Technical Support
Log out
Skip to content
Verbal Handoff Assessment – Single
Home
/
Observations Landing Page
/
Verbal Handoff Assessment – Single
Verbal Handoff Assessment – Single
Christina
2017-03-02T15:41:09+00:00
Verbal Handoff Assessment (SINGLE patient)
Location
*
Central Medical Center
South Medical Center
Unit - Central
*
Emergency Room
General Surgery
ICU
PACU
Labor and Delivery
Other
Choose the unit where your observation took place.
Unit - South
*
Cardiology
Emergency Department
ICU
Internal Medicine
NICU
OB / GYN
Oncology
Pediatrics
Surgery
Other
Choose the unit where your observation took place.
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-Single
Indicate whether or not each element of the mnemonic is present
*
No
Yes
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.
Indicate the frequency with which the provider who gave the handoff did the following.
*
No
Yes
Giver actively engaged with receiver to ensure understanding of patients
Giver appropriately prioritized key information, concerns, or actions
Provided to-do list restricted to items that need to be accomplished on next shift
Used high quality contingency plans with clear if/then format
Did you provide verbal feedback to the handoff team?
*
Yes
No
Rate the overall quality of the following:
*
Unable to evaluate
Does NOT yet meet high standard
Meets high standard
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