NCLEX Care Coordination: SBAR, Handoff & Discharge

bolt The 60-second version

check_circleSBAR: Situation, Background, Assessment, Recommendation — a structured way to report to a provider.
check_circleHandoff should be structured, include current status, pending results, and concerns, and allow questions; bedside handoff involves the client.
check_circleUse the chain of command when a concern about client safety is not resolved (for example, an unsafe order the provider will not change).
check_circleRefer to the right discipline: social work for resources and placement, physical therapy for mobility, occupational therapy for daily living skills, dietitian for nutrition, case manager for coordination.
check_circleDischarge planning starts at admission and includes teaching with teach-back, medication reconciliation, follow-up, and home needs.
check_circleVerbal orders are limited to urgent situations; read back the order and document it per policy.

target What you'll be able to do · aligned to NCLEX-RN Test Plan · Management of Care

MGMT CAREReport a client concern using SBAR.
MGMT CAREGive a structured handoff and escalate unresolved safety concerns.
MGMT CARERefer clients to the appropriate member of the interprofessional team.
MGMT CAREPlan a safe discharge with teaching and follow-up.

SBAR and reporting to providers

A clear report gets the right action faster.

SBAR. Have the chart, vital signs, medications, and recent labs ready before calling.

SBAR part	Example (client with possible sepsis)
Situation	"Mr. L in room 12 has a new temperature of 102.4°F and BP 88/50."
Background	"He is day 2 after bowel surgery and has a urinary catheter."
Assessment	"HR 118, lactate pending, he is newly confused. I am concerned about sepsis."
Recommendation	"I am requesting you evaluate him now and order cultures and fluids."

Read back verbal or telephone orders and test results to confirm accuracy.

Handoff and the chain of command

Most communication failures happen at transitions.

Give handoff in a structured format, ideally at the bedside, with time for questions.
Include code status, allergies, recent changes, pending tests, lines and drains, and safety risks.
If an order seems unsafe, clarify it with the prescriber; if unresolved, follow the chain of command (charge nurse, nurse manager, supervisor or medical director).
Never carry out an order you believe is unsafe; document the attempts to clarify.

Chain of command. Rapid response teams are called for acute deterioration without waiting for the chain of command.

Referrals and the interprofessional team

Matching needs to the right team member is a frequent question.

Client need	Refer to
Insurance, finances, placement, community resources	Social worker or case manager
Walking, strength, transfer training, assistive devices	Physical therapist
Dressing, bathing, feeding skills, adaptive equipment	Occupational therapist
Swallowing evaluation, communication after stroke	Speech-language pathologist
Therapeutic diet, tube-feeding plan, weight loss	Registered dietitian
Spiritual needs	Chaplain or the client's faith leader

Case managers coordinate care across settings and payers.

Discharge planning

Safe discharge depends on preparation that starts on day one.

Discharge. Report concerns that make discharge unsafe to the provider and case manager.

NGN-style case

Escalation and referral together.

functions Clinical judgment case — the unsafe order

A provider orders a medication dose the nurse calculates as 10 times the usual range. The provider says to give it as written. What should the nurse do?

Recognize cues: dose far outside the safe range.
Analyze: potentially harmful order.
Do not give the medication; the nurse is accountable for administering a harmful order.
Contact the pharmacist and follow the chain of command; document clarification attempts.

Answer. Withhold the medication, consult the pharmacist, and escalate through the chain of command while documenting.

Next in the roadmap

Infection Control

arrow_forward

quiz Test yourself