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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)
Location
*
Central Medical Center
South Medical Center
Unit - Central
*
ICU
Internal Medicine
OB / GYN
Pediatrics
Surgery
Other
Unit - South
*
Cardiology
Emergency Department
ICU
Internal Medicine
NICU
OB / GYN
Oncology
Pediatrics
Surgery
Other
Other Unit
Clinician Type of Individual Giving Handoff
*
Nurse
Attending Physician
Physician Fellow
Resident Physician
Nurse Practitioner
Multiple/Inpatient Night Rounding
Other
Other Provider
Day of Week
*
Weekday
Weekend
Time of Day
*
AM
PM
Verbal Handoff Assessment Tool-Multiple Patients
Indicate the frequency that each element of the mnemonic is present
*
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 provider who gave the handoff did the following.
*
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/than format
(eg. encourages questions, asked questions, considers learning style of receiver)
Did you provide verbal feedback to the handoff team?
*
Yes
No
Rate the overall quality of the following:
*
Meets high standard
Does NOT yet meet high standard
Unable to evaluate
Patient Summary
Synthesis by the receiver
Share one REINFORCING piece of feedback based on your handoff observation. For HIPAA compliance, patient-specific information should NOT be entered in to this form.
Share one CORRECTIVE piece of feedback based on your handoff observation. For HIPAA compliance, patient-specific information should NOT be entered in to this form.
Observer Name
*
First
Last