Interprofessional Communication Note (Clinical Aromatherapy)

Date/Time of Note: [Date and time of documentation]

Date/Time of Aromatherapy Administration: [Date and time of intervention]

Author: [Name, credentials, service/program]

Recipients: [Receiving disciplines or clinicians]

Reason for Communication: [initiation / plan change / adverse event / discharge handoff / consultation response]

SBAR Summary

Situation: [Immediate purpose of communication and explicit ask of recipients] (State what is needed from the recipient and why; include brief patient context only if not visible elsewhere in EHR.)
Background: [Concise aromatherapy-relevant history] (Include only information that affects aromatherapy decisions: pertinent diagnoses, prior aromatherapy exposure and response, relevant allergies or fragrance sensitivities, risk factors such as reactive airway disease, migraine/seizure history, pregnancy/lactation if applicable. Note any patient-supplied products and safety counseling provided. Limit to 2–4 brief statements.)
Assessment: [Aromatherapy candidacy and precautions] (State suitability and any precautions; include rationale for selected product/method and baseline symptom score if obtained. Note limitations if baseline not obtained or patient cannot self-report.)
Recommendation: [Explicit requests with owner, action, and timeframe] (Number each request; specify who does what by when.)

Intervention Details

Indication: [Patient-centered comfort/support goal] (Use supportive language; 1–2 short phrases.)

Product: [Common name, botanical name if known, single oil vs blend, delivery form, facility-approved or patient-supplied] (If blend, list components. Include manufacturer/lot/expiration only if operationally tracked.)

Method: [Route, amount/device details, timing, frequency, administrator] (For topical: include dilution %, carrier, and site. Note if self-administration was taught. Include environmental controls if relevant, e.g., shared room or diffusion avoided.)

Safety Screening: (Indicate status for each relevant item. For safety-critical unknowns, write "Unknown—please confirm" and include a team request.)

• Prior adverse reaction to essential oils: [Yes / No / Unknown—please confirm / Not assessed]
• Fragrance sensitivity or migraine triggers: [Yes / No / Unknown—please confirm / Not assessed]
• Reactive airway disease: [Yes / No / Unknown—please confirm / Not assessed]
• Pregnancy/lactation status: [Yes / No / Unknown—please confirm / Not applicable / Not assessed]
• Skin sensitivity (if topical): [Yes / No / Unknown—please confirm / Not assessed]

Response & Plan

Response: [Pre/post measures with timing if collected, patient's subjective report, relevant objective observations, preference to continue/modify/stop] (If adverse event occurred: describe event, timing, severity, suspected trigger, actions taken, notifications made, and disposition.)

Plan: [continue / adjust / discontinue] [Conditions for use, stop criteria, and reassessment window if applicable] (Use supportive/comfort-focused language rather than treatment language.)

Team Requests: (Number each item with owner and specific action.)

1. [Discipline/Owner]: [Specific action requested]
2. [Discipline/Owner]: [Specific action requested]

Education: [Consent status, key teaching points covered, patient understanding] (Cover supportive role of aromatherapy, safe use, when to stop and report, product restrictions.)

(Omit elements that do not apply to the encounter rather than leaving blank sections. Safety screening items must explicitly state their assessment status even if negative or unknown.)