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Verbal Handoff Assessment – Multiple
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Verbal Handoff Assessment – Multiple
Verbal Handoff Assessment – Multiple
2017-03-02T15:42:46+00:00
Verbal Handoff Assessment (MULTIPLE patients)
Service
*
Acute Care Surgery
BEST
General Surgery
Pediatric Surgery
Surgical Oncology
Transplant Surgery
Urology
Vascular Surgery
Provider Type of Individual Giving Handoff
*
Advanced Nurse Practitioner
Attending Physician
Physician Assistant
Resident Physician
Physician Fellow
Other
Other Provider
Date of Observation
*
MM slash DD slash YYYY
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/then format
(eg. encourages questions, asked questions, considers learning style of receiver)
Did you provide verbal feedback to the handoff team?
*
Yes
No
Share one REINFORCING piece of feedback based on your handoff observation. No patient information should be entered into this form.
*
Share one CORRECTIVE piece of feedback based on your handoff observation. No patient information should be entered into this form.
*
Observer Name
*
First
Last
