Long-Term Care (LTC) & SNF SBAR Template
Engineered specifically for post-acute care, skilled nursing, and assisted living staff communicating acute changes in resident status to on-call providers, medical directors, and hospital transfer teams.
Why Long-Term Care & SNF Communication Differs
In long-term care, physicians are rarely on-site 24/7. When a nurse contacts an on-call practitioner, the goal is often determining whether the resident can be safely diagnosed and managed in-facility or requires immediate 911 transfer. Key distinct factors include:
LTC / SNF SBAR Clinical Worksheet (Blank)
Standardized acute change in condition report for geriatric and post-acute nursing.
Identify primary acute trigger: unwitnessed fall, fever/hypothermia, acute lethargy/delirium, shortness of breath, or sudden refusal to eat.
• Primary Acute Change: ____________________________________________________________________
• Onset / Time First Observed: _____________________ Observed By: [ ] CNA [ ] Nurse [ ] Family
• Current Immediate Status: [ ] Stable in bed [ ] Acute distress [ ] Unresponsive [ ] Post-fall on floor
Primary admission diagnoses, baseline ADLs, cognitive baseline, recent medication changes, anticoagulation, and allergies.
• Primary Diagnoses: ________________________________________________________________________
• Baseline Functional Status: Ambulation: [ ] Indep [ ] Walker [ ] Wheelchair | Continence: [ ] Continent [ ] Incontinent
• Baseline Cognition: [ ] Alert & Oriented x4 [ ] Mild Dementia [ ] Severe Dementia [ ] Non-verbal
• Anticoagulant / Antiplatelet: [ ] None [ ] Eliquis [ ] Warfarin [ ] Aspirin [ ] Plavix
• Recent Antibiotic or Medication Changes in Last 14 Days: _______________________________________
Full vital signs, oxygenation, pain assessment, mental status shift (CAM delirium check), and point-of-care diagnostics.
• Vital Signs: BP: _____/_____ | HR: _____ | RR: _____ | Temp: _____°F | SpO2: _____% on [ ] RA [ ] ____L O2
• Blood Glucose: _____ mg/dL | Bladder Scan: _____ mL | Urine Dipstick: [ ] Leuk [ ] Nitrite
• Mental Status Shift: [ ] Acute confusion / Delirium [ ] Lethargic / difficult to arouse [ ] Unchanged from baseline
• Focused Physical Findings (Chest, Abdomen, Skin/Wound, Injury): _________________________________
Specific request for orders, mobile imaging, in-house lab collection, oral/IV antibiotics, or emergency department transfer.
• Recommended Level of Care: [ ] Manage in SNF with new orders [ ] Mobile X-Ray/Labs [ ] Transfer to Emergency Dept via 911
• Specific Orders Requested: __________________________________________________________________
• Next Assessment Schedule & Physician Callback Expectations: ________________________________
LTC Escalation Example: Acute Lethargy & Suspected Urosepsis
Scenario: An 82-year-old female skilled nursing resident with mild vascular dementia becomes acutely lethargic, hypotensive, and febrile during evening medication pass.
"Dr. Henderson, this is Elena, RN at Meadowbrook Skilled Nursing calling regarding resident Clara M., Room 208-B. Her POLST is DNR, but Do Hospitalize for medical management. She has experienced an acute change in condition over the last 3 hours: she is unable to stay awake for her evening meal, is unusually confused, and is febrile with new-onset hypotension."
"She is an 82-year-old resident with a history of mild vascular dementia, Type 2 Diabetes, recurrent UTIs, and hypertension. Baseline cognition is Alert & Oriented to person and place, able to converse and feed herself with setup. Current medications include Metformin 500 mg BID and Lisinopril 10 mg daily (held this evening). She takes Eliquis 2.5 mg BID. No known drug allergies. Her last oral intake was only 10% of lunch today."
"Current vital signs: BP 88/54 (baseline is 130/70), HR 106 bpm regular, Temp 101.8°F orally, RR 22 breaths/min, SpO2 94% on room air. Point-of-care blood glucose is 142 mg/dL. Her urine is cloudy, malodorous, and positive on dipstick for nitrites and large leukocyte esterase. Lungs are clear bilaterally; abdomen is soft with mild suprapubic discomfort on palpation. She is lethargic, opening eyes only to loud verbal stimulation, which is a marked departure from her baseline."
"Given the combination of fever, tachycardia, acute encephalopathy, and hypotension unresponsive to oral hydration, I am concerned for early urosepsis. I recommend immediate transfer to the local Emergency Department via 911 for IV fluids, blood cultures, and IV antibiotics. Her daughter, who is DPOA, has been notified and agrees with hospital evaluation. Would you like me to dispatch the ambulance and prepare the transfer packet?"
Available SBAR Formats
Choose the format that fits your clinical workflow or educational setting.
Authoritative Geriatric & Post-Acute Sources
- •INTERACT™ (Interventions to Reduce Acute Care Transfers): Evidence-based clinical communication tools and SBAR worksheets for nursing homes.
- •AMDA – The Society for Post-Acute and Long-Term Care Medicine: Clinical practice guidelines for acute condition changes and clinical escalation.
- •Centers for Medicare & Medicaid Services (CMS): State Operations Manual Appendix PP – Guidance to Surveyors for Long Term Care Facilities.