HAND OFF (SBAR)

To be used at shift change and during in – house patient transfers between departments.

SITUATION: Today’s date: ____________________

Patient Sticker Diagnosis: _______________________
Admit date: _____________________

BACKGROUND:
Medical history: Fall precautions:
Allergies: Restraints precautions:
Current treatments/interventions:

ASSESSMENTS:
Neuro: Last vital signs:
BP_________ HR _________ RR __________
Temp __________ Pain Scale ____________
Respiratory:

Abnormal lab:
Cardiac:

GI:
Imaging results:

Musculoskeletal:
Lines/fluids:

IV dressing:

RECOMMENDATIONS:

Goals:

Consultation:

Tests/Treatments:

Discharge needs:

Name & Signature

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