Sbar Nursing Handoff Example Details

Pregnancy and childbirth can be intimidating, especially for first-time mothers. There are so many things to worry about – will the baby be healthy? Will I know how to care for it? What if something goes wrong? One way to help ease your mind is to create a perinatal sbar form. This document will track your progress through pregnancy and list any warning signs or concerns you should watch out for. Having this information readily available will help you feel more prepared for what lies ahead. If you experience any problems during your pregnancy, you can immediately consult your form and take appropriate action. Creating a perinatal sbar form is a great way to take control of your health and that of your child.

Listed here, you'll find quite a few information about perinatal sbar PDF. You might want to browse it just before writing the gaps.

QuestionAnswer
Form NamePerinatal Sbar
Form Length1 pages
Fillable?Yes
Fillable fields16
Avg. time to fill out3 min 27 sec
Other namessbar nursing handoff template, sbar template for non clinical issue, sbar handoff report sheet, ob sbar

Form Preview Example

 

 

 

Perinatal SBAR

 

Before Calling The Physician Or CNM

 

 

 

 

1. Assess the patient.

 

 

 

 

 

 

 

 

 

 

2. Read most recent notes.

 

 

 

A 30-60 Second Report

 

 

3. Have the chart in-hand.

 

 

 

 

 

 

 

 

 

SBAR Report

 

 

Obstetric Patients

 

Newborn/Pediatric Patients

 

Anesthesia Patients

 

 

Identify yourself and where you are calling

Identify yourself and where you are

GOAL: Anesthesiologist and

 

 

from

 

calling from

 

 

Obstetrician/CNM conversation

 

 

Patient’s name and reason for report

Baby Boy or Girl __________ and reason

 

 

 

 

 

All Red Cesarean Sections, Use “911”

 

 

Patient was admitted for:_____________

 

for report:

 

 

 

Situation

 

 

 

prefix for pagers

 

I am concerned about:

 

O Oxyhood use, icterus, etc.

 

 

 

 

 

 

Identify yourself and where you are

 

 

O

FHR

I am concerned about:

 

 

 

calling from

 

 

 

 

 

 

 

 

 

 

O

Contraction Pattern

 

O

Respirations, SaO2,

“I’m calling for Dr.________ for a

 

 

 

O Blood Pressure (give examples)

 

O

Temperature

 

 

 

 

 

[]Red []Yellow []Green C/S

 

 

 

O

Vaginal Bleeding, etc.

 

O

Blood Sugar

 

 

 

 

 

 

[]Epidural ___________________”

 

 

 

 

 

 

 

 

 

 

 

 

 

Gravida___ Para___ @___ weeks gestation

Baby born via []C/S (give reason for____)

Gravida__ Para__ @__ weeks gest.

 

 

OB or CNM attending ________________

[]NSVD []Forceps

[]Vacuum Extractor

Reason for C/S:________________

 

Background

Significant medical and obstetrical history

Apgar Score, any resuscitative measures

Significant medical and obstetrical

 

 

includes:____________________________

GBS Status and treatment prior to birth

 

history includes ______________

 

Problems with current pregnancy are______

Significant maternal history

NPO Status

 

 

Relate the complaints by the patient and the

Relate the physical assessment pertinent to

Does patient currently have a labor

 

 

 

pain level

 

the problem, especially any changes

 

epidural?

 

 

Maternal Vital Signs

Vital Signs are:

 

 

Vital Signs are:

 

 

FH=Variability, Baseline, Accelerations,

 

O Respiratory status, presences of

 

O

Maternal issues

 

 

 

Decelerations, Contraction Pattern

 

 

grunting, flaring, retractions?

 

O

Fetal issues

 

 

NICHD Language: see back of form.

 

O

TPR, SaO2

 

 

Contraction Pattern, VE, Current

 

Assessment

Significant Lab Values

 

O Blood glucose levels, feedings

labor status

 

Intrauterine Resuscitative Measures

O

Significant Lab Values

Significant Lab Values

 

Give your conclusions about the present

Give your conclusions about the present

Current status in preparation for OR

 

 

 

 

 

situation. Words like “might be” or “could

 

situation. Words like “might be” or

 

 

 

 

 

 

be” are helpful.

“could be” are helpful.

 

 

 

 

 

 

 

 

Clinical Impressions, Concerns

 

 

 

 

 

 

 

 

 

 

 

 

What I need from you is_______________

What I need from you is______________

What time can we be ready for you?

 

 

Be specific about a time frame

Be specific about a time frame

 

 

 

 

 

Suggestions for tests/treatments:

Suggestions for tests/treatments:

 

 

 

 

Recommendation

 

O Liver Function Studies, CMP, UA,

 

O IV, Antibiotics, Chest Xray,

 

 

 

 

 

 

Pitocin, Methergine, Magnesium

 

 

CBC, cBG’s, ABG’s, NPO if

 

 

 

 

 

 

Level, Coagulation Profile, KB,

 

 

significant resuscitative efforts,

 

 

 

 

 

 

 

Antibiotics, Brethine, etc.

 

 

etc.

 

 

 

 

 

 

 

Clarify orders, vital sign frequency, under

Clarify orders, vital sign frequency, under

 

 

 

 

 

 

what circumstances to call back,

 

what circumstances to call back,

 

 

 

 

U:\Redesign\SBAR Perinatal Nov2005.doc

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