Page 185 - CHHA Binder 2.3.20

4/11/2019

Example of SBAR (Situation, Background,
Assessment, Recommendation)

• Situation:
• Hello Dr. Smith. My name is Ana Smith. I am a Home Care Consultant from
VNSNY. I am at Mount Sinai Hospital and I have just met with your patient
Mr. Q and his wife to discuss the plan for Home Health Services ordered by
the referring physician Dr. Miller that include RN, PT and SW.
• Background:
• As you know, Mr. Q has a history of dementia, COPD and macular
degeneration and has 2 non-healing pressure ulcers. He has been in the
hospital 3 times in the last 8 months. This recent hospitalization is related
to a fall when trying to walk to the commode with his caregiver.
• Assessment:
• While meeting with the patient and family I observed Mr. Q to be alert and
oriented x 1, and his breakfast tray was largely untouched. The wife reports
that he rarely ambulates and needs assistance with all self-care. She
reports that her husband says he doesn’t want him to keep coming back to
the hospital, but isn’t sure what else to do. His Palliative Performance Scale
score is 40%, which combined with the overall picture indicates that the
patient may benefit from the Hospice level of care.

SBAR Example

Ask referring physician if prognosis and patient’s wishes regarding
goals of care have been discussed.

Recommendation: Would you be agreeable to discussing Hospice with
the patient and wife as an option?

• Refer to hospice if physician is in agreement AND patient
and wife are agreeable.
• If “not ready” for hospice, document need for social work
(SW) referral once patient is admitted

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