Home Health Nursing SBAR Template
Tailored for visiting registered nurses, physical therapists, and case managers communicating in-home clinical assessments, medication discrepancies, wound measurements, and safety hazards to primary care physicians.
Why Home Health SBAR Communication Differs
Unlike inpatient nurses who have immediate access to on-site labs, imaging, and rapid response teams, home health clinicians operate as independent evaluators in patients' living environments. Critical distinct elements include:
Home Health SBAR Clinical Worksheet (Blank)
Standardized layout for home visits, physician verbal order requests, and clinical updates.
Identify primary reason for physician outreach: worsening symptoms, medication reconciliation error, wound non-healing, or high fall risk.
• Primary In-Home Finding / Issue: ________________________________________________________________
• Date/Time of Home Visit: ________________________ Visit Type: [ ] Routine [ ] Urgent [ ] Post-Discharge
• Current Patient Status: [ ] Stable in home [ ] Decompensating [ ] High readmission risk
Hospital discharge date, primary homebound diagnosis, physical med check findings, caregiver support, and allergies.
• Primary Homebound Diagnoses: __________________________________________________________________
• Recent Hospitalization: Discharged on: _____________ for: _________________________________________
• Medication Reconciliation Findings: [ ] Discrepancy identified [ ] Omitted high-risk meds [ ] Duplicate therapy
• Caregiver / Support System: [ ] Lives alone [ ] Family caregiver present [ ] Paid aide
Vital signs, daily weight trend, wound measurements (cm), cardiopulmonary status, and environmental hazard check.
• In-Home Vitals: BP: _____/_____ | HR: _____ | RR: _____ | Temp: _____°F | SpO2: _____% on [ ] RA [ ] O2: ____L
• Weight Trend: Current: _____ lbs (Change: [ ] +____ lbs [ ] -____ lbs over last ____ days)
• Wound Assessment: Location: ____________ | Size: L: ____ cm x W: ____ cm x D: ____ cm | Drainage: ____________
• Home Environment & Safety: [ ] Fall hazards noted [ ] Inadequate food/refrigeration [ ] Safe environment
Specific request for verbal medication orders, outpatient lab orders, dressing order changes, physical therapy referral, or clinic visit.
• Requested Orders: [ ] Medication adjustment [ ] Mobile phlebotomy/lab order [ ] Wound dressing order [ ] PT/OT eval
• Specific Request: ____________________________________________________________________________
• Next Home Nursing Visit Scheduled: _____________________
Home Health Escalation Example: Heart Failure Decompensation & Med Confusion
Scenario: A visiting nurse performs a post-acute follow-up visit on a 71-year-old male recently discharged from the hospital with CHF exacerbation, discovering a 5 lb weight gain and confusion over two different diuretic prescriptions.
"Dr. Morales, this is Sarah, RN with CarePath Home Health calling regarding your patient Arthur G., DOB 04/12/1955. I am currently in his home for a post-discharge visit following his CHF hospitalization 4 days ago. He has gained 5 pounds over his discharge weight, has increased shortness of breath with mild exertion, and was taking the incorrect dose of his loop diuretic due to conflicting prescription bottles."
"He was discharged on Thursday for acute-on-chronic systolic heart failure (EF 35%). Discharge instructions increased his Furosemide to 40 mg PO BID. However, upon reviewing his medication bottles today, he was still taking an old bottle labeled Furosemide 20 mg once daily because the new 40 mg prescription was never filled at the retail pharmacy. He lives alone with once-weekly assistance from his daughter. Allergies: Penicillin (rash)."
"Current vital signs: BP 144/88, HR 84 bpm regular, RR 20 breaths/min, SpO2 93% on room air (discharge baseline was 96%). Weight today is 184.2 lbs compared to discharge dry weight of 179.0 lbs (a 5.2 lb gain). On exam, he has fine bilateral crackles in the lung bases and 2+ pitting bilateral ankle edema (baseline was trace). He denies chest pain or orthopnea. I have already contacted his retail pharmacy to arrange delivery of his correct Furosemide 40 mg tablets this afternoon."
"To prevent an emergency department readmission, I recommend a one-time order for an additional dose of Furosemide 40 mg PO today once delivered, and orders for a mobile phlebotomy BMP in 48 hours to monitor renal function and potassium. I will return to his home tomorrow morning to re-weigh him, assess lung sounds, and review pre-poured medication boxes with his daughter."
Available SBAR Formats
Choose the format that fits your clinical workflow or educational setting.
Authoritative Home Care & Community Nursing Sources
- •National Association for Home Care & Hospice (NAHC): Clinical communication standards and readmission reduction best practices.
- •Centers for Medicare & Medicaid Services (CMS): Home Health Quality Reporting Program (HH QRP) & OASIS Guidance Manual.
- •Institute for Healthcare Improvement (IHI): Reducing 30-day readmissions through standardized outpatient communication.