No. 01
Example 1: Deteriorating med-surg patient (respiratory)
S:Mrs. P., 412, increasing oxygen requirement and respiratory distress.
B:67-year-old, COPD, day 3 of pneumonia, on ceftriaxone.
A:SpO2 dropped from 94% on 2L to 88% on 5L NC over 4 hours. RR 28, HR 112, BP 142/88, temp 38.6. Coarse crackles bilaterally.
R:Need urgent CXR, ABG, and consideration of step-down or ICU transfer.
No. 02
Example 2: Post-op pain not controlled
S:Mr. K., POD 1 from open cholecystectomy, pain 8/10 despite ordered regimen.
B:54M, no opioid tolerance, current orders: morphine 4 mg IV q4h prn, oxycodone 5 mg PO q4h prn. Last morphine 30 minutes ago.
A:Pain 8/10 sharp at incision, splinting, refusing IS use. Vitals stable.
R:Request transition to PCA pump or breakthrough order. Pain is impeding pulmonary toilet.
No. 03
Example 3: Fall on the unit
S:Mrs. R., 308, fell while ambulating to bathroom.
B:78F, admitted for pneumonia, on Lasix and lisinopril, history of orthostatic hypotension.
A:Witnessed fall onto carpeted floor. No LOC. Vitals: BP 102/64 (baseline 130/80), HR 92, SpO2 97% RA. No visible head injury, no bleeding. Pain 0/10. Neuro intact. Skin shear noted on left elbow.
R:Request fall protocol orders: q15min vitals × 4, neuro checks × 24h, hold Lasix, head CT if any LOC develops, fall huddle in 30 min.
No. 04
Example 4: New onset chest pain
S:Mr. T., 514, new chest pain 7/10 substernal.
B:62M, admitted for pneumonia, history of HTN, hyperlipidemia, no prior MI.
A:Pain started 10 min ago, radiating to left jaw, diaphoretic. Vitals: HR 102, BP 158/96, SpO2 96% RA. EKG showing ST elevation in leads II/III/aVF.
R:Activated rapid response. Need stat troponin, aspirin 325 mg chewed, second IV access, cardiology consult, possible cath lab activation.
No. 05
Example 5: Code status conversation needed
S:Mrs. L., 207, family meeting requested re: code status.
B:89F, advanced metastatic colon CA on hospice consult, currently full code. Family expressed yesterday that she has indicated DNR wishes verbally to them.
A:Patient is alert and oriented today, able to participate in conversation.
R:Recommend MD discuss code status formally with patient and family today. Social work and chaplain available if helpful.
No. 06
Example 6: Critical lab value
S:Mr. C., 619, critical potassium of 6.8.
B:71M, end-stage renal disease, day 1 missed dialysis, on lisinopril.
A:EKG showing peaked T waves in leads V2-V4, no widening of QRS. HR 68, BP 138/82. No symptoms.
R:Need stat orders for calcium gluconate, insulin/D50, kayexalate, and emergent dialysis. Notified nephrology.
No. 07
Example 7: Family member upset
S:Family of Mr. D. (room 415) requesting urgent meeting with MD re: care decisions.
B:84M, septic shock, on pressors, day 5 in ICU. Daughter and son disagreeing about goals of care.
A:Patient currently sedated and intubated, unable to participate. Family requests palliative care consult.
R:Need MD meeting with family today, palliative care consult ordered, social work for family support.
No. 08
Example 8: Pediatric weight-based med error caught
S:Order error caught: pediatric vancomycin dose written for adult.
B:Patient is 12kg toddler with osteomyelitis, admitting MD ordered vancomycin 1g IV q12h.
A:Standard pediatric dose is 15 mg/kg q6h = 180 mg q6h, not 1g q12h. Order would result in 5x overdose.
R:Order corrected with admitting MD. Pharmacy notified for ongoing weight-based verification. Med error reported via incident system.
No. 09
Example 9: Calling MD at night for non-urgent issue
S:Routine page re: Mrs. F., 322, requesting sleep medication.
B:58F, day 2 admission for cellulitis, no sleep medication ordered. Patient reports she normally takes melatonin at home.
A:Patient awake at 2300, requesting something to sleep. Vitals stable. No safety concerns.
R:Request order for melatonin 5 mg PO PRN at bedtime, or alternative per provider preference.
No. 10
Example 10: Travel nurse handoff to oncoming staff
S:End-of-shift handoff for travel nurse covering 4 patients on med-surg.
B:All 4 patients within scope (2 post-op, 1 pneumonia, 1 cellulitis). 2 admissions expected this evening.
A:Vitals stable across the assignment. Pain controlled on all 4. No critical labs pending. Mrs. P. in 412 is the highest acuity (see separate SBAR — being followed by hospitalist).
R:Receiving nurse should know: Mrs. P. needs ABG in next hour; Mr. K. (518) PCA started 1700, evaluate efficacy at 2100; family of Mr. D. (415) requested update at 2000; patient in 304 is NPO after midnight for tomorrow's procedure.