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Verbal Handoff Assessment – Multiple
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Verbal Handoff Assessment – Multiple
Verbal Handoff Assessment – Multiple
Christina
2017-03-02T15:42:46+00:00
Verbal Handoff Assessment (MULTIPLE patients)
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Hospital or Location
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Please Select
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Second Choice
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Department or Service
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Please Select
Adolescent Medicine
Ambulatory Care
Anesthesiology
Behavioral Health
Bone Marrow Transplant
Cardiology
Critical Care
Emergency Medicine
Endocrine
Family Medicine
Gastroenterology
Hematology / Oncology
Immunology
Infectious Disease
Internal Medicine
Intermediate Care Unit
Leukemia
Medical/Surgical
Neonatal Intensive Care
Neonatology
Nephrology
Neurology
Obstetrics & Gynecology
Oncology
Orthopedics
Otolaryngology
PACU
Palliative Care
Pediatric Critical Care
Pediatric Oncology
Pediatrics
Podiatry
Psychiatry
Pulmonary
Respiratory Therapy
Rheumatology
Sleep Medicine
Surgery
Telemetry Unit
Urology
Other
Other Department or Service
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Unit or Care Area - [Hospital 1]
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Second Choice
Third Choice
Unit or Care Area - [Hospital 2]
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First Choice
Second Choice
Third Choice
Unit or Care Area - [Hospital 3]
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Please Select
First Choice
Second Choice
Third Choice
Provider Type of Individual Giving Handoff
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Nurse
Nurse Practitioner
Physician Assistant
Resident Physician
Physician Fellow
Attending Physician
Respiratory Therapist
Other
Other Provider
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Day of Week
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Weekday
Weekend
Time of Day
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AM
PM
Transition of Care Type (If this is a change in the phase of care, please indicate "transfer").
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Shift Change
Transfer
Verbal Handoff Assessment Tool-Multiple Patients
Indicate the frequency that each element of the mnemonic is present. For transfer handoffs that are conducted over the phone, please ask the clinician giving handoff whether or not the receiver performed the synthesis.
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Never
Rarely
Sometimes
Usually
Always
I. Illness Severity
P. Patient Summary
A. Action List
S. Situation Awareness/Contingency Planning
S. Synthesis by Receiver
I. Illness Severity: Identification as stables, "watcher", or unstable; must occur at the beginning of each patient handoff.
P. Patient Summary: Might include summary statement, events leading up to admission, hospital course, ongoing assessment, plan. A. Action list: To do list; (must be separated from patient summary). S. Situation Awareness/Contingency Planning: Know what’s going on; plan for what might happen. S. Synthesis by Receiver: Written reminder to prompt receiver to summarize what was heard during verbal handoff.
Indicate the frequency with which the following elements were present in the observed handoff. For transfer handoffs that are conducted over the phone, please ask the clinician giving handoff whether the receiver exhibited a quality synthesis as outlined below.
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Never
Rarely
Sometimes
Usually
Always
Giver actively engaged with receiver to ensure understanding of patients
Giver appropriately prioritized key information, concerns, or actions
To-do list restricted to items that need to be accomplished on next shift
High quality contingency plans with clear if/then format
Receiver provided a synthesis that summarized the key components of the handoff, rather than restating all information
(eg. encourages questions, asked questions, considers learning style of receiver)
Was an I-PASS Written Handoff Tool used to facilitate the verbal handoff process?
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Yes
No
How would you rate the overall quality of the written handoff tool?
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Excellent – The tool is clear, complete, up to date, and highly useful for ensuring safe and effective handoffs
Good – The tool is generally clear, complete, and up to date, with minor areas for improvement
Fair – The tool has notable gaps or ambiguities that could impact safe and effective handoffs
Poor – The tool is unclear, incomplete, or lacks critical information needed for safe and effective handoffs
Not Applicable – A written handoff tool was not reviewed
Did you provide verbal feedback to the handoff team?
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Yes
No
Share one REINFORCING piece of feedback based on your handoff observation
Share one CORRECTIVE piece of feedback based on your handoff observation
Observer Name
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