Technical Support
Log out
Skip to content
Verbal Handoff Assessment – Single
Home
/
Observations Landing Page
/
Verbal Handoff Assessment – Single
Verbal Handoff Assessment – Single
2017-03-02T15:41:09+00:00
Verbal Handoff Assessment (SINGLE patient)
Unit or Service
*
Obstetrics & Gynecology
Unit or Service
*
Postpartum
Labor & Delivery
Other Unit
Provider Type of Individual Giving Handoff
*
Nurse
Resident Physician
Attending Physician
Nurse Midwife
Other
If you are observing an Attending Hospitalist Physician, CCPI Physician, or LSU Attending, please select "Attending Physician".
Physician Type
*
Attending Hospitalist Physician
CCPI Physician
LSU Attending
Other Provider
Day of Week
*
Weekday
Weekend
Time of Day
*
AM
PM
Where Did the Handoff Occur?
Entirely in the patient room
Not entirely in the patient room
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 whether or not the provider who gave the handoff did each of 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
Share one REINFORCING piece of feedback based on your handoff observation
Share one CORRECTIVE piece of feedback based on your handoff observation
Observer Name
*
First
Last
Name of Nurse Giving Handoff
*
First
Last