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NURSE BRAIN SHEET TELEMETRY UNIT SBAR

PatientnameAge

allergies

RoomnumberAdmitdate

Attending
Codestatus

1Dx2Dx

Advanceddirectiveon
chart?

C/O

B
A

Physician

Consultants
Pgr/#

History

IsolationCoreMeasures

Surgery:Surgeon

RestraintsCHFMIPNA

AnesthesiaAnesthesiologistEBL

FallriskVaccinePNAFlu

Cardiac:BP/HR/Peripheralpulses/Edema/Heartsounds

Pain/sedation

Currentrhythm

Painscale

Dailywt?

Location
Medstypeandlastdose

DVTprophylaxis
Pulmonary:Breathsounds/Secretions/SpO2/UPAs/PIP/
SpontaneousVT&VE

Vent/bipapetc

AccuchecksA1C

settings

Frequency
LastResults

GING/OGT

Skin
Wounds/Drainage

BSLastBM

DietGIProphylaxis

GUFoley/void

Staples
Drains
Location

Output

Ducubphotoonadmission
IVDateinserted

PsychSocial

FluidsGtts
Meds

Pendingorders

Na

Cl

Bun

gluc

mg

BNP

Co

Cr

Ca

Phos

DDimer

Coags

Hct UA

CT

INR

WPl

CXR

PTT

Nextlab

Hgb

Cardiacenz

DCPlan.Isptinformedofplan___24hourordersreviewed____

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Cultures

MRI
Echo

Shiftgoals