Sbar Template For Pressure Ulcers
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1
2April 2011
MONTHLY SPOTLIGHT
SBAR: For Pressure Ulcers
S
Situation
Resident Name: ____________________________________________ Age:______ Admit Date: ___________________
Diagnosis/reason for admission: ________________________________________________________________________
Treatment plan: _____________________________________________________________________________________
B
Background
Past medical history: ___________________________________________________________________________________
Allergies: ____________________________________________________________________________________________
Diet type: __________________________________
G-tube feedings
TPN/PPN
Ostomy/drains
Foley
Medications: __________________________________________________________________________________________
A
Assessment
Pressure ulcer:
New
Worse
Location: ________________ Stage: ___________ Size: ______________________
Pressure ulcer Description: (tissue type, drainage, color, odor) ___________________________________________________
Redness
Warmth
Edema
Increased drainage
Purulent drainage
Increased pain
Current treatment of ulcer: ____________________________________________________________________________
Pt assessment: T:_____ P:_____ R:_____ B/P:_____ Wgt:_____ (last 3 wgt’s/date ___/_____ ___/_____ ___/_____)
Most resent Labs: WBC ___ Hgb ___ Glucose ___ Na+ ___ K+ ___ BUN ___ Creat. ___ Albumin ____
Completely immobile
Limited mobility
Fully mobile
Incontinent (bowel bladder both)
Impaired sensation
Alert/oriented
Confused
Lethargic/unresponsive
Contractures
Other________________________
Braden Score:_____
High risk
Moderate risk
Low risk
No risk
Prevention measures in place:__________________________________________________________________________
R
Recommendation
Pressure Ulcer Prevention Measures
Pressure Ulcer Management
Keep skin clean and dry
Avoid diaper/brief use
Ulcer treatment:_________________________________
Apply barrier cream to ___________ every ___ hours
Dressings (
): ________________
specify type and frequency
Special bed/mattress (
):______________________
________________________________________________
type
Turn and reposition resident every ______ hours
________________________________________________
Chair cushion (
):___________
Elbow protectors
Dietician/Nutrition consult
type
Float heels
Heel protectors/heel lift______________
Other Consults:_________________________________
Other:______________________________________________
Other:______________________________________________
_____________________________________________________
_____________________________________________________
______________________________________
_____________________________________________________
_________________________________
________________________________________________
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