Change Ideas - Standardized Processes

1. Monitor, evaluate, and audit your handoff process.

2. Identify local causes for handoff communication failures and barriers to improvement in your setting.8

3. Standardize tools and methods to communicate handoff information to receivers, allowing for customization for different areas or situations (e.g., change of shift, transfer between units). These could include:

  • Forms
  • Templates
  • Checklists. Click here for example
  • Protocols
  • Mnemonics such as I-PASS or SBAR.
    •  I-PASS
      • Illness Severity: describes the patient’s clinical status as stable, watcher (e.g., potential to decompensate), or unstable
      • Patient Summary: describes the age, diagnosis, and pertinent medical management including summary statement, events leading up to admission, hospital course, ongoing assessment organized by problems/diagnoses, and plan organized by problems/diagnoses
      • Action List: list of things to do for each patient with contingency plans
      • Situation Awareness: allowing the receiver to develop an understanding for potential unanticipated events related to the patient’s condition
      • Synthesis: opportunity for the receiver to synthesize and re-state key elements and question key points; NOT a re-stating of the entire verbal handoff
    • SBAR (click here for sample of SBAR Templates)
      • Situation: describe the specific situation about a particular patient including name, location, doctor, vital signs, resuscitation status, and any specific concerns
      • Background: relay the patient’s background including date of admission, diagnosis, current medications, allergies, laboratory results, progress during the admission
      • Assessment: critically assess the situation, clinical impression and detailed expression of concerns
      • Recommendation: state the management plan, making suggestions and being specific about requests and time frame
    • Other mnemonics available in The Joint Commission Sentinel Event Alert8 and here.

4. Report information in the same order every time.
5. Standardize the order in which patients are discussed in handoff. It is generally recommended to prioritize the most acute (e.g., “sickest”) patients first.22,26
6. Use NICU-specific simulation to assist in teaching and gaining comfort with the use of standardized handoff tools.