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Written Handoff Assessment – Single

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Written Handoff Assessment – SingleChristina2017-07-25T21:04:22+00:00

Written Handoff Assessment (SINGLE patient)

"*" indicates required fields

Provider Type of Individual Giving Handoff*
Day of Week*
Time of Day*

Written Handoff Assessment Tool: Single

NoYes
I. Illness Severity
P. Patient Summary
A. Action List
S. Situation Awareness/Contingency Planning
S. Synthesis by Receiver
I. Illness Severity: Identification as Stable, 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.
NoYes
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
YesNo
Observer Name*
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