Postoperative Neurological Symptom SBAR Communication Form
Use this form to communicate and document postoperative neurological symptoms using the SBAR format.
Patient and Encounter Information
Patient initials or chart reference
Age group
*
Please Select
Neonate
Infant
Child
Adolescent
Adult
Older adult
Unit/Ward
*
Room/Bed number
*
Surgery/Procedure name
*
Date and time of surgery
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Date and time symptoms were first noticed
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
SBAR Clinical Communication Details
Situation: Current neurological symptom description
*
Situation: Symptom onset
*
Situation: Symptom progression
Situation: Severity
*
Mild
Moderate
Severe
Rapidly worsening
Other
Background: Relevant surgery details and baseline neurological status
*
Assessment: Observed findings
*
Orientation change
Pupil change
Weakness or drift
Speech change
Decreased consciousness
Sensory change
Headache
Nausea or vomiting
Seizure activity
Other
Recommendation: Requested next step
*
Immediate bedside evaluation
Urgent provider review
Stat imaging
Medication review or adjustment
Close monitoring
Transfer to higher level of care
Other
Recommendation: Urgency and specific request
*
Vital Signs, Escalation, and Follow-Up
Blood Pressure
Pulse
Respiratory Rate
Oxygen Saturation
Temperature
Pain Score
1
2
3
4
5
6
7
8
9
10
Who was notified/contacted?
Surgeon
Resident
Charge Nurse
Rapid Response Team
Other
Repeat Neuro Checks, Actions Taken, and Follow-Up Monitoring Plan
Submit Communication
Should be Empty: