1. Shalamar Institute of Health Sciences
Nurses Handover (SBAR)
Handed over by RN Received by RN Shift: M – E E – N N – M Date
Vitals
B.P:
Temp:
R/R:
P/R:
SpO2:
Intake
PO
NPO
NGT/NJT
Mother
Feed
Diet type
Free Fluid
Semi-solid
Soft
Regular
S Situation Mobility
Bed bound Out of bed
Complete bed rest Up to washroom
Up and about Chair bound
Encourage activities Walking with aids
Assistive devices
Specify if any
Breathing
Room air Oxygen Therapy
If on oxygen therapy
Breathing device:
Nasal cannula Face mask
Non Re-breather mask BIPEP/Vent
Flow rate
Coughing
Yes No
Cough type:
Dry Productive Hemopytsis
Drain
Yes No
If yes
Drain site Drain color
NGT NJT Peg tube
Purpose: Feeding Aspiration
Fecal Elimination Yes No
No. of times per shift
Stoma
Colostomy Ileostomy
Condition
Urinary Elimination
Self voiding Foleys catheter
External catheter Supra-pubic
Urostomy
Urine color I/O / ml
I/V Lines
Treatment
Surgery Conservative Other
Admitting Diagnosis
Presenting complaint/s
Surgery/Procedure
Code status : Full Code DNR:
B Background
Admission Related Information
Co-morbid: HTN DM IHD
Others
known Allergies
R Recommendation
A Assessment
Pending orders
Remarks
Patient condition
Stable High Intervention Critical
Orientation
Time oriented Place oriented
Person oriented GCS
Continous I/V fluid onflow
Fluid
Rate
Patient Name
MR #
Age Gender
Bed No.
I/V Line Site Insertion Date
Peripheral 1
Peripheral 2
CVC
