SBAR Examples: Nursing Handoffs and Escalation Scenarios

SBAR stands for Situation, Background, Assessment and Recommendation—or Request. A useful SBAR tells the receiver what matters now, why it matters, what you have assessed and what you need them to do. The conversation continues until the next action and responsibility are clear. AHRQ TeamSTEPPS: SBAR

Explore three nursing SBAR examples: an urgent change in condition, a shift handoff and a medication/allergy discrepancy. Each includes source facts, a spoken message and a receiver response. Examples are fictional. RN/clinical educator review: pending. Sources checked October 19, 2026.

For immediate danger, use the local emergency response pathway without waiting to finish an SBAR or receive a routine callback. Use your unit's response criteria; the example timings are specific to each scenario.

A quick SBAR handoff example

Start with this shift handoff, then see SB-02 below for its source facts and explanation.

S — Situation: “I'm Elena, RN, handing over Morgan Lee, SB-102, at 19:00. Pain reassessment and physiotherapy review are still due.”

B — Background: “Morgan is day two after knee surgery. The current plan is one-person assistance with a walker. Prescribed analgesia was given at 18:30 and recorded in the MAR.”

A — Assessment: “At 18:40, Morgan reported pain 3/10 at rest and was alert and conversing. Physiotherapy has not reviewed Morgan; independent walking is not cleared.”

R — Request: “Nora, please reassess pain at 19:15 and check physiotherapy at 19:30. If the therapist has not arrived then, contact therapy and the charge nurse. Escalate worsening symptoms sooner through the clinical pathway. Can you confirm?”

Receiver and confirmation: Nora accepts care, repeats the 19:15 reassessment, 19:30 therapy check and backup route, and confirms the assisted-mobility plan remains in place. Elena confirms the summary. The reassessment and therapy review remain outstanding.

What to put in each SBAR section

AHRQ's framework makes room for both an interpretation and an explicit request. Assessment is more than reading numbers; Recommendation is more than “just letting you know.” Introduce yourself, verify the patient and choose the relevant facts for the receiver. AHRQ SBAR guidance

Before speaking

Open the correct encounter and use the organization's approved patient identifiers. Have relevant observations, their times, allergies, recent medication administration and the current plan available. Say which information comes from your assessment, the patient, another staff member or an earlier record. A copied value without its time may describe yesterday rather than this moment.

Preparation should support care, not postpone it. If you cannot obtain a measurement, say it is unavailable and communicate the concern you can establish. Do not fill an empty field with “normal,” “none” or an invented number to make the report sound complete.

These examples focus on the communication exchange. For organizing a longitudinal nursing entry, see the SOAP nursing note guide; for broader nursing-record requirements, see nursing notes and documentation.

Example 1: urgent change in condition

SB-01 source packet

• Patient: Alex Rowan, training record SB-101, on the surgical ward after hip surgery yesterday. Identity has been checked against the record and wristband.
• Earlier assessment: at 08:00, respiratory rate 18/minute and oxygen saturation 96% on room air; speaking comfortably.
• Current assessment at 09:10: respiratory rate 30/minute, oxygen saturation 88% on room air and pulse 118/minute. New difficulty speaking in full sentences.
• Completed action: the nurse activated the ward's emergency response pathway at 09:10. A colleague is contacting the response team while the nurse stays with Alex.
• Nursing concern and request: acute respiratory deterioration of uncertain cause; immediate bedside assessment. No additional treatment or diagnostic result is supplied.

SB-01: the escalation message

S: “This is Priya Sen, RN, on the surgical ward, calling about Alex Rowan, record SB-101. Alex has new breathing difficulty and needs immediate bedside assessment. I have activated our emergency response pathway.”

B: “Alex had hip surgery yesterday. At 08:00, respiratory rate was 18 and oxygen saturation was 96% on room air, with comfortable speech.”

A: “At 09:10, respiratory rate is 30, saturation is 88% on room air and pulse is 118. Alex is having difficulty speaking in full sentences. I am concerned about acute respiratory deterioration; the cause is not established.”

R: “Please assess Alex at the bedside now. I am staying with the patient, and my colleague is contacting the response team. Confirm that you are responding and who is leading the immediate review.”

The receiver's response and check-back

Response and arrival: at 09:11, Dr. Dev Shah replies, “I am coming now and will lead the bedside review with the response team.” Priya repeats that response and Dr. Shah confirms it. Dr. Shah arrives at 09:13; the subsequent assessment and actions are recorded separately.

The three-part exchange—message, receiver's repeat or acknowledgment, sender's confirmation—makes the shared understanding explicit. AHRQ calls this a check-back. “Sent” or “delivered” on a screen is not the same exchange. AHRQ check-back guidance

Why this example works

The opening conveys urgency before background. The assessment compares the same measurement conditions at two times. It states a clinical concern without inventing a cause, and distinguishes the emergency pathway already activated from a bedside assessment still requested. “Coming now” is recorded at 09:11; “arrived” belongs to 09:13. Neither statement establishes that a treatment has been administered.

Continue the assessment, care and escalation required by the local pathway while communicating.

Example 2: nurse-to-nurse shift handoff

SB-02 source packet

• Patient and handoff: Morgan Lee, training record SB-102. Outgoing RN Elena Brooks hands over to RN Nora Patel at 19:00 after identity verification.
• Context: postoperative day two after knee surgery. The current mobility plan specifies one-person assistance with a walker; independent mobilization has not been cleared.
• Current information: at 18:40, Morgan reports pain 3/10 at rest and is alert and conversing. The 18:30 prescribed analgesic administration is recorded in the medication administration record (MAR).
• Existing plan: reassess pain at 19:15. Physiotherapy review is scheduled for 19:30 but has not happened. If the therapist has not arrived by 19:30, Nora is to contact the therapy service and charge nurse to arrange coverage. Worsening symptoms require the unit's clinical escalation route rather than waiting for that appointment.
• Open work: the reassessment, physiotherapy review and any resulting mobility-plan update remain outstanding.

SB-02: the shift-handoff message

S: “I am Elena, handing over Morgan Lee, SB-102, to you at 19:00. The priorities are the 19:15 pain reassessment and the pending physiotherapy review.”

B: “Morgan is day two after knee surgery. The current plan is one-person assistance with a walker. The prescribed analgesic was administered at 18:30 and is recorded in the MAR.”

A: “At 18:40, Morgan reported pain 3/10 at rest and was alert and conversing. The post-medication reassessment is still due. Physiotherapy has not reviewed Morgan, so independent mobilization has not been cleared.”

R: “Please take over the 19:15 reassessment and check for the 19:30 physiotherapy review. If the therapist has not arrived at 19:30, contact the therapy service and charge nurse for coverage. Use the clinical escalation route sooner for worsening symptoms. Can you confirm those tasks?”

Acceptance is a separate event

Accepted handoff: Nora says, “I accept Morgan's care now. I will reassess pain at 19:15 and check physiotherapy at 19:30. If they have not arrived then, I will contact therapy and the charge nurse. The current assisted-mobility plan stays in place until it is updated.” Elena confirms that summary; Nora asks where the current mobility plan is recorded, and they open it together.

AHRQ describes handoff as transferring responsibility as well as information, with acknowledgment and an opportunity for questions. A message left for the incoming nurse is not equivalent to that accepted exchange. AHRQ handoff guidance

This is the priority portion of a shift report. Complete the unit's full handoff with current observations, allergies, lines, medicines and care preferences, using the linked source records for detail.

Example 3: medication and allergy discrepancy

SB-03 source packet

• Patient: Taylor Chen, training record SB-103; identity verified.
• Conflict at 10:30: the transfer summary says “no known allergies.” Taylor reports hives after amoxicillin in childhood. The receiving record has not yet reconciled that report.
• Medication state: an amoxicillin order is pending its first scheduled administration; no dose has been administered. Under the unit's medication-safety process, the nurse pauses that administration workflow and contacts the prescriber and pharmacist for clarification.
• Assessment: the records conflict. The reaction is patient-reported; its mechanism and clinical significance have not been independently established in this exercise.
• Request: reconcile the allergy information and obtain a prescriber decision before administering the pending medicine.

SB-03: the clarification request

S: “This is Mateo Ruiz, RN, calling about Taylor Chen, SB-103. I need a medication and allergy discrepancy resolved before the pending amoxicillin administration.”

B: “The transfer summary says no known allergies, but Taylor reports childhood hives after amoxicillin. That report has not been reconciled in the receiving record.”

A: “We have conflicting allergy information. No amoxicillin has been administered. I have paused the administration workflow under our medication-safety process and contacted pharmacy.”

R: “Please review the reported reaction, clarify the medication plan and confirm the order state. Who will complete the allergy reconciliation?”

Follow the decision into the record

Prescriber's decision: at 10:35, Dr. Lina Park instructs that the pending amoxicillin order be discontinued and assigns herself the clinical allergy review with pharmacy. No replacement medicine is ordered in this source packet. Mateo reads back the decision and Dr. Park confirms it.

At 10:37, Mateo verifies that the order is discontinued and records Taylor's report with its source and unresolved verification status. Dr. Park's allergy review remains open. The handoff should not say “allergy confirmed,” “alternative started” or “reconciliation complete.” Each would convert an unfinished action into a completed event.

The useful outcome is not a more polished paragraph. It is agreement about the pending medicine, a visible patient-reported reaction, a named review owner and a medication record consistent with the supplied decision. This is the same distinction between connected records explored in the medical chart guide.

When the first request does not resolve the concern

Consider an alternate branch of SB-01, not an event that happened after Dr. Shah arrived: the initial recipient says, “Leave it for routine rounds,” without addressing the new respiratory findings. The nurse must make the unresolved concern and required response explicit.

“I am concerned because Alex's breathing and oxygen saturation have changed markedly since 08:00. I am not comfortable waiting for routine rounds. This is a patient-safety concern; immediate bedside assessment is still needed. I have activated the emergency response pathway and am contacting the next designated responder and charge nurse.”

AHRQ's CUS tool uses concern, discomfort and a safety statement to make a risk unmistakable. Its Two-Challenge Rule supports restating an ignored concern and escalating through the chain of command when the response remains inadequate. These are tools for speaking up, not a requirement to wait through two unanswered messages in an emergency. The receiver also has a duty to acknowledge and address the concern. AHRQ CUS · AHRQ Two-Challenge Rule

For a non-emergency request, establish the expected response time and backup contact under the unit's process. If an agreed response does not occur, communicate the outstanding request and current condition to that backup. Document contact attempts as attempts, identify any actual response, and keep the work open until someone accepts it.

A blank SBAR template

Copy the blank worksheet into your approved documentation workspace and fill in the findings and events from the encounter. Use fictional information for training.

SBAR COMMUNICATION WORKSHEET

IDENTITY AND CHANNEL
Date/time of communication: [ ]
Sender name, role, unit and callback route: [ ]
Receiver name and role: [ ]
Verified patient identifiers and encounter: [ ]
Communication channel: [ ]

S — SITUATION
Current problem/change and urgency: [ ]

B — BACKGROUND
Relevant history, baseline and current plan: [ ]
Pertinent medicines/allergies and their sources: [ ]
Recent actions and times: [ ]

A — ASSESSMENT
Current findings, times and trend: [ ]
Source of reported information: [ ]
Nursing concern, uncertainty or missing information: [ ]

R — REQUEST
Specific action or decision requested: [ ]
Requested timing and proposed owner: [ ]
Clarification needed: [ ]

ACTUAL RESPONSE — complete after the reply
Reply time, responding person's name/role and actual response: [ ]
No reply yet? Record contact attempts, not an assumed response: [ ]

CONFIRMATION
What was repeated back; corrections or questions: [ ]
Who confirmed the shared plan and when: [ ]

ACCEPTED RESPONSIBILITY — not just a proposed owner
Person accepting care/task, exact responsibility and acceptance time: [ ]
Agreed action/review time and outstanding work: [ ]

BACKUP AND ESCALATION
Agreed contingency, trigger and contact route under local policy: [ ]
Actual escalation attempts and responses, with times: [ ]

SUBSEQUENT OUTCOME — complete only after the event
What actually happened, when and who performed/reported it: [ ]
Reassessment findings and source: [ ]
What remains open; next owner and review time: [ ]

Recorded by (name/role) and entry date/time: [ ]

Use approved patient identifiers and local escalation routes.
Activate emergency help without waiting to finish this worksheet.
Record requested, accepted and completed actions separately.
RN/clinical educator review: pending.

The response, accepted responsibility and subsequent outcome sit outside the four-letter message because they are new information. Leave those fields unfilled until the events occur. In a rehearsal, have the receiver deliberately repeat one time or task incorrectly; the sender should notice and correct it before both confirm the plan.

Practice: find the gap in a handoff

Use the SB-02 facts above. Compare these two statements before opening the review:

Draft A: “Morgan is comfortable after medication. Physio has cleared independent walking. Continue routine care; handover completed.”

Draft B: “Morgan reported pain 3/10 at 18:40 after medication at 18:30. Physiotherapy has not yet reviewed Morgan.”

Draft B sounds more reliable. Is it enough for Nora to take over the outstanding work?

A practical review checklist

For each rehearsal, mark present, missing or needs clarification, and point to the exact words supporting the finding. Review each finding and its supporting words rather than totaling checked boxes.

• Identity: are sender, receiver, patient and encounter unambiguous?
• Situation: can the receiver tell why this communication is happening now?
• Background: are the selected facts relevant, attributed and dated where needed?
• Assessment: are findings distinguished from interpretation and uncertainty?
• Request: is there a specific action rather than only a notification?
• Timing and ownership: are the expected response, assigned work and backup clear?
• Confirmation: did the receiver accept or clarify the request, and did the sender check the reply?
• Record: does the saved entry distinguish requested, accepted and completed actions?

A clinical educator can observe both participants, not just grade the sender's script. For SB-02, success includes Nora asking about an unclear mobility instruction and Elena answering it. Silence or a generic “okay” gives less evidence that the receiver understood the two different deadlines.

Document the response, not just the call

“Doctor aware” leaves the reader unable to reconstruct what was raised or agreed. Record the concern, relevant findings and times, person contacted, request, response, escalation, assigned work and subsequent outcome. Keep “called,” “acknowledged,” “arrived” and “completed” separate.

For SB-01, the communication entry could read:

09:10 — New breathing difficulty with respiratory rate 30/minute, oxygen saturation 88% on room air and pulse 118/minute; difficulty speaking in full sentences. Emergency response pathway activated. Stayed with patient; colleague contacted response team. At 09:11, Dr. Dev Shah contacted with current and 08:00 findings; immediate bedside assessment requested. Dr. Shah stated he was coming now to lead review with the response team. Response repeated back and confirmed. Dr. Shah arrived at 09:13. Subsequent assessment and actions recorded in the continuing care entry. — Priya Sen, RN.

In British Columbia, BCCNM's documentation standard explicitly includes escalated concerns, the contacted professional's name/title and response, and prohibits documenting care before it is given. BCCNM documentation standard, in force April 1, 2026

An EHR template can help retain these fields, but a saved SBAR does not itself deliver the request or transfer responsibility. Keep sensitive details on approved communication channels, verify the recipient, and use a private setting for bedside or telephone discussion. Record patient and family contributions with attribution rather than treating them as observed findings. For a later correction, preserve the sequence using the medical documentation guide.

Evaluating software for nursing documentation? Explore Vero's nursing-note workflow against your organization's approved process. Review the draft, communicate through the appropriate clinical channel and confirm the receiver accepts the handoff.

Use SBAR alongside the unit's handoff standard

Some services use ISBAR, adding Identify before Situation. The Australian Aged Care Quality and Safety Commission lists this expanded format as a communication resource. Use your organization's approved version and patient identifiers; identity verification still matters when using four-letter SBAR.

SBAR is particularly useful for a focused concern or request. A full shift or service transfer also needs a shared approach to task lists, contingencies and acceptance. AHRQ's I-PASS tool explicitly addresses illness severity, patient summary, action list, situation awareness/contingencies and the receiver's synthesis. Follow the unit's chosen handoff protocol rather than substituting a short SBAR for required content. AHRQ I-PASS guidance

For local teaching, have an RN educator check role boundaries, escalation contacts, assessment language and required handoff fields. Rehearse the actual phone, messaging or bedside route, including an unavailable receiver and a misunderstood request.

For transitions beyond a shift, the discharge summary guide covers another part of the same problem: passing on the current plan without losing unfinished work.

Sources and further reading

• AHRQ TeamSTEPPS: SBAR
• AHRQ: check-back and repeat-back
• AHRQ: handoff and responsibility transfer
• AHRQ: CUS
• AHRQ: Two-Challenge Rule
• AHRQ: I-PASS
• Australian Aged Care Quality and Safety Commission: ISBAR — Identify, Situation, Background, Assessment and Recommendation
• BCCNM: nursing documentation standard