03.05 Handoff Report

In this lesson, we’ll discuss handoff report.

Handoff report, or change-of-shift report is how you communicate to the next nurse what’s going on with the patient or patients. Your goal here is to be accurate, concise and efficient. Include the most important, pertinent information.

Handoff report is a detailed report, usually given at the bedside on units. It paints a broad picture of what’s going on with the patient from their admission all the way until their plans for discharge. Report is given nurse to nurse, and can also be used between units, like if your patient is being transferred to the floor; you’d need to call report then.

When you give report, best practice is given at bedside. Bedside report brings the patient into the conversation, allowing for them and their families to have input in their care. It also increases safety and the quality of care that the patients receive.

Another thing that it does is that it confirms what the previous nurse is telling you about the patient.

Be sure to do this for all of your patients.

When you give report, the biggest, most important thing for you to remember is to develop a routine. If you do it consistently every time, you’ll be less likely to miss important information.

Typically, you’ll start with a history, code status, any big medications that they’re on. Also, you’ll tell the new nurse what the patient’s plans are (like transfer to the floor, step down, extubation, etc), but we’ll get into more of that later.

Then, go system by system. Every unit and facility is different, but be consistent. When I was in the ICU, it was neuro, then cardiac, pulm, GI/GU, musculoskeletal, then skin. In each of these systems you’d have breakdowns of labs, lines, drains, etc. Either way, do it in the same order every time.

Be sure that the information you give is clear and concise. If there is something the nurse is not understanding, clarify it for them. An example of this would be the first time I had a patient with peritoneal dialysis. I’d never done it, but I had the nurse show me how they did it and how it was ordered. What seemed daunting was actually a piece of cake. The other thing that we did was ask the patient how HE did it because we gave report at the bedside. That helped a ton too!

Another thing you’ll want to include in your report is safety stuff. Does your patient have restraints, do you have a current order? Also, and I’ll say this now. Don’t just trust the nurse leaving if you’re the nurse coming on. Don’t get burned. If there is supposed to be a new restraint order and it’s not in there, hold them accountable or reach out to the doc for it. That also means that you need to make sure they know when certain orders expire.

Also, if your patient has droplet, contact, c.diff, or other precautions, let them know! You don’t want to walk into a patient’s room unprotected.

One other thing to mention. Make sure that if your patient has a plan for surgery that the consents are signed. Look with your eyeballs at them. Don’t trust the nurse that it’s good to go and check for yourself.

And lastly, be honest when it comes to safety. If your patient has only had restraints off for an hour, then let the nurse know. If not, then the nurse may be under the impression that your patient is a-ok without those restraints, when really they should be watched closely! So be honest and open about safety issues.

In report you also want to make sure that you tell the next nurse what the plan is. Include plans for surgeries or procedures. It’s not uncommon in some ICUs to do bedside procedures. Include upcoming changes you think might happen. For example, if you expect the foley to be pulled, let them know (and be a good work partner and pull supplies if you have time - they’ll appreciate that). Also if you expect the patient to be transferred out to another facility, discharged, or transferred to a different unit, let them know.

Nursing concepts for today’s lesson are communication, teamwork & collaboration.

Let’s recap.

When you give report, give detailed information that paints a solid picture for the next nurse.

Give report at the bedside. This will bring your patient front and center.

Go system by system and outline everything that’s important.

Include plans of care, plans for discharge or transfer and safety concerns.

Most importantly, develop a routine when you give report so that you consistently give report every time.

That’s it for our lesson on handoff. Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!