Nursing Knowledge
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A nursing shift report, often referred to as a handoff or handover, is a communication process between outgoing and incoming nursing staff at the change of shift.
Note: Estimates of up to 70% of errors occur as a result of ineffective handoff communication. Make sure the client handoff includes the needed report information.
A good end-of-shift report to the new oncoming shift ensures safe continuity of patient care and the delivery of best clinical practices between the nursing staff.
There are several types of end of shift hand-offs. They include:
Best-practice handoffs mandate an opportunity for discussion between the giver and receiver of patient information.
To give a good end-of-shift report:
The SBAR technique is a tool that allows nurses to communicate distinct elements of a patient’s condition. It places emphasis on quality care. The SBAR is used for each patient during report.
SBAR is an acronym for: Situation, Background, Assessment, and Recommendation.
Patient information
Name:
Room number:
Age/gender:
Situation
Current status: (e.g., stable, critical, etc.)
Primary diagnosis:
Other diagnoses if applicable:
Background
Medical history: (brief summary)
Admission rate:
Key lab results:
Treatment to date: (including surgeries, if applicable)
Assessment
Vital signs: (most recent)
Physical exam highlights: (e.g., lung sounds, edema)
Mental status: (e.g., alert and oriented)
Medications given:
Pending tests/procedures:
Issues/concerns: (e.g., any changes in condition)
Recommendation
Upcoming treatments/procedures:
Tasks needing attention:
Potential risks/concerns:
Additional comments
Family/patient preferences:
Special instructions:
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