
nder
to to
uch.
Th
ere
is n
o dr
aina
ge a
nd n
o te
mpe
ratu
re. P
ain
and
edem
a ar
e in
terfe
ring
with
am
bula
tion
and
exer
cise
pro
gram
toda
y.
ASS
ESSM
ENT
– W
hat d
o yo
u th
ink
the
prob
lem
is?
Exa
mpl
e: P
ossi
ble
infe
ctio
n of
sur
gica
l inc
isio
n.
REC
OM
MEN
DA
TIO
N –
Wha
t wou
ld y
ou d
o to
cor
rect
the
prob
lem
?E
xam
ple:
PR
N s
kille
d nu
rsin
g vi
sit f
or w
ound
ass
essm
ent
and
to c
onta
ct p
hysi
cian
for w
ound
car
e or
ders
and
teac
h fa
mily
wou
nd
care
. Sch
edul
e a
follo
w-u
p vi
sit w
ith p
hysi
cian
.
SS BBAA
RRII nn
tt eerr dd
ii sscc ii
pp llii nn
aa rryy
CCoo mm
mmuu nn
ii ccaa tt
ii oonn
PP hhyy ss
ii ccaa ll
TThh ee
rr aapp yy
Use
the
follo
win
g SB
AR
ste
ps to
com
mun
icat
e is
sues
, pr
oble
ms
or o
ppor
tuni
ties
for i
mpr
ovem
ent t
o co
wor
kers
or
sup
ervi
sors
. SB
AR
can
be
appl
ied
to b
oth
writ
ten
and
verb
al c
omm
unic
atio
ns.
SITU
ATI
ON
–St
ate
wha
t is
happ
enin
g at
the
pres
ent t
ime
that
has
war
rant
ed th
e SB
AR
com
mun
icat
ion.
Exa
mpl
e: H
i Ja
mes
(reh
ab m
anag
er).
This
is P
hil T
hom
pson
, the
phy
sica
l the
rapi
st. I
am
cal
ling
abou
t my
patie
nt, M
r. C
lark
Ken
t, w
ho is
com
plai
ning
of
incr
ease
d pa
in a
nd re
dnes
s of
the
right
kne
e.
BA
CK
GR
OU
ND
– E
xpla
in c
ircum
stan
ces
lead
ing
up to
this
si
tuat
ion.
Put
the
situ
atio
n in
to c
onte
xt fo
r the
read
er/li
sten
er.
Exa
mpl
e: M
r. K
ent h
ad a
righ
t tot
al k
nee
repl
acem
ent (
TKR
) 10
days
ag
o. S
utur
es w
ere
rem
oved
by
nurs
e 3
days
ago
and
the
clos
ed in
cisi
on
is o
pen
to a
ir. C
areg
iver
has
not
cle
aned
inci
sion
as
dire
cted
by
the
nurs
e an
d th
erap
ist.
Pai
n le
vel h
as in
crea
sed
from
a 3
to a
n 8
over
the
last
24
hour
s. P
atie
nt is
usi
ng ic
e to
kne
e ap
prop
riate
ly a
nd ta
king
pai
n m
edic
atio
ns a
s or
dere
d. T
here
is a
n in
crea
sed
amou
nt o
f ede
ma
in ri
ght
knee
from
1+
to a
2+,
and
inci
sion
is re
dden
ed a
nd te
nder
to to
uch.
Th
ere
is n
o dr
aina
ge a
nd n
o te
mpe
ratu
re. P
ain
and
edem
a ar
e in
terfe
ring
with
am
bula
tion
and
exer
cise
pro
gram
toda
y.
ASS
ESSM
ENT
– W
hat d
o yo
u th
ink
the
prob
lem
is?
Exa
mpl
e: P
ossi
ble
infe
ctio
n of
sur
gica
l inc
isio
n.
REC
OM
MEN
DA
TIO
N –
Wha
t wou
ld y
ou d
o to
cor
rect
the
prob
lem
?E
xam
ple:
PR
N s
kille
d nu
rsin
g vi
sit f
or w
ound
ass
essm
ent
and
to c
onta
ct p
hysi
cian
for w
ound
car
e or
ders
and
teac
h fa
mily
wou
nd
care
. Sch
edul
e a
follo
w-u
p vi
sit w
ith p
hysi
cian
.
Last Update 9/12807
SS BBAA
RRII nn
tt eerr dd
ii sscc ii
pp llii nn
aa rryy
CCoo mm
mmuu nn
ii ccaa tt
ii oonn
OOcc cc
uu ppaa tt
ii oonn aa
ll TThh ee
rr aapp yy
Use
the
follo
win
g SB
AR
ste
ps to
com
mun
icat
e is
sues
, pr
oble
ms
or o
ppor
tuni
ties
for i
mpr
ovem
ent t
o co
wor
kers
or
supe
rvis
ors.
SB
AR
can
be
appl
ied
to b
oth
writ
ten
and
verb
al
com
mun
icat
ions
.
SITU
ATI
ON
–St
ate
wha
t is
happ
enin
g at
the
pres
ent t
ime
that
has
war
rant
ed th
e SB
AR
com
mun
icat
ion.
Exa
mpl
e: H
i Ja
mes
(reh
ab m
anag
er).
This
is O
liver
Tho
rpe,
the
occu
patio
nal
ther
apis
t (O
T) c
allin
g ab
out m
y pa
tient
, Mrs
. Mar
tha
Ken
t, w
ho is
re
fusi
ng a
sho
wer
bat
h at
this
tim
e.
BA
CK
GR
OU
ND
– E
xpla
in c
ircum
stan
ces
lead
ing
up to
this
si
tuat
ion.
Put
the
situ
atio
n in
to c
onte
xt fo
r the
read
er/li
sten
er.
Exa
mpl
e: M
rs. K
ent h
ad a
n O
RIF
of t
he le
ft fe
mur
from
a fa
ll in
the
hom
e.
Pin
s w
ere
rem
oved
and
pat
ient
is n
ow a
llow
ed to
sho
wer
. Pat
ient
has
re
fuse
d ac
tual
sho
wer
and
/or h
andh
eld
show
er u
nit.
OT
has
inst
ruct
ed a
nd
perfo
rmed
dry
tran
sfer
s an
d pr
actic
ed b
athi
ng a
ctiv
ities
usi
ng th
e tu
b tra
nsfe
r ben
ch. O
T ha
s pr
ovid
ed e
mot
iona
l and
phy
sica
l sup
port.
Mrs
. Ken
t liv
es a
lone
, is
very
anx
ious
and
fear
ful o
f fal
ling.
Am
bula
ting
20 –
25
feet
w
ith s
td. w
alke
r and
is b
eing
follo
wed
by
phys
ical
ther
apy
(PT)
. Bal
ance
in
show
er is
fair
to fa
ir +.
Pat
ient
sco
red
high
risk
leve
l on
falls
scr
eeni
ng
chec
klis
t. E
duca
tion
prov
ided
on
falls
pre
vent
ion.
ASS
ESSM
ENT
– W
hat d
o yo
u th
ink
the
prob
lem
is?
Exa
mpl
e: P
atie
nt is
too
anxi
ous
and
afra
id o
f fal
ling
at th
is ti
me,
whi
ch is
cr
eatin
g an
uns
afe
envi
ronm
ent.
REC
OM
MEN
DA
TIO
N –
Wha
t wou
ld y
ou d
o to
cor
rect
the
prob
lem
?E
xam
ple:
Sup
ervi
sor t
o ob
tain
a h
ome
heal
th a
ide
orde
r for
2
– 3
wee
ks to
allo
w P
T to
impr
ove
stre
ngth
, bal
ance
and
con
fiden
ce. P
T to
not
ify O
T w
hen
patie
nt is
ste
ady
enou
gh a
nd is
willi
ng to
beg
in to
wor
k on
sho
wer
bat
hing
. Ski
lled
nurs
ing/
med
ical
soc
ial w
orke
r to
eval
uate
pa
tient
’s a
nxie
ty a
nd e
mot
iona
l sta
tus.
All
disc
iplin
es to
con
tinue
te
achi
ng fa
lls p
reve
ntio
n pr
ogra
m to
pat
ient
and
fam
ily.
SS BBAA
RRII nn
tt eerr dd
ii sscc ii
pp llii nn
aa rryy
CCoo mm
mmuu nn
ii ccaa tt
ii oonn
OOcc cc
uu ppaa tt
ii oonn aa
ll TThh ee
rr aapp yy
Use
the
follo
win
g SB
AR
ste
ps to
com
mun
icat
e is
sues
, pr
oble
ms
or o
ppor
tuni
ties
for i
mpr
ovem
ent t
o co
wor
kers
or
supe
rvis
ors.
SB
AR
can
be
appl
ied
to b
oth
writ
ten
and
verb
al
com
mun
icat
ions
.
SITU
ATI
ON
–St
ate
wha
t is
happ
enin
g at
the
pres
ent t
ime
that
has
war
rant
ed th
e SB
AR
com
mun
icat
ion.
Exa
mpl
e: H
i Ja
mes
(reh
ab m
anag
er).
This
is O
liver
Tho
rpe,
the
occu
patio
nal
ther
apis
t (O
T) c
allin
g ab
out m
y pa
tient
, Mrs
. Mar
tha
Ken
t, w
ho is
re
fusi
ng a
sho
wer
bat
h at
this
tim
e.
BA
CK
GR
OU
ND
– E
xpla
in c
ircum
stan
ces
lead
ing
up to
this
si
tuat
ion.
Put
the
situ
atio
n in
to c
onte
xt fo
r the
read
er/li
sten
er.
Exa
mpl
e: M
rs. K
ent h
ad a
n O
RIF
of t
he le
ft fe
mur
from
a fa
ll in
the
hom
e.
Pin
s w
ere
rem
oved
and
pat
ient
is n
ow a
llow
ed to
sho
wer
. Pat
ient
has
re
fuse
d ac
tual
sho
wer
and
/or h
andh
eld
show
er u
nit.
OT
has
inst
ruct
ed a
nd
perfo
rmed
dry
tran
sfer
s an
d pr
actic
ed b
athi
ng a
ctiv
ities
usi
ng th
e tu
b tra
nsfe
r ben
ch. O
T ha
s pr
ovid
ed e
mot
iona
l and
phy
sica
l sup
port.
Mrs
. Ken
t liv
es a
lone
, is
very
anx
ious
and
fear
ful o
f fal
ling.
Am
bula
ting
20 –
25
feet
w
ith s
td. w
alke
r and
is b
eing
follo
wed
by
phys
ical
ther
apy
(PT)
. Bal
ance
in
show
er is
fair
to fa
ir +.
Pat
ient
sco
red
high
risk
leve
l on
falls
scr
eeni
ng
chec
klis
t. E
duca
tion
prov
ided
on
falls
pre
vent
ion.
ASS
ESSM
ENT
– W
hat d
o yo
u th
ink
the
prob
lem
is?
Exa
mpl
e: P
atie
nt is
too
anxi
ous
and
afra
id o
f fal
ling
at th
is ti
me,
whi
ch is
cr
eatin
g an
uns
afe
envi
ronm
ent.
REC
OM
MEN
DA
TIO
N –
Wha
t wou
ld y
ou d
o to
cor
rect
the
prob
lem
?E
xam
ple:
Sup
ervi
sor t
o ob
tain
a h
ome
heal
th a
ide
orde
r for
2
– 3
wee
ks to
allo
w P
T to
impr
ove
stre
ngth
, bal
ance
and
con
fiden
ce. P
T to
not
ify O
T w
hen
patie
nt is
ste
ady
enou
gh a
nd is
willi
ng to
beg
in to
wor
k on
sho
wer
bat
hing
. Ski
lled
nurs
ing/
med
ical
soc
ial w
orke
r to
eval
uate
pa
tient
’s a
nxie
ty a
nd e
mot
iona
l sta
tus.
All
disc
iplin
es to
con
tinue
te
achi
ng fa
lls p
reve
ntio
n pr
ogra
m to
pat
ient
and
fam
ily.
Last Update 9/12808
SS BBAA
RRII nn
tt eerr dd
ii sscc ii
pp llii nn
aa rryy
CCoo mm
mmuu nn
ii ccaa tt
ii oonn
SS ppee ee
cc hhTT
hh eerr aa
pp yyU
se th
e fo
llow
ing
SBA
R s
teps
to c
omm
unic
ate
issu
es,
prob
lem
s or
opp
ortu
nitie
s fo
r im
prov
emen
t to
cow
orke
rs
or s
uper
viso
rs. S
BA
R c
an b
e ap
plie
d to
bot
h w
ritte
n an
d ve
rbal
com
mun
icat
ions
.
SITU
ATI
ON
–St
ate
wha
t is
happ
enin
g at
the
pres
ent t
ime
that
has
war
rant
ed th
e SB
AR
com
mun
icat
ion.
Exa
mpl
e: H
i G
inny
(nur
sing
man
ager
). Th
is is
Sam
anth
a Tu
rner
, the
spe
ech
ther
apis
t. I e
valu
ated
our
pat
ient
, Mr.
Per
ry W
hite
, tod
ay fo
r diff
icul
ty
swal
low
ing.
BA
CK
GR
OU
ND
– E
xpla
in c
ircum
stan
ces
lead
ing
up to
this
si
tuat
ion.
Put
the
situ
atio
n in
to c
onte
xt fo
r the
read
er/li
sten
er.
Exa
mpl
e: M
r. W
hite
has
a h
x of
CV
A a
nd h
as d
evel
oped
occ
asio
nal
chok
ing
on th
in li
quid
s. In
stru
cted
his
wife
to h
ave
patie
nt in
upr
ight
po
sitio
n (9
0 de
gree
s) w
hen
feed
ing
him
and
the
use
of c
hin
to c
hest
te
chni
que
for s
wal
low
ing.
Als
o in
stru
cted
to a
dd “T
hick
-it” t
o th
e co
nsis
tenc
y of
hon
ey fo
r all
thin
liqu
ids
(wat
er, c
offe
e, ju
ice)
and
to e
at
slow
ly a
nd c
hew
food
thor
ough
ly. A
pat
ient
edu
catio
n sh
eet o
n dy
spha
gia
and
s/s
aspi
ratio
n w
as le
ft in
the
patie
nts’
fold
er in
the
hom
e.
ASS
ESSM
ENT
– W
hat d
o yo
u th
ink
the
prob
lem
is?
Exa
mpl
e: P
atie
nt’s
phy
sica
l sta
tus
begi
nnin
g to
dec
line,
losi
ng s
ome
mus
cle
tone
in th
roat
mus
cles
.
REC
OM
MEN
DA
TIO
N –
Wha
t wou
ld y
ou d
o to
cor
rect
the
prob
lem
?E
xam
ple:
Ski
lled
nurs
ing
(SN
) to
rein
forc
e S
T te
achi
ng,
teac
hing
she
et, u
se o
f “Th
ick-
it,” a
nd s
/s to
not
ify a
genc
y or
phy
sici
an.
SN
to c
ontin
ue to
mon
itor s
wal
low
ing
diffi
culty
and
re-c
onsu
lt S
T if
stat
us
star
ts to
dec
line.
ST
wou
ld o
btai
n or
der f
or B
ariu
m S
wal
low
if s
tatu
s de
clin
es.
SS BBAA
RRII nn
tt eerr dd
ii sscc ii
pp llii nn
aa rryy
CCoo mm
mmuu nn
ii ccaa tt
ii oonn
SS ppee ee
cc hhTT
hh eerr aa
pp yyU
se th
e fo
llow
ing
SBA
R s
teps
to c
omm
unic
ate
issu
es,
prob
lem
s or
opp
ortu
nitie
s fo
r im
prov
emen
t to
cow
orke
rs
or s
uper
viso
rs. S
BA
R c
an b
e ap
plie
d to
bot
h w
ritte
n an
d ve
rbal
com
mun
icat
ions
.
SITU
ATI
ON
–St
ate
wha
t is
happ
enin
g at
the
pres
ent t
ime
that
has
war
rant
ed th
e SB
AR
com
mun
icat
ion.
Exa
mpl
e: H
i G
inny
(nur
sing
man
ager
). Th
is is
Sam
anth
a Tu
rner
, the
spe
ech
ther
apis
t. I e
valu
ated
our
pat
ient
, Mr.
Per
ry W
hite
, tod
ay fo
r diff
icul
ty
swal
low
ing.
BA
CK
GR
OU
ND
– E
xpla
in c
ircum
stan
ces
lead
ing
up to
this
si
tuat
ion.
Put
the
situ
atio
n in
to c
onte
xt fo
r the
read
er/li
sten
er.
Exa
mpl
e: M
r. W
hite
has
a h
x of
CV
A a
nd h
as d
evel
oped
occ
asio
nal
chok
ing
on th
in li
quid
s. In
stru
cted
his
wife
to h
ave
patie
nt in
upr
ight
po
sitio
n (9
0 de
gree
s) w
hen
feed
ing
him
and
the
use
of c
hin
to c
hest
te
chni
que
for s
wal
low
ing.
Als
o in
stru
cted
to a
dd “T
hick
-it” t
o th
e co
nsis
tenc
y of
hon
ey fo
r all
thin
liqu
ids
(wat
er, c
offe
e, ju
ice)
and
to e
at
slow
ly a
nd c
hew
food
thor
ough
ly. A
pat
ient
edu
catio
n sh
eet o
n dy
spha
gia
and
s/s
aspi
ratio
n w
as le
ft in
the
patie
nts’
fold
er in
the
hom
e.
ASS
ESSM
ENT
– W
hat d
o yo
u th
ink
the
prob
lem
is?
Exa
mpl
e: P
atie
nt’s
phy
sica
l sta
tus
begi
nnin
g to
dec
line,
losi
ng s
ome
mus
cle
tone
in th
roat
mus
cles
.
REC
OM
MEN
DA
TIO
N –
Wha
t wou
ld y
ou d
o to
cor
rect
the
prob
lem
?E
xam
ple:
Ski
lled
nurs
ing
(SN
) to
rein
forc
e S
T te
achi
ng,
teac
hing
she
et, u
se o
f “Th
ick-
it,” a
nd s
/s to
not
ify a
genc
y or
phy
sici
an.
SN
to c
ontin
ue to
mon
itor s
wal
low
ing
diffi
culty
and
re-c
onsu
lt S
T if
stat
us
star
ts to
dec
line.
ST
wou
ld o
btai
n or
der f
or B
ariu
m S
wal
low
if s
tatu
s de
clin
es.
Last Update 9/12809
SS BBAA
RRII nn
tt eerr dd
ii sscc ii
pp llii nn
aa rryy
CCoo mm
mmuu nn
ii ccaa tt
ii oonn
MMee dd
ii ccaa ll
SS oocc ii
aa llWW
oo rrkk ee
rr(( MM
SS WW))
Use
the
follo
win
g SB
AR
ste
ps to
com
mun
icat
e is
sues
, pr
oble
ms
or o
ppor
tuni
ties
for i
mpr
ovem
ent t
o co
wor
kers
or
supe
rvis
ors.
SB
AR
can
be
appl
ied
to b
oth
writ
ten
and
verb
al
com
mun
icat
ions
.
SITU
ATI
ON
–St
ate
wha
t is
happ
enin
g at
the
pres
ent t
ime
that
has
war
rant
ed th
e SB
AR
com
mun
icat
ion.
Exa
mpl
e: H
i G
inny
(nur
sing
man
ager
). Th
is is
Mel
issa
Ste
war
t, th
e m
edic
al s
ocia
l w
orke
r. I w
as c
onsu
lted
to s
ee o
ur p
atie
nt, M
r. Ja
mes
Ols
en, r
elat
ed to
m
edic
atio
n no
n-co
mpl
ianc
e w
ith o
ral m
edic
atio
ns, d
iet a
nd p
ossi
ble
finan
cial
issu
es.
BA
CK
GR
OU
ND
– E
xpla
in c
ircum
stan
ces
lead
ing
up to
this
si
tuat
ion.
Put
the
situ
atio
n in
to c
onte
xt fo
r the
read
er/li
sten
er.
Exa
mpl
e: M
r. O
lsen
was
adm
itted
for d
iabe
tes
man
agem
ent 2
wee
ks
ago.
Pat
ient
’s b
lood
sug
ars
rem
ain
abov
e 20
0, e
ven
with
med
icat
ion
adju
stm
ents
. Dia
betic
edu
cato
r saw
pat
ient
and
will
be
follo
win
g up
with
pa
tient
this
wee
k. P
atie
nt h
as b
een
only
taki
ng h
is b
lood
sug
ar p
ills o
nce
a da
y to
try
to s
tretc
h th
em o
ut u
ntil
he g
ets
his
chec
k in
2 w
eeks
.
ASS
ESSM
ENT
– W
hat d
o yo
u th
ink
the
prob
lem
is?
Exa
mpl
e: M
SW
foun
d th
at h
e do
es h
ave
finan
cial
har
dshi
p w
ith o
ral
med
icat
ions
and
with
buy
ing
suga
r-fre
e fo
ods.
Mr.
Ols
en d
oes
qual
ify fo
r ad
ditio
nal m
edic
al a
nd fi
nanc
ial a
ssis
tanc
e.
REC
OM
MEN
DA
TIO
N –
Wha
t wou
ld y
ou d
o to
cor
rect
the
prob
lem
?E
xam
ple:
MS
W m
ade
appr
opria
te re
ferr
als
to m
edic
al
assi
stan
ce o
ffice
rela
ted
to m
edic
atio
ns a
nd fo
od. A
lso
refe
rral
mad
e to
lo
cal f
ood
bank
and
com
mun
ity n
etw
ork
to h
elp
prov
ide
him
imm
edia
te
food
ass
ista
nce.
MS
W c
onta
cted
the
patie
nt’s
nie
ce, w
ho w
ill p
urch
ase
the
addi
tiona
l med
icat
ions
nee
ded,
unt
il fin
anci
al a
ssis
tanc
e is
in p
lace
. sk
illed
nurs
ing
(SN
) to
follo
w u
p w
ith p
atie
nt’s
nie
ce a
nd e
valu
ate
his
med
icat
ion
regi
men
for p
ossi
ble
cons
olid
atio
n of
med
icat
ions
. SN
nee
ds
to re
min
d th
e pa
tient
to fo
llow
thro
ugh
with
the
med
ial a
ssis
tanc
e of
fice.
SS BBAA
RRII nn
tt eerr dd
ii sscc ii
pp llii nn
aa rryy
CCoo mm
mmuu nn
ii ccaa tt
ii oonn
MMee dd
ii ccaa ll
SS oocc ii
aa llWW
oo rrkk ee
rr(( MM
SS WW))
Use
the
follo
win
g SB
AR
ste
ps to
com
mun
icat
e is
sues
, pr
oble
ms
or o
ppor
tuni
ties
for i
mpr
ovem
ent t
o co
wor
kers
or
supe
rvis
ors.
SB
AR
can
be
appl
ied
to b
oth
writ
ten
and
verb
al
com
mun
icat
ions
.
SITU
ATI
ON
–St
ate
wha
t is
happ
enin
g at
the
pres
ent t
ime
that
has
war
rant
ed th
e SB
AR
com
mun
icat
ion.
Exa
mpl
e: H
i G
inny
(nur
sing
man
ager
). Th
is is
Mel
issa
Ste
war
t, th
e m
edic
al s
ocia
l w
orke
r. I w
as c
onsu
lted
to s
ee o
ur p
atie
nt, M
r. Ja
mes
Ols
en, r
elat
ed to
m
edic
atio
n no
n-co
mpl
ianc
e w
ith o
ral m
edic
atio
ns, d
iet a
nd p
ossi
ble
finan
cial
issu
es.
BA
CK
GR
OU
ND
– E
xpla
in c
ircum
stan
ces
lead
ing
up to
this
si
tuat
ion.
Put
the
situ
atio
n in
to c
onte
xt fo
r the
read
er/li
sten
er.
Exa
mpl
e: M
r. O
lsen
was
adm
itted
for d
iabe
tes
man
agem
ent 2
wee
ks
ago.
Pat
ient
’s b
lood
sug
ars
rem
ain
abov
e 20
0, e
ven
with
med
icat
ion
adju
stm
ents
. Dia
betic
edu
cato
r saw
pat
ient
and
will
be
follo
win
g up
with
pa
tient
this
wee
k. P
atie
nt h
as b
een
only
taki
ng h
is b
lood
sug
ar p
ills o
nce
a da
y to
try
to s
tretc
h th
em o
ut u
ntil
he g
ets
his
chec
k in
2 w
eeks
.
ASS
ESSM
ENT
– W
hat d
o yo
u th
ink
the
prob
lem
is?
Exa
mpl
e: M
SW
foun
d th
at h
e do
es h
ave
finan
cial
har
dshi
p w
ith o
ral
med
icat
ions
and
with
buy
ing
suga
r-fre
e fo
ods.
Mr.
Ols
en d
oes
qual
ify fo
r ad
ditio
nal m
edic
al a
nd fi
nanc
ial a
ssis
tanc
e.
REC
OM
MEN
DA
TIO
N –
Wha
t wou
ld y
ou d
o to
cor
rect
the
prob
lem
?E
xam
ple:
MS
W m
ade
appr
opria
te re
ferr
als
to m
edic
al
assi
stan
ce o
ffice
rela
ted
to m
edic
atio
ns a
nd fo
od. A
lso
refe
rral
mad
e to
lo
cal f
ood
bank
and
com
mun
ity n
etw
ork
to h
elp
prov
ide
him
imm
edia
te
food
ass
ista
nce.
MS
W c
onta
cted
the
patie
nt’s
nie
ce, w
ho w
ill p
urch
ase
the
addi
tiona
l med
icat
ions
nee
ded,
unt
il fin
anci
al a
ssis
tanc
e is
in p
lace
. sk
illed
nurs
ing
(SN
) to
follo
w u
p w
ith p
atie
nt’s
nie
ce a
nd e
valu
ate
his
med
icat
ion
regi
men
for p
ossi
ble
cons
olid
atio
n of
med
icat
ions
. SN
nee
ds
to re
min
d th
e pa
tient
to fo
llow
thro
ugh
with
the
med
ial a
ssis
tanc
e of
fice.
Last Update 9/12810
SS BBAA
RRII nn
tt eerr dd
ii sscc ii
pp llii nn
aa rryy
CCoo mm
mmuu nn
ii ccaa tt
ii oonn
HHoo mm
eeHH
ee aall tt hh
AAii dd
eeU
se th
e fo
llow
ing
SBA
R s
teps
to c
omm
unic
ate
issu
es,
prob
lem
s or
opp
ortu
nitie
s fo
r im
prov
emen
t to
cow
orke
rs
or s
uper
viso
rs. S
BA
R c
an b
e ap
plie
d to
bot
h w
ritte
n an
d ve
rbal
com
mun
icat
ions
.
SITU
ATI
ON
–St
ate
wha
t is
happ
enin
g at
the
pres
ent t
ime
that
has
war
rant
ed th
e SB
AR
com
mun
icat
ion.
Exa
mpl
e: H
i B
erth
a (n
ursi
ng s
uper
viso
r). T
his
is H
olly
, the
hom
e he
alth
aid
e,
and
I am
cal
ling
to re
port
that
my
patie
nt, M
r. Le
x Lu
thor
, is
mor
e sh
ort o
f bre
ath
toda
y.
BA
CK
GR
OU
ND
– E
xpla
in c
ircum
stan
ces
lead
ing
up to
this
si
tuat
ion.
Put
the
situ
atio
n in
to c
onte
xt fo
r the
read
er/li
sten
er.
Exa
mpl
e: M
r. Lu
thor
bec
ame
shor
t of b
reat
h w
hen
he w
alke
d to
th
e ba
thro
om a
nd d
urin
g hi
s sh
ower
. His
wife
is c
once
rned
and
sa
id th
at h
e ha
s no
t bee
n w
atch
ing
his
salt
and
is e
atin
g w
hat h
e w
ants
.
ASS
ESSM
ENT
– W
hat d
o yo
u th
ink
the
prob
lem
is?
Exa
mpl
e: H
e is
mor
e sh
ort o
f bre
ath,
and
he
is n
ot fo
llow
ing
his
diet
. REC
OM
MEN
DA
TIO
N –
Wha
t wou
ld y
ou d
o to
cor
rect
the
prob
lem
?E
xam
ple:
Hav
e th
e nu
rse
mak
e a
visi
t or p
hone
cal
l to
Mr.
Luth
or.
SS BBAA
RRII nn
tt eerr dd
ii sscc ii
pp llii nn
aa rryy
CCoo mm
mmuu nn
ii ccaa tt
ii oonn
HHoo mm
eeHH
ee aall tt hh
AAii dd
eeU
se th
e fo
llow
ing
SBA
R s
teps
to c
omm
unic
ate
issu
es,
prob
lem
s or
opp
ortu
nitie
s fo
r im
prov
emen
t to
cow
orke
rs
or s
uper
viso
rs. S
BA
R c
an b
e ap
plie
d to
bot
h w
ritte
n an
d ve
rbal
com
mun
icat
ions
.
SITU
ATI
ON
–St
ate
wha
t is
happ
enin
g at
the
pres
ent t
ime
that
has
war
rant
ed th
e SB
AR
com
mun
icat
ion.
Exa
mpl
e: H
i B
erth
a (n
ursi
ng s
uper
viso
r). T
his
is H
olly
, the
hom
e he
alth
aid
e,
and
I am
cal
ling
to re
port
that
my
patie
nt, M
r. Le
x Lu
thor
, is
mor
e sh
ort o
f bre
ath
toda
y.
BA
CK
GR
OU
ND
– E
xpla
in c
ircum
stan
ces
lead
ing
up to
this
si
tuat
ion.
Put
the
situ
atio
n in
to c
onte
xt fo
r the
read
er/li
sten
er.
Exa
mpl
e: M
r. Lu
thor
bec
ame
shor
t of b
reat
h w
hen
he w
alke
d to
th
e ba
thro
om a
nd d
urin
g hi
s sh
ower
. His
wife
is c
once
rned
and
sa
id th
at h
e ha
s no
t bee
n w
atch
ing
his
salt
and
is e
atin
g w
hat h
e w
ants
.
ASS
ESSM
ENT
– W
hat d
o yo
u th
ink
the
prob
lem
is?
Exa
mpl
e: H
e is
mor
e sh
ort o
f bre
ath,
and
he
is n
ot fo
llow
ing
his
diet
. REC
OM
MEN
DA
TIO
N –
Wha
t wou
ld y
ou d
o to
cor
rect
the
prob
lem
?E
xam
ple:
Hav
e th
e nu
rse
mak
e a
visi
t or p
hone
cal
l to
Mr.
Luth
or.
Last Update 9/12811
AssessmentAnalysis and considerations ofoptionsWhat you found/think is going on
SituationA concise statement of the problemWhat is going on now
BackgroundPertinent and brief informationrelated to the situationWhat has happened
RecommendationRequest/recommend actionWhat you want done
SBARA structured communication technique designed to conveya great deal of information in a succinct and brief manner.This is important as we all have different styles ofcommunicating, varying by profession, culture, and gender.
SBAR
© 2004 Kaiser Foundation Health Plan, Inc.Kaiser Foundation Health Plan, Inc. is the owner and holds the copyright of the material(s) and must be
acknowledged in all print and electronic media as the original developer and copyright holder of the material(s).
Last Update 9/12812
Copy on heavy paper and laminate for staff
Last Update 9/12813
S – Situation & identify self/agency
B – Background
A – Assessment
R – Recommendation
S – Situation & identify self/agency
B – Background
A – Assessment
R – Recommendation
S – Situation & identify self/agency
B – Background
A – Assessment
R – Recommendation
S – Situation & identify self/agency
B – Background
A – Assessment
R – Recommendation
S – Situation & identify self/agency
B – Background
A – Assessment
R – Recommendation
S – Situation & identify self/agency
B – Background
A – Assessment
R – Recommendation
S – Situation & identify self/agency
B – Background
A – Assessment
R – Recommendation
S – Situation & identify self/agency
B – Background
A – Assessment
R – Recommendation
S – Situation & identify self/agency
B – Background
A – Assessment
R – Recommendation
S – Situation & identify self/agency
B – Background
A – Assessment
R – Recommendation
S – Situation & identify self/agency
B – Background
A – Assessment
R – Recommendation
S – Situation & identify self/agency
B – Background
A – Assessment
R – Recommendation
S – Situation & identify self/agency
B – Background
A – Assessment
R – Recommendation
S – Situation & identify self/agency
B – Background
A – Assessment
R – Recommendation
S – Situation & identify self/agency
B – Background
A – Assessment
R – Recommendation
S – Situation & identify self/agency
B – Background
A – Assessment
R – Recommendation
S – Situation & identify self/agency
B – Background
A – Assessment
R – Recommendation
S – Situation & identify self/agency
B – Background
A – Assessment
R – Recommendation
S – Situation & identify self/agency
B – Background
A – Assessment
R – Recommendation
S – Situation & identify self/agency
B – Background
A – Assessment
R – Recommendation
S – Situation & identify self/agency
B – Background
A – Assessment
R – Recommendation
S – Situation & identify self/agency
B – Background
A – Assessment
R – Recommendation
S – Situation & identify self/agency
B – Background
A – Assessment
R – Recommendation
S – Situation & identify self/agency
B – Background
A – Assessment
R – Recommendation
S – Situation & identify self/agency
B – Background
A – Assessment
R – Recommendation
S – Situation & identify self/agency
B – Background
A – Assessment
R – Recommendation
S – Situation & identify self/agency
B – Background
A – Assessment
R – Recommendation
S – Situation & identify self/agency
B – Background
A – Assessment
R – Recommendation
S – Situation & identify self/agency
B – Background
A – Assessment
R – Recommendation
S – Situation & identify self/agency
B – Background
A – Assessment
R – Recommendation
Last Update 9/12814
SBA
R S
cena
rio
Re
ad
th
e f
oll
ow
ing
sce
na
rio
an
d t
he
n c
om
ple
te t
he
S
BA
R i
nd
ivid
ua
lly
or
in a
sm
all
gro
up
. D
iscu
ss y
ou
r S
BA
R w
ith
yo
ur
pa
rtn
er
or
you
r sm
all
gro
up
.
Nur
sing
Mr.
Sm
ith
is a
78
-yea
r-ol
d p
atie
nt
wit
h C
HF
an
d H
TN
wh
o li
ves
wit
h e
lder
ly w
ife.
Tod
ay’s
vit
al s
ign
s w
ere:
T -
98
.6, B
P -
18
8/9
0,
RR
- 2
4. H
e is
mor
e SO
B t
oday
as
evid
ence
d b
y an
incr
ease
d
resp
irat
ion
rat
e an
d n
ow S
OB
am
bula
tin
g 8
feet
(ba
seli
ne
abil
ity
- am
bula
te 2
0 f
eet)
. Lu
ng
sou
nd
s w
ere
pre
viou
sly
clea
r, b
ut
tod
ay h
e h
as c
rack
les
in t
he
pos
teri
or b
ilat
eral
low
er b
ases
(1/
3rd
lun
g fi
eld
s). H
e u
sual
ly h
as +
1 ed
ema,
bu
t to
day
it is
now
+2
and
sl
igh
tly
pit
tin
g. M
r. S
mit
h’s
wif
e fo
rgot
to
wei
gh h
im f
or t
he
last
3
day
s, b
ut
he
has
now
gai
ned
6 lb
s. o
ver
4 d
ays.
His
cu
rren
t m
ed r
egim
e in
clu
des
: D
igox
in, 0
.125
mg,
eve
ry d
ay;
Las
ix, 2
0 m
g, e
very
day
; Slo
w-K
, 20
meq
, eve
ry d
ay; a
nd
P
rin
ivil
, 5 m
g, e
very
day
. He
has
no
stan
din
g/p
rn o
rder
s. Y
ou
talk
wit
h h
is w
ife
abou
t h
is c
omp
lian
ce w
ith
his
med
icat
ion
re
gim
en a
nd
sh
e st
ates
her
dau
ghte
r p
re-f
ills
th
e m
edic
atio
ns
once
a w
eek.
Up
on e
xam
inin
g th
e p
illb
ox, i
t ap
pea
rs t
hat
th
e m
edic
atio
ns
wer
e gi
ven
as
ord
ered
. His
die
t re
call
was
not
mu
ch
dif
fere
nt
than
his
nor
mal
2 g
m N
a d
iet,
exc
ept
for
a h
am d
inn
er
2 d
ays
ago.
His
wif
e is
an
xiou
s ov
er h
is c
han
ge in
sta
tus.
Nan
cy
Nu
rse
call
s D
r. G
ann
on w
ith
th
e u
pd
ate.
S B A R
Skill
ed N
ursi
ng W
orks
heet
Last Update 9/12815
SD
r. G
anno
n, I
am N
ancy
Nur
se fr
om A
BC
Hom
e C
are.
I am
cal
ling
abou
t Mr.
Jam
es S
mith
, who
se b
lood
pr
essu
re, r
espi
ratio
ns &
wei
ght a
re e
leva
ted.
BM
r. S
mith
, a 7
8-ye
ar-o
ld p
atie
nt, w
ith d
iagn
osis
of C
HF
& H
TN. B
P h
as in
crea
sed
to 1
88/9
0, re
sp. t
o 24
. SO
B
whe
n am
bula
ting
8 fe
et, p
revi
ousl
y S
OB
at 2
0 fe
et. W
gtin
crea
sed
6#/4
day
s. C
rack
les
in th
e po
ster
ior b
ilate
ral
low
er b
ases
(1/3
rd lu
ng fi
eld)
. Com
plia
nt w
ith
med
icat
ions
. For
the
mos
t par
t he
is c
ompl
iant
with
his
2
gm N
a di
et, w
ith th
e ex
cept
ion
of e
atin
g ha
m fo
r di
nner
two
days
ago
.
Rea
d th
e sa
mpl
e sc
enar
io
insi
de a
nd c
ompl
ete
the
SBA
R. T
hen,
look
at t
he b
ack
pane
l for
a p
ossi
ble
exam
ple.
AM
r. S
mith
is e
xper
ienc
ing
fluid
rete
ntio
n w
hich
may
or
may
not
hav
e be
en e
xace
rbat
ed b
y th
e ha
m d
inne
r.
R Skill
ed N
ursi
ng W
orks
heet
I wou
ld li
ke to
giv
e M
r. S
mith
a d
ose
of IV
Las
ix n
ow
and
then
con
tinue
with
his
dai
ly L
asix
p.o
. dos
e in
the
a.m
. I w
ill h
ave
his
wife
mea
sure
his
urin
e ou
tput
for
the
next
24
hour
s to
ass
ess
his
diur
esis
. I w
ould
like
an
orde
r to
visi
t in
the
a.m
. to
asse
ss h
is re
spira
tory
st
atus
, and
urin
e ou
tput
. M
ay I
draw
a s
tat K
+ le
vel?
I w
ill c
all y
ou w
ith th
e vi
sit r
esul
ts in
the
a.m
. The
on-
call
nurs
e w
ill c
all h
is w
ife in
2 h
ours
to a
sses
s M
r. Sm
ith’s
S
OB
and
urin
e ou
tput
. Mrs
. Sm
ith w
ill b
e in
stru
cted
on
the
s/s
to w
atch
for a
nd to
cal
l if t
he p
atie
nt’s
SO
B
wor
sens
.
Last Update 9/12816
SBA
R S
cena
rio
Re
ad
th
e f
oll
ow
ing
sce
na
rio
an
d t
he
n c
om
ple
te t
he
S
BA
R i
nd
ivid
ua
lly
or
in a
sm
all
gro
up
. D
iscu
ss y
ou
r S
BA
R w
ith
yo
ur
pa
rtn
er
or
you
r sm
all
gro
up
.
Phys
ical
The
rapy
Mrs
. Jon
es is
a 7
8-y
ear-
old
fem
ale.
Sh
e li
ves
in a
on
e-st
ory
hom
e w
ith
her
eld
erly
hu
sban
d, w
ho
is a
lso
a p
atie
nt
on h
ome
care
, an
d s
he
is h
is p
rim
ary
care
give
r. M
rs. J
ones
’s p
ast
med
ical
d
iagn
osis
is H
TN
. Sh
e h
as b
ecom
e in
crea
sin
gly
un
stea
dy
on h
er
feet
wit
hin
th
e la
st s
ever
al w
eeks
. A r
efer
ral w
as m
ade
to P
T t
o ev
alu
ate
low
er e
xtre
mit
y st
ren
gth
enin
g an
d g
ait
trai
nin
g.
Ph
illi
p T
hom
as’ (
ph
ysic
al t
her
apis
t) fi
nd
ings
incl
ud
e: a
mbu
late
s 15
– 2
0 fe
et u
sin
g fu
rnit
ure
& w
alls
. Bot
h a
mbu
lati
on a
nd
st
and
ing
bala
nce
fair
(-)
. Str
engt
h B
LE
3+
/5 &
BU
E 3
+/5
. No
oth
er g
ait
abn
orm
alit
ies
exis
t. P
t. s
how
ers
alon
e an
d t
her
e ar
e n
o gr
ab b
ars
or a
ny
oth
er s
how
er e
quip
men
t. A
fall
ris
k as
sess
men
t ev
iden
ces
the
pat
ien
t sc
ored
as
hig
h r
isk.
PT
in
itia
tes
call
to
Dr.
Gan
non
, th
e p
atie
nt’
s p
hys
icia
n.
S B A R
Phys
ical
The
rapy
Wor
kshe
et
Last Update 9/12817
SD
r. G
anno
n, I
am P
hilli
p Th
omas
, a p
hysi
cal t
hera
pist
at
AB
C H
ome
Car
e. I
am c
allin
g ab
out M
rs. H
elen
Jon
es
who
was
refe
rred
with
wea
knes
s, a
nd I
am id
entif
ying
as
a hi
gh ri
sk fo
r fal
ling.
BM
rs. J
ones
, a 7
8-ye
ar-o
ld p
atie
nt, l
ives
at h
ome
with
her
el
derly
, ill
husb
and.
She
sco
red
at h
igh
risk
on o
ur fa
lls
risk
asse
ssm
ent r
elat
ed to
am
bula
ting
only
with
wal
ls
and
furn
iture
for s
uppo
rt sh
ort d
ista
nces
; her
bal
ance
is
fair
(-).
She
doe
s no
t hav
e an
y sa
fety
equ
ipm
ent i
n th
e ba
thro
om (n
o gr
ab b
ars)
. Her
sta
ndin
g ba
lanc
e is
fair.
Th
ere
is n
o ot
her s
/s a
t thi
s tim
e.
Rea
d th
e sa
mpl
e sc
enar
io
insi
de a
nd c
ompl
ete
the
SBA
R. T
hen,
look
at t
he b
ack
pane
l for
a p
ossi
ble
exam
ple.
AP
atie
nt h
as d
evel
oped
som
e w
eakn
ess
with
her
legs
and
sh
e ha
s a
bala
nce
issu
e th
at is
put
ting
her a
t ris
k fo
r a
fall.
Pat
ient
nee
ds a
n or
der f
or: a
sta
ndar
d w
alke
r and
a
med
ical
soc
ial w
orke
r ref
erra
l to
asse
ss M
rs. J
ones
de
clin
ing
cond
ition
, whi
ch m
ay n
egat
ivel
y im
pact
her
ab
ility
to c
are
for h
er h
usba
nd.
R Phys
ical
The
rapy
Wor
kshe
et
Last Update 9/12818
SBA
R S
cena
rio
Re
ad
th
e f
oll
ow
ing
sce
na
rio
an
d t
he
n c
om
ple
te t
he
S
BA
R i
nd
ivid
ua
lly
or
in a
sm
all
gro
up
. D
iscu
ss y
ou
r S
BA
R w
ith
yo
ur
pa
rtn
er
or
you
r sm
all
gro
up
.
Occ
upat
iona
l The
rapy
Mr.
Wil
son
is a
69
-yea
r-ol
d p
atie
nt
wit
h C
VA
5 y
ears
ago
wit
h
righ
t la
ten
t h
emip
legi
a. S
kill
ed n
urs
ing
(SN
) w
as r
efer
red
to
see
pat
ien
t d
ue
to a
n o
pen
wou
nd
on
rig
ht
thu
mb
from
con
trac
ture
of
th
e ri
ght
han
d. S
N in
itia
ted
app
rop
riat
e w
oun
d c
are
and
ob
tain
ed a
n o
rder
for
an
OT
eva
luat
ion
. Oli
ver
Th
orp
e, O
T’s
fi
nd
ings
incl
ud
ed:
righ
t h
and
con
trac
ture
, fis
t-li
ke, w
ith
p
ress
ure
bei
ng
app
lied
to
mid
th
um
b jo
int
from
th
e in
dex
fin
ger.
R
igh
t w
rist
dro
p w
as a
lso
not
ed.
Th
e p
atie
nt
is u
nab
le t
o gr
ip
wit
h h
is r
igh
t h
and
. Th
ere
is g
ood
cir
cula
tion
to
the
han
d
wit
hou
t ot
her
red
den
ed a
reas
at
this
tim
e. T
he
pat
ien
t is
at
hig
h
risk
for
mor
e br
eakd
own
. Car
egiv
er d
enie
s h
avin
g a
spli
nt
or
con
e fo
r p
atie
nt.
OT
wan
ts t
o fa
bric
ate
a co
ck-u
p s
pli
nt
for
the
righ
t h
and
an
d t
o se
e th
e p
atie
nt
acco
rdin
g to
th
e fo
llow
ing
sch
edu
le -
3x/
wee
k x
2 w
eeks
; 2x/
wee
k x
2 w
eeks
. T
he
OT
vis
its
wil
l in
volv
e te
ach
ing
the
care
give
r a
mas
sage
an
d e
xerc
ise
pro
gram
to
pre
ven
t sk
in b
reak
dow
n. O
T h
as c
onta
cted
Dr.
G
ann
on, t
he
pat
ien
t’s
ph
ysic
ian
reg
ard
ing
his
pla
n f
or t
he
pat
ien
t.
S B A R
Occ
upat
iona
l The
rapy
Wor
kshe
et
Last Update 9/12819
SD
r. G
anno
n, I
am O
liver
Tho
rpe,
the
occu
patio
nal
ther
apis
t at A
BC
Hom
e C
are.
I a
m c
allin
g ab
out M
r. W
ilson
’s re
sidu
al ri
ght h
and
cont
ract
ure
and
hand
dro
p ca
usin
g an
ope
n w
ound
.
BM
r. W
ilson
is y
our 6
9-ye
ar-o
ld p
atie
nt w
ith a
his
tory
of
CV
A w
ith re
sidu
al ri
ght h
emip
legi
a, ri
ght h
and
cont
ract
ure
and
right
wris
t dro
p. O
pen
area
righ
t mid
dle
thum
b jo
int
whi
ch th
e nu
rse
initi
ated
wou
nd c
are.
The
re is
goo
d ci
rcul
atio
n to
righ
t han
d. P
atie
nt d
oes
not h
ave
a sp
lint o
r a
cone
for p
reve
ntio
n.
Rea
d th
e sa
mpl
e sc
enar
io
insi
de a
nd c
ompl
ete
the
SBA
R. T
hen,
look
at t
he b
ack
pane
l for
a p
ossi
ble
exam
ple.
AP
ress
ure
and
poor
pos
ition
ing
of ri
ght w
rist c
ause
d on
op
en w
ound
on
right
mid
dle
thum
b.
OT
wou
ld li
ke to
see
pat
ient
3x/
wee
k x
2 w
eeks
; 2x/
wee
k x
2 w
eeks
to fa
bric
ate
a co
ck-u
p sp
lint r
ight
han
d, te
ach
the
care
give
r a m
assa
ge a
nd e
xerc
ise
prog
ram
to
prev
ent s
kin
brea
kdow
n.
R Occ
upat
iona
l The
rapy
Wor
kshe
et
Last Update 9/12820
SBA
R S
cena
rio
Re
ad
th
e f
oll
ow
ing
sce
na
rio
an
d t
he
n c
om
ple
te t
he
S
BA
R i
nd
ivid
ua
lly
or
in a
sm
all
gro
up
. D
iscu
ss y
ou
r S
BA
R w
ith
yo
ur
pa
rtn
er
or
you
r sm
all
gro
up
.
Spee
ch T
hera
py
Mrs
. Ad
ams,
a 7
4-y
ear-
old
wh
o h
ad a
CV
A 7
wee
ks a
go, h
as
resi
du
al m
ild
wea
knes
s of
rig
ht
sid
e. S
he
has
bee
n o
n h
ome
care
se
rvic
es f
or t
he
pas
t 6
wee
ks.
Serv
ices
incl
ud
e SN
an
d P
T.
OT
w
as p
revi
ousl
y d
isco
nti
nu
ed.
She
has
now
dev
elop
ed s
ome
swal
low
ing
dif
ficu
ltie
s, e
spec
iall
y w
ith
sol
id fo
ods.
Sh
e co
mp
lain
s th
at it
is d
iffi
cult
to
get
the
“foo
d t
o go
dow
n a
t ti
mes
,” b
ut
has
no
pro
blem
wit
h li
quid
s. S
pee
ch t
her
apy
fin
din
gs in
clu
ded
: A
, A, &
ori
ente
d x
3.
Spee
ch is
cle
ar a
nd
n
on-s
lurr
ed, a
nd
fac
ial m
usc
le t
one
is n
orm
al. S
he
has
goo
d g
ag
refl
ex a
nd
is a
ble
to s
wal
low
liqu
ids
wit
hou
t ch
okin
g or
d
iffi
cult
y. M
rs. A
dam
s is
abl
e to
sw
allo
w s
oft
food
s, i.
e. m
ash
ed
pot
atoe
s an
d a
pp
lesa
uce
, bu
t is
hav
ing
dif
ficu
lty
wit
h p
iece
s of
m
eat
and
som
e ra
w v
eget
able
s. T
he
pat
ien
t an
d f
amil
y w
ere
give
n in
stru
ctio
ns
on p
rop
er f
eed
ing
tech
niq
ues
as
wel
l as
safe
ty
inst
ruct
ion
s on
eat
ing
soli
d f
ood
s. S
aman
tha
Tu
rner
, th
e sp
eech
th
erap
ist,
has
con
tact
ed D
r. G
ann
on w
ith
th
e af
orem
enti
oned
fi
nd
ings
.
S B A R
Spee
ch T
hera
py W
orks
heet
Last Update 9/12821
SD
r. G
anno
n, I
am S
aman
tha
Turn
er, a
spe
ech
ther
apis
t fro
m A
BC
Hom
e C
are.
I am
cal
ling
abou
t Mrs
. Sar
ah
Ada
ms
who
is h
avin
g di
fficu
lty s
wal
low
ing
solid
food
s.
BM
rs. A
dam
s is
you
r 74-
year
-old
pat
ient
who
had
a C
VA
7
wee
ks a
go.
She
had
som
e re
sidu
al m
ild w
eakn
ess
of
right
sid
e fro
m th
e C
VA
. Rec
ently
she
dev
elop
ed
swal
low
ing
diffi
culti
es w
ith s
olid
food
s, s
uch
as m
eats
and
ra
w v
eget
able
s. N
o pr
oble
m w
ith li
quid
s. M
uscl
e to
ne o
f fa
ce a
nd th
roat
mus
cles
app
ear i
ntac
t and
WN
L. N
o ne
uro
abno
rmal
ities
incl
udin
g no
rmal
gag
refle
x.
Rea
d th
e sa
mpl
e sc
enar
io
insi
de a
nd c
ompl
ete
the
SBA
R. T
hen,
look
at t
he b
ack
pane
l for
a p
ossi
ble
exam
ple.
AM
rs. A
dam
s’ d
ysph
agia
may
be
obst
ruct
ive
in n
atur
e,
such
as
stric
ture
or a
par
tial m
echa
nica
l obs
truct
ion.
Req
uest
ing
a M
odifi
ed B
ariu
m S
wal
low
.
R Spee
ch T
hera
py W
orks
heet
Last Update 9/12822
SBA
R S
cena
rio
Re
ad
th
e f
oll
ow
ing
sce
na
rio
an
d t
he
n c
om
ple
te t
he
S
BA
R i
nd
ivid
ua
lly
or
in a
sm
all
gro
up
. D
iscu
ss y
ou
r S
BA
R w
ith
yo
ur
pa
rtn
er
or
you
r sm
all
gro
up
.
Med
ical
Soc
ial W
orke
r
Mrs
. Wh
ite
is a
72-
year
-old
wit
h C
HF
, dia
bete
s, H
TN
an
d r
enal
in
suff
icie
ncy
. C
urr
entl
y sh
e is
ord
ered
10
dif
fere
nt
med
icat
ion
s.T
he
nu
rse
feel
s th
e p
atie
nt
is n
on-c
omp
lian
t w
ith
her
m
edic
atio
ns,
an
d t
her
e is
ver
y li
ttle
foo
d in
th
e h
ome.
MSW
M
elis
sa S
tew
art’
s ev
alu
atio
n in
clu
des
: P
atie
nt
rece
ives
Soc
ial
Secu
rity
of
XX
dol
lars
a m
onth
. H
er e
xpen
ses
incl
ud
e re
nt,
u
tili
ties
, etc
. plu
s h
er a
pp
roxi
mat
ed m
edic
ine
co-p
aym
ents
are
m
ore
than
her
mon
thly
inco
me.
Pat
ien
t ad
mit
s th
at s
he
has
to
skip
med
icat
ion
s be
cau
se s
he
can
not
aff
ord
to
get
them
ref
ille
d.
Th
e M
SW f
ind
s th
e p
atie
nt
elig
ible
for
som
e of
th
e st
ate
and
co
mm
un
ity
pro
gram
s, s
ince
her
inco
me
is b
elow
pov
erty
leve
l. T
he
pat
ien
t is
inte
rest
ed in
ap
ply
ing
for
ben
efit
s. A
pp
rop
riat
e re
ferr
als
wil
l be
mad
e, b
ut
it w
ill t
ake
tim
e to
pro
cess
th
em.
Th
e M
SW c
alls
a c
ase
con
fere
nce
wit
h t
he
pri
mar
y n
urs
e. T
he
MSW
al
so c
onta
cts
the
ph
ysic
ian
to
ask
for
app
rop
riat
e p
aper
wor
k fo
r th
e st
ate
refe
rral
s an
d r
evie
ws
Mrs
. Wh
ite’
s m
edic
atio
n li
st f
or
the
pu
rpos
e of
red
uci
ng
or c
onso
lid
atin
g an
y of
her
med
icat
ion
s.
Th
e M
SW w
ill s
end
th
e ap
pro
pri
ate
stat
e p
aper
wor
k to
Dr.
G
ann
on, t
he
ph
ysic
ian
for
his
com
ple
tion
. A c
omp
lete
m
edic
atio
n li
st a
nd
th
e SB
AR
com
mu
nic
atio
n w
ill b
e fa
xed
to
Dr.
Gan
non
.
S B A R
Med
ical
Soc
ial W
orke
r Wor
kshe
et
Last Update 9/12823
SD
r. G
anno
n, I
am M
elis
sa S
tew
art,
the
med
ical
soc
ial
wor
ker f
rom
AB
C H
ome
Car
e. M
rs. W
hite
is n
ot ta
king
he
r med
icat
ions
cor
rect
ly a
nd is
hav
ing
finan
cial
di
fficu
lties
.
BS
he is
a 7
2-ye
ar-o
ld w
ith C
HF,
dia
bete
s, H
TN a
nd re
nal
insu
ffici
ency
. C
urre
ntly
she
is o
rder
ed 1
0 di
ffere
nt
med
icat
ions
. Her
Soc
ial S
ecur
ity in
com
e do
es n
ot m
eet
her m
onth
ly e
xpen
ses
(ren
t, ut
ilitie
s, m
edic
atio
n co
-pay
s,
etc.
) and
ther
e is
littl
e fo
od in
the
hom
e. S
he d
oes
mee
t th
e po
verty
leve
l for
som
e st
ate
and
com
mun
ity
prog
ram
s, b
ut it
will
take
tim
e to
mak
e re
ferr
als
and
be
appr
oved
.
Rea
d th
e sa
mpl
e sc
enar
io
insi
de a
nd c
ompl
ete
the
SBA
R. T
hen,
look
at t
he b
ack
pane
l for
a p
ossi
ble
exam
ple.
AM
rs. W
hite
is n
ot ta
king
her
med
icat
ions
as
orde
red
rela
ted
to fi
nanc
ial i
ssue
s. S
he d
oes
qual
ify fo
r med
ical
as
sist
ance
and
add
ition
al c
omm
unity
pro
gram
s to
whi
ch
she
is a
gree
able
.
Ple
ase
have
the
atta
ched
refe
rral
form
s co
mpl
eted
by
Dr.
Gan
non
as s
oon
as p
ossi
ble,
and
sen
d to
this
add
ress
(X
XX
) to
initi
ate
refe
rral
. D
r. G
anno
n w
ill n
eed
to re
view
he
r med
icat
ion
list (
atta
ched
) to
see
if an
y m
edic
atio
n re
duct
ion
or re
conc
iliat
ions
cou
ld o
ccur
to a
ssis
t with
fin
anci
al s
avin
gs w
hile
wai
ting
for r
efer
rals
to b
e pr
oces
sed.
R Med
ical
Soc
ial W
orke
r Wor
kshe
et
Last Update 9/12824
SBA
R S
cena
rio
Re
ad
th
e f
oll
ow
ing
sce
na
rio
an
d t
he
n c
om
ple
te t
he
S
BA
R i
nd
ivid
ua
lly
or
in a
sm
all
gro
up
. D
iscu
ss y
ou
r S
BA
R w
ith
yo
ur
pa
rtn
er
or
you
r sm
all
gro
up
.
Hom
e H
ealth
Aid
e
Hel
en t
he
hom
e h
ealt
h a
ide
visi
ts M
rs. E
lmer
tw
ice
a w
eek
for
bath
ing.
Wh
en H
elen
ass
ists
Mrs
. Elm
er t
o th
e ba
thro
om t
oday
, sh
e n
otic
es t
hat
th
e p
atie
nt
beca
me
incr
easi
ngl
y sh
ort
of b
reat
h.
Wh
en H
elen
ask
s M
rs. E
lmer
abo
ut
her
incr
ease
in h
er
shor
tnes
s of
bre
ath
, Mrs
. Elm
er r
esp
ond
ed b
y sa
yin
g th
at it
st
arte
d la
st n
igh
t. T
his
mor
nin
g w
hen
sh
e w
eigh
ed h
erse
lf s
he
not
iced
th
at s
he
was
2 lb
s h
eavi
er. H
elen
sat
Mrs
. Elm
er o
n t
he
chai
r an
d c
alle
d T
amm
y, t
he
pat
ien
t’s
pri
mar
y n
urs
e to
fin
d o
ut
wh
at s
he
shou
ld d
o.
S B A R
Hom
e H
ealth
Aid
e W
orks
heet
Last Update 9/12825
SH
i Tam
my
(nur
se) t
his
is H
elen
Ada
ms
the
hom
e he
alth
ai
de.
I am
at M
rs. E
lmer
’s h
ouse
and
she
is e
xper
ienc
ing
mor
e sh
ortn
ess
of b
reat
h (S
OB
) whe
n w
alki
ng to
day.
BW
hen
I wal
ked
Mrs
. Elm
er to
the
bath
room
for h
er b
ath
she
had
SO
B th
an s
he d
idn’
t hav
e on
Mon
day
(toda
y is
W
edne
sday
). M
rs. E
lmer
als
o ve
rbal
ized
that
she
wei
ghs
2 lb
s m
ore
than
yes
terd
ay. I
als
o no
ticed
that
her
ank
les
are
swol
len.
If I
pres
s on
the
swol
len
area
and
rem
ove
my
finge
r you
can
see
the
inde
ntat
ion.
Rea
d th
e sa
mpl
e sc
enar
io
insi
de a
nd c
ompl
ete
the
SBA
R. T
hen,
look
at t
he b
ack
pane
l for
a p
ossi
ble
exam
ple.
AI t
hink
that
it is
her
Con
gest
ive
Hea
rt Fa
ilure
(CH
F) a
gain
.
RI t
hink
that
you
nee
d to
see
Mrs
. Elm
er.
Hom
e H
ealth
Aid
e W
orks
heet
Last Update 9/12826
ReferencesLeonard, M., Bonacum, D., Taggart, B. 2006. Using SBAR to Improve Communication Between Caregivers. Institute for Healthcare Improvement.
Leonard, M. 2006. The SBAR Technique: Improving Verbal Communication and Teamwork in Clinical Care. PONL Bulletin, 2(1).
Leonard, M., Graham, S., Bonacum, D. 2004. The Human Factor: The Critical Importance of Teamwork and Communication in Providing Self Care. Qual Saf Heath Care 2004, 13:i85-i90. BMJ Publishing Group Ltd. and Institute for Healthcare Improvement.
Maison, D. 2006. The Interdisciplinary Team Perspective. Effective Communications Are More Important Than Ever, A Physician’s Perspective. Home Healthcare Nurse, 24(3). http://www.homehealthcarenurseonline.com.
Nunes, J. 2005. Patient Safety Leadership Fellowship Learnings Help Put Theory into Practice. A Newsletter from the National Patient Safety Foundation. 8(3). http://www.npsf.org.
Quality Insights of Pennsylvania. 2006. Organizational Culture – The Path Through the Woods.
Sentinel Events Statistics – March 31, 2006. 2006. Joint Commission on Accreditation of Healthcare Organizations. http://www.jointcommission.org/SentinelEvents/Statistics.
Whittington, J., Nagamine, J. 2006. SBAR: Application and Critical Success Factors of Implementation. Institute for Healthcare Improvement.
Last Update 9/12827
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