How to Use SBAR in Nursing Handover and MDT Communication

How to use SBAR in nursing handover is a practical question for students and nurses who must communicate patient information safely, briefly and accurately. SBAR organises a clinical message into Situation, Background, Assessment and Recommendation. This guide explains each stage, shows how to use the framework in nurse-to-nurse handover and multidisciplinary team (MDT) communication, and demonstrates how to escalate deterioration without replacing clinical judgement or local policy.

Effective handover is more than reading a list of observations. It transfers relevant information, responsibility and an agreed plan to the receiving professional. The Nursing and Midwifery Council (NMC, 2018; 2024) expects nurses to communicate effectively, keep colleagues informed and share information to reduce risk. Therefore, a strong SBAR nursing handover should be concise, person-centred, clinically reasoned and followed by confirmation that the receiver understands the required action.

What Is SBAR in Nursing Handover?

SBAR is a structured communication framework. It gives the sender and receiver a shared order for discussing a patient:

• Situation: What is happening now, and why are you communicating?
• Background: Which clinical history and context are relevant?
• Assessment: What have you observed, measured and concluded?
• Recommendation: What action, review or decision is required?

The Institute for Healthcare Improvement (IHI, 2026) describes SBAR as a concrete mechanism for framing conversations that require a clinician’s attention and action. Similarly, the Agency for Healthcare Research and Quality (AHRQ, 2023a) presents it as a widely used TeamSTEPPS communication tool. NHS England (2023a) also recognises structured approaches such as SBAR as useful for communicating safety-critical information, while cautioning that one structure should not be imposed on every interaction.

That limitation matters. SBAR in nursing handover improves organisation, but it does not decide which facts are clinically important. It cannot replace an assessment, emergency response, safeguarding procedure, documentation standard or local escalation pathway. Instead, it helps a nurse present sound clinical reasoning in a predictable sequence.

Why Use SBAR in Nursing Handover and MDT Communication?

Clinical teams often exchange information under time pressure. Without a shared structure, the speaker may start with an extended history, omit the current concern or finish without stating what response is needed. SBAR addresses this problem by placing the immediate issue first and ending with an explicit request.

A structured SBAR nursing handover can support:

• clear transfer of responsibility between shifts or services;
• rapid identification of a deteriorating patient;
• focused communication with doctors, pharmacists and other MDT members;
• prioritisation of information that affects immediate care;
• reduced ambiguity about the next action;
• active listening, questions and closed-loop confirmation.

Recent evidence is encouraging but should be interpreted carefully. Pinto, Roberto, Ferrario, Marotta, Montani, Auletta, Zoppini and Foglia (2025) evaluated a tailored SBAR guide in one hospice. After implementation, handover completeness improved and medication errors decreased. However, the study involved a small setting, a short observation period and a locally developed guide. Consequently, it supports context-sensitive implementation rather than the claim that SBAR alone guarantees safety everywhere.

A 2025 scoping review also linked SBAR with clearer communication, fewer handover errors and stronger teamwork, yet called for further research across diverse settings (Soed, Syed Abdullah and Al-Zahrawi, 2025). Therefore, students should avoid writing that SBAR “eliminates” communication failure. A stronger academic conclusion is that SBAR can improve the reliability of information exchange when staff use it consistently, adapt it appropriately and combine it with clinical judgement.

How to Use SBAR in Nursing Handover Step by Step

Before speaking, review the current record, recent observations, medication chart, allergies, investigations and agreed care plan. Verify the patient’s identity and decide why the receiver needs the information. In urgent escalation, do not delay the call simply to collect non-essential detail. State the immediate concern first, then provide the most relevant supporting information.

1. Situation: State the Immediate Concern

The Situation should identify you, identify the patient according to local policy, name the location and state the reason for the handover or call. It should answer: “What is happening now?”

A clear Situation might be: “This is Amina, the registered nurse on Ward 3. I am calling about Mr K, who has developed new breathlessness and whose oxygen saturation has fallen to 89% on room air.” The opening is specific. It gives the receiver enough information to recognise urgency before hearing the history.

A weak Situation begins with unrelated background or vague language such as “He does not look right.” Clinical intuition can be important, but it should be translated into observable concerns where possible. For example, describe altered consciousness, increased respiratory effort, reduced urine output, new confusion, uncontrolled pain or a change from baseline.

2. Background: Select Relevant Context

Background explains the facts needed to interpret the situation. Depending on the case, it may include the admission reason, diagnosis, procedure, allergies, resuscitation status where appropriate, significant comorbidities, recent medicines, baseline function and important investigation results.

The purpose is selection, not biography. In SBAR nursing handover, include background that changes risk, interpretation or management. For sudden breathlessness after surgery, the procedure, postoperative day, anticoagulation, mobility, respiratory history and recent analgesia may be relevant. A remote childhood illness may not be.

Students commonly overload this section because they want to show knowledge. However, effective clinical communication demonstrates judgement through relevance. If the receiver needs more information, they can ask a focused question. The sender should nevertheless have the record available and be prepared to clarify.

3. Assessment: Explain What You Found

Assessment is the clinical centre of SBAR. Report relevant observations, trends, examination findings, risk scores, interventions already completed and the patient’s response. Then state what you think the findings mean, while remaining within your competence.

For deterioration, an ABCDE structure can organise the assessment before it is summarised through SBAR. Include actual values and trends rather than only saying that observations are “abnormal”. For example, compare the current respiratory rate with the previous rate, state oxygen saturation and delivery method, and report blood pressure, pulse, temperature and consciousness where relevant.

Assessment does not require a nurse to make an unsupported medical diagnosis. Suitable language includes: “I am concerned about acute respiratory deterioration,” “the pain remains uncontrolled despite the prescribed intervention,” or “the patient is newly confused and has a raised NEWS2.” This communicates professional concern without claiming certainty that the available evidence cannot support.

4. Recommendation: Request a Specific Response

Recommendation answers: “What needs to happen next?” It can be a request for urgent review, prescribing decision, investigation, transfer, senior support or confirmation of a monitoring plan. A useful recommendation is specific and time-bound.

For example: “Please review Mr K immediately. While you attend, should I commence oxygen according to the local protocol and repeat the full observations in five minutes?” This statement requests attendance and clarifies interim action. The nurse should record the advice, read back critical instructions where appropriate and escalate again if the response is delayed or the patient worsens.

Recommendation is sometimes omitted because junior staff fear appearing demanding. However, respectful assertiveness is part of safe escalation. The nurse can state the level of concern, ask for a clear decision and use the organisation’s escalation pathway if the initial response does not protect the patient.

SBAR Nursing Handover Example: Shift-to-Shift Transfer

The following fictional example demonstrates structure. It is not a clinical prescription and must be adapted to the patient, setting and local policy.

SBAR stage	Example handover	Why it works
Situation	“Mrs D is a 72-year-old patient in bed 8. The main concern for the next shift is increasing confusion and a fall risk.”	Identifies the patient and immediate priority.
Background	“She was admitted with a urinary infection, normally lives independently and was orientated this morning. She has type 2 diabetes and uses a walking frame.”	Provides only context that affects interpretation and care.
Assessment	“Since 16:00 she has become disorientated to place. Temperature is 38.1°C, pulse 104 and blood glucose 8.9 mmol/L. The medical team reviewed her, treatment has started and she remains unsteady.”	Reports change, measurements, action and continuing risk.
Recommendation	“Continue the prescribed monitoring plan, maintain the agreed falls precautions and repeat observations at 20:00. Escalate sooner if consciousness, observations or mobility worsen.”	Transfers the plan and defines escalation triggers.

This example avoids unrelated history and makes the receiving nurse’s responsibilities visible. Nevertheless, verbal SBAR does not replace written documentation. The clinical record should contain the assessment, care delivered, decisions, advice received and agreed follow-up in line with professional and organisational requirements.

How to Use SBAR in Nursing Handover for Clinical Escalation

Escalation differs from routine handover because the sender is asking another professional to respond to risk. NHS England (2026) notes that structured tools such as SBARD can improve the reliability of communication and reduce loss of safety-critical information between teams. In this context, the nurse should lead with urgency and should not wait until the Recommendation to indicate that immediate help is needed.

A practical escalation sequence is:

1. Recognise the change and begin the appropriate immediate assessment.
2. Call the correct professional or emergency response according to local policy.
3. Use SBAR to state the concern, relevant context, findings and required action.
4. Confirm the response time and any instructions.
5. Read back critical information or orders when necessary.
6. Continue monitoring and provide care within competence and policy.
7. Escalate to a more senior level if the response is inadequate or deterioration continues.
8. Document the assessment, communication, decision, action and outcome.

Closed-loop communication strengthens SBAR. The receiver summarises the request or agreed plan, and the sender confirms accuracy. AHRQ (2023b) describes a proper handoff as including clarity, acknowledgement by the receiver and transfer of responsibility and accountability. Therefore, sending an SBAR message without confirming receipt is incomplete.

Urgent Escalation Example

Situation: “I need an urgent review of Ms L in bed 4 because her blood pressure has fallen and she is difficult to rouse.”

Background: “She is six hours postoperative following abdominal surgery. She received the prescribed analgesia 40 minutes ago and has no documented drug allergy.”

Assessment: “Her blood pressure is 82/50 compared with 118/72 one hour ago, pulse is 122, respiratory rate is 24 and consciousness has reduced. I have called for assistance and started the immediate actions required by our deterioration protocol.”

Recommendation: “Please attend immediately. I will continue ABCDE assessment and monitoring while the emergency response is activated according to policy.”

The example communicates urgency without offering treatment outside the nurse’s role. In real practice, the correct action depends on the clinical context and local escalation procedure.

Using SBAR for MDT Communication

MDT communication requires translation across professional perspectives. A nurse may need to speak with a doctor about deterioration, a pharmacist about a medication discrepancy, a physiotherapist about mobility, a dietitian about nutritional risk or a discharge coordinator about unresolved support needs. SBAR keeps the message centred on the patient and the decision required.

For a pharmacist, the Assessment might highlight a discrepancy between the medication history and current chart. The Recommendation might request medicines reconciliation before the next dose. For a physiotherapist, the Assessment might report a new mobility decline and the Recommendation might request review before discharge. The framework remains stable, but the content changes with the recipient’s role.

NMC standards require nurses to communicate in ways that support safe, compassionate and person-centred care (NMC, 2024). Consequently, SBAR in nursing handover should not reduce the person to observations and diagnoses. Include preferences, communication needs, capacity concerns, safeguarding information, reasonable adjustments and family involvement when these are relevant and lawful to share.

Confidentiality still applies. Use an appropriate setting, verify the recipient and share information necessary for care. Avoid discussing identifiable details in public spaces or including excessive personal information merely because the template contains a Background section.

How to Write About SBAR in a Nursing Assignment

A nursing assignment should do more than define the acronym. Strong academic work explains why structured communication matters, applies SBAR to a case and evaluates its strengths and limitations. The discussion should connect communication to patient safety, professional standards, teamwork and clinical reasoning.

A useful paragraph structure is:

1. Make a focused claim about the case or communication problem.
2. Support the claim with a current guideline or research source.
3. Apply the SBAR component to the patient’s actual findings.
4. Evaluate what the framework improves and what it cannot guarantee.
5. Link the analysis to the nurse’s responsibility and required action.

For example, a student might argue that placing acute deterioration in the Situation section reduces the risk that urgency is obscured by lengthy history. The student could then apply specific observations in Assessment and request senior review in Recommendation. Critical evaluation would add that successful use depends on accurate assessment, organisational culture, receiver engagement and escalation routes.

If you are developing a broader academic paper, our guide to types of nursing assignments explains how different tasks require different forms of analysis. You can also review our guide on writing a nursing reflective essay when SBAR forms part of reflection on a communication event.

Common SBAR Nursing Handover Mistakes

Giving Too Much Background

Excessive history delays the current concern. Select information that affects interpretation, risk or action. Keep the full record available for questions.

Reporting Data Without Clinical Meaning

A list of observations is not an Assessment. Explain the change from baseline, the pattern and why it concerns you. Stay within your competence and avoid unsupported diagnosis.

Using a Vague Recommendation

“Please advise” may leave responsibility unclear. Ask for a specific review, decision or action and confirm when it will occur.

Ignoring the Receiver’s Response

SBAR is a dialogue, not a speech. Allow questions, confirm understanding and use read-back for critical information where appropriate.

Failing to Escalate Further

If the response is delayed or inadequate, follow the local escalation pathway. Repeating the same message without increasing the response level may leave the patient exposed to risk.

Treating SBAR as Documentation

SBAR supports communication but does not replace the clinical record. Document relevant findings, decisions, advice, actions and outcomes accurately.

Practical SBAR Checklist for Nursing Students

Before completing an SBAR nursing handover, check that you can answer the following questions:

• Have I verified the patient and the correct recipient?
• Can I state the immediate concern in one or two sentences?
• Which background facts change risk or management?
• What are the current findings and trends?
• What action has already been taken, and what was the response?
• What specific review, decision or action do I need?
• Have we agreed who will do what and by when?
• Do I need to escalate further?
• Have I documented the communication and outcome?

Practise aloud using fictional scenarios. Aim for clarity rather than speed. Afterwards, ask a peer whether they could identify the priority, reconstruct the relevant clinical picture and state the required next action. This approach develops clinical reasoning as well as presentation skills.

Frequently Asked Questions

What does SBAR stand for in nursing?

SBAR stands for Situation, Background, Assessment and Recommendation. Some organisations use “Request” for the final letter or add other elements, such as identification or decision. Always follow the version adopted by your placement or employer.

When should nurses use SBAR?

Nurses can use SBAR during shift handover, transfer between services, telephone escalation, MDT communication and other focused exchanges. However, local policy may specify another tool for particular settings or emergencies.

Does SBAR replace nursing documentation?

No. SBAR structures verbal or written communication, but the nurse must still complete the clinical record according to professional standards and organisational policy.

What belongs in the Assessment section?

Include relevant observations, trends, examination findings, risk scores, interventions, response to care and your evidence-based clinical concern. Avoid making a diagnosis beyond your competence.

What if the receiver does not respond to an SBAR escalation?

Continue appropriate monitoring and care, then escalate through the organisation’s defined pathway. Record whom you contacted, the information shared, the response and further action. In an emergency, activate the emergency procedure without delay.

Can SBAR be used in a nursing assignment?

Yes. Apply it to the case rather than only defining it. Support the analysis with professional standards and research, and critically explain its benefits, limitations and relationship to clinical judgement.

Get Ethical Support With Your Nursing Assignment

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Related Nursing Guides

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Conclusion

Knowing how to use SBAR in nursing handover means doing more than memorising four headings. The nurse must identify the immediate problem, select relevant background, communicate an evidence-based assessment and request a clear response. Used with active listening, closed-loop confirmation, accurate records, clinical judgement and local escalation policy, SBAR can strengthen nurse-to-nurse handover and MDT communication. Nevertheless, it is a communication framework, not a substitute for assessment, emergency action or professional accountability.

References

Agency for Healthcare Research and Quality (2023a) Tool: SBAR. Available at: https://www.ahrq.gov/teamstepps-program/curriculum/communication/tools/sbar.html (Accessed: 25 August 2026).

Agency for Healthcare Research and Quality (2023b) TeamSTEPPS Pocket Guide. Available at: https://www.ahrq.gov/sites/default/files/wysiwyg/teamstepps-program/teamstepps-pocket-guide.pdf (Accessed: 25 August 2026).

Institute for Healthcare Improvement (2026) SBAR Tool: Situation-Background-Assessment-Recommendation. Available at: https://www.ihi.org/library/tools/sbar-tool-situation-background-assessment-recommendation (Accessed: 25 August 2026).

NHS England (2023a) Improving patient safety culture: a practical guide. Available at: https://www.england.nhs.uk/long-read/improving-patient-safety-culture-a-practical-guide/ (Accessed: 25 August 2026).

NHS England (2023b) Supporting clinical leadership in virtual wards. Available at: https://www.england.nhs.uk/long-read/supporting-clinical-leadership-in-virtual-wards-a-guide-for-integrated-care-system-clinical-leaders/ (Accessed: 25 August 2026).

NHS England (2026) Managing acute physical deterioration through the PIER approach. Available at: https://www.england.nhs.uk/patient-safety/managing-acute-physical-deterioration-through-the-prevention-identification-escalation-response-pier-approach/ (Accessed: 25 August 2026).

Nursing and Midwifery Council (2018) The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. Available at: https://www.nmc.org.uk/standards/code/read-the-code-online/ (Accessed: 25 August 2026).

Nursing and Midwifery Council (2024) Standards of proficiency for registered nurses. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/standards/2024/standards-of-proficiency-for-nurses.pdf (Accessed: 25 August 2026).

Pinto, F., Roberto, P., Ferrario, L., Marotta, L., Montani, D., Auletta, G., Zoppini, L. and Foglia, E. (2025) ‘Using Situation-Background-Assessment-Recommendation method in palliative care to enhance handover quality and nursing practice: a mixed method study’, Journal of Clinical Nursing, 34(1), pp. 117–127. Available at: https://doi.org/10.1111/jocn.17537.

Soed, N., Syed Abdullah, S.N. and Al-Zahrawi, R. (2025) ‘Exploring the impact of the SBAR on nursing handover: a scoping review’, The Malaysian Journal of Nursing, 17(1). Available at: https://doi.org/10.31674/mjn.2025.v17i01.024.