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NURSE BRAIN SHEET – TELEMETRY UNIT SBAR
     Patient
name













































































Age
                                               allergies
                                      Physician

S
   Room
number






























































Admit
date
                                                                                                        Attending

                                                                                                                                                  Code
status


     1
Dx











































































2
Dx
                                                                                                        Consultants

                                                                                                                                                  Advanced
directive
on

     C/O
                                                                                                                                         chart?
                                         Pgr/#


     History
                                                                                                                                                       Isolation







Core
Measures

B
   Surgery:




























Surgeon








































                                                                          Restraints





CHF

MI

PNA


     Anesthesia

























Anesthesiologist


































EBL
                                                                    Fall
risk




Vaccine‐
PNA

Flu


     Cardiac:

BP/HR/Peripheral
pulses/Edema/Heart
sounds
                                                                                                          Pain/sedation

A
   Current
rhythm
                                                                                                                                                Pain
scale


     Daily
wt?
                                                                                                                                                     Location


                                                                                                                                                                    Meds
type
and
last
dose

     DVT
prophylaxis


     Pulmonary:

Breath
sounds/Secretions/
SpO2/UPAs/PIP/
                                                                 Vent/bipap
etc
                          Accu
checks





















A1C

     Spontaneous
VT
&
VE

                                                                                                                           settings
                                Frequency


                                                                                                                                                                    Last
Results


     GI




































NG/OGT
                                      
                                                                          Skin













































































                                                                                                                                                                    Wounds/Drainage

     BS






































Last
BM
                                    Diet



































GI
Prophylaxis

                                                                                                                                                                    Staples











































































                                                                                                                                                                    Drains

     GU


Foley/void

                                                                                                                                                                    Location

     Output

                                                                                                                                                                    Ducub
photo
on
admission


     IV





























































Date
inserted
                                                                                 Psych
Social


     Fluids





















































Gtts





































































     Meds
                                                                                                                                                          Pending
orders





     Na
            Cl
               Bun
            gluc
           mg
              BNP
                    Coags
                      




Hct














 UA
                            CT


                                                                                                               INR
                        W













Pl




                                 CXR

     K
             Co
               Cr
             Ca
             Phos
            DDimer
                                                                      Cultures


                                                                                                              PTT
                        



                                                   MRI



    Cardiac
enz
                     1



















2

















3
                               Next
lab
                   





Hgb
                                             Echo



    DC
Plan.
Is
pt
informed
of
plan___
24
hour
orders
reviewed____
                                                                                                Shift
goals

R


                                                                                                                                                                   


                                                                                                                                                                    




                                                                                                                                                                                                 



                                                                                                                                                                                                                                                   


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Nurse brain sheet_telemetry_unit_sbar

  • 1. NURSE BRAIN SHEET – TELEMETRY UNIT SBAR Patient
name













































































Age
 allergies
 Physician
 S
 Room
number






























































Admit
date
 Attending
 Code
status

 1
Dx











































































2
Dx
 Consultants
 Advanced
directive
on
 C/O
 chart?
 Pgr/#
 History
 Isolation







Core
Measures
 B
 Surgery:




























Surgeon








































 Restraints





CHF

MI

PNA
 Anesthesia

























Anesthesiologist


































EBL
 Fall
risk




Vaccine‐
PNA

Flu
 Cardiac:

BP/HR/Peripheral
pulses/Edema/Heart
sounds
 Pain/sedation
 A
 Current
rhythm
 Pain
scale
 Daily
wt?
 Location
 Meds
type
and
last
dose
 DVT
prophylaxis
 Pulmonary:

Breath
sounds/Secretions/
SpO2/UPAs/PIP/
 Vent/bipap
etc
 Accu
checks





















A1C
 Spontaneous
VT
&
VE
 settings
 Frequency
 Last
Results
 GI




































NG/OGT
 
 Skin












































































 Wounds/Drainage
 BS






































Last
BM
 Diet



































GI
Prophylaxis
 Staples










































































 Drains
 GU


Foley/void
 Location
 Output
 Ducub
photo
on
admission
 IV





























































Date
inserted
 Psych
Social
 Fluids





















































Gtts


































































 Meds
 Pending
orders
 Na
 Cl
 Bun
 gluc
 mg
 BNP
 Coags
 




Hct














 UA
 CT
 INR
 W













Pl




 CXR
 K
 Co
 Cr
 Ca
 Phos
 DDimer
 Cultures
 
 PTT
 



 MRI
 
 Cardiac
enz
 1



















2

















3
 Next
lab
 





Hgb
 Echo
 
 DC
Plan.
Is
pt
informed
of
plan___
24
hour
orders
reviewed____
 Shift
goals
 R