SBAR Handover Checklist Copie

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Instructions

• This is a tool to allow observers to give feedback to colleagues on their use of the SBAR model structured communication in patient handover.
  
  

• SBAR Reporting

  

Patient Handover/ Information Gathering

• Assesses the patient using an ABCDE approach

  Yes

  Partially

  No

  N/A

• Checks the admitting diagnosis

  Yes

  Partially

  No

  N/A

• Has appropriate documentation (e.g. Nursing, medical records, EWS chart, Drug chart, Observation chart, IV fluids, resuscitation status)

  Yes

  Partially

  No

  N/A

• Collects the patient's vital signs pre and post treatment and takes relevant notes to the phone

  Yes

  Partially

  No

  N/A

• On making the phone call states " This is an SBAR call"

  Yes

  Partially

  No

  N/A

Escalation Handover call - 'S' for Situation

• Gives own name, role and ward

  Yes

  Partially

  No

  N/A

• Identifies patient for handover

  Yes

  Partially

  No

  N/A

• Explains reason for calling and headlines any concerns

  Yes

  Partially

  No

  N/A

Escalation Handover Call - 'B' for Background

• Gives admitting diagnosis and date

  Yes

  Partially

  No

  N/A

• Provides relevant medical history

  Yes

  Partially

  No

  N/A

• Reports any changes in patient condition and gives time frame

  Yes

  Partially

  No

  N/A

• Gives a brief summary of treatment to date

  Yes

  Partially

  No

  N/A

Escalation Handover Call - 'A' for Assessment

• Says clearly what he/she thinks the problem is

  Yes

  Partially

  No

  N/A

• Gives all relevant details of Airway, Breathing, Circulation, Disability, Exposure, EWS (ABCDE )

  Yes

  Partially

  No

  N/A

Escalation Handover Call - 'R' for Recommendation & Review

• States clearly the request (e.g. "I need you to come now")

  Yes

  Partially

  No

  N/A

• Checks that receiver has understood details of call

  Yes

  Partially

  No

  N/A

• Determines timescale for review and records name of receiver

  Yes

  Partially

  No

  N/A

• Is assertive. (e.g. if timescale for review is too long asks insists on urgency or for alternative contact)

  Yes

  Partially

  No

  N/A

• Asks if something should be done now while waiting for review/help

  Yes

  Partially

  No

  N/A

Overall Rating of Handover

• Taking completeness, structure and clarity of English expression this handover was:

  Very Effective

  Effective

  Fair

  Ineffective

  Very ineffective

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