Urinalysis and UTIs: Improving Care. [Name] [Organization]. Agenda. Background and Purpose Suspected Urinary Tract Infection Situation Background Assessment and Recommendation Form (UTI SBAR form) Using the UTI SBAR form Next Steps. Overview. UTI SBAR form:
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S – Situation: A concise statement of the problem (what is going on now).
B – Background: Pertinent and brief information related to the situation (what has happened).
A – Assessment: Analysis and consideration of options (what you found/think is going on).
R – Recommendation: Request/recommend action (what you want done).
Suspected UTI SBAR
ABC Nursing Home
123 First Street
Hello, KS 12345 Facility Phone/Fax ____________________
Resident Name _______________________Date of Birth__________________________
Physician/NP/PA ______________________ Physician/NP/PA phone/fax _____________
Nurse ______________________________ _Date/Time ___________________________
How was information provided to clinician?: □ Phone □ Fax □ In Person □ Other _______
S – Situation (Use this information to complete Section A&R)
Current Assessment (check all that apply):
Vital Signs: BP _______/________ Pulse ____________ Resp. rate ___________ Temp. ___________
Resident complaints (check all that apply):
Recent Urinalysis Results (within the last 10 days) If Available:
UA results that were obtained on ___________ (date) due to _______________________ (reason).
The results accompanying this communication are as follows:
B – Background
Indwelling catheter:NO YES
Incontinence: NO YES
If yes, is this new/worsening?NO YES
Advance directives for limiting treatment (especially antibiotics): NO YES
Medication allergies: NO YES
The resident is on: Warfarin (Coumadin™) NO YES
The resident is diabetic: NO YES
CLINICIANS ONLY NEED TO FAX BACK THIS PAGE
Nursing Home Name _________Facility FAX#__________
Resident Name ______________DOB:________________
A – Assessment(check boxes and determine recommendation)
A – Assessment (check boxes and determine recommendation)
How were orders received from clinician? Phone Fax In Person Other
Would you like to initiate any of the following?
Physician/NP/PA Orders: (continued)
Telephone order received by date/time
Family/POA notified (name)