Handoff Report

A handoff report is a critical communication tool in healthcare that ensures continuity of care between shifts or when one respiratory therapist (RT) transfers responsibility for a patient to another. For respiratory therapists, an effective handoff report is crucial for maintaining patient safety, promoting optimal care, and preventing errors. During this process, RTs share key information about the patient’s respiratory status, treatments, progress, and any concerns that may impact ongoing management.

1. Patient Identification and Basic Information:

• Name, gestational age, and birth weight: Identifies the infant and provides essential background for understanding the infant’s developmental stage.

• Medical record number (MRN): Ensures accurate tracking of the patient.

• Date of birth and age (corrected and chronological): Important for developmental care and tracking growth parameters.

• Diagnosis and clinical history: Includes primary diagnoses (e.g., prematurity, respiratory distress syndrome, congenital anomalies), any prenatal complications, and significant NICU events (e.g., sepsis, NEC).

2. Current Clinical Status:

• Respiratory status:

  • Oxygen therapy or ventilatory support: Specifics on any modes of ventilation (e.g., CPAP, mechanical ventilation), oxygen concentration (FiO2), and flow rates.

  • Respiratory rate and pattern: Observations of any changes in breathing (e.g., tachypnea, apnea, or bradypnea).

  • Blood gas results: Arterial or capillary blood gases (e.g., pH, CO2, PO2) to assess respiratory and metabolic status.

  • Signs of respiratory distress: Any use of accessory muscles, nasal flaring, grunting, or retractions.

• Cardiovascular status:

  • Heart rate and rhythm: Tachycardia, bradycardia, or arrhythmias should be reported.

  • Blood pressure: Any hypotension or hypertension, especially relevant in preterm infants or those with cardiac concerns.

  • Circulatory support: Presence of any medications or interventions (e.g., inotropes, blood pressure support) to maintain perfusion.

3. Current Treatment and Therapies:

• Oxygen or respiratory therapies: Current settings for oxygen therapy (e.g., nasal cannula, CPAP, high-frequency oscillatory ventilation) and any titrations or adjustments made during the shift.

• Medications: A list of medications being administered (e.g., surfactant, antibiotics, caffeine for apnea, diuretics for fluid overload), including dosage and administration schedules.

• IV fluids and nutrition: Current IV or enteral nutrition (e.g., breast milk, formula, parenteral nutrition), and fluid balance (intake/output).

• Invasive monitoring devices: Central venous catheters, umbilical lines, arterial lines, or other devices, including site condition and patency.

4. Neurological Status and Developmental Considerations:

• Neurological status: Report any signs of abnormal neurological findings (e.g., seizures, lethargy, irritability) and update on any imaging or diagnostic workups (e.g., cranial ultrasound results).

• Neurodevelopmental progress: Developmentally appropriate interventions for preterm or critically ill infants, such as positioning, environmental modifications (e.g., minimizing stimulation), and any ongoing developmental support.

• Pain management: Any signs of discomfort or pain (e.g., crying, grimacing) and current pain management strategies (e.g., analgesia, sedation).

5. Growth and Feeding Progress:

• Growth parameters: Weight, head circumference, and length; trends in weight gain or loss, and comparisons to expected growth charts (e.g., intrauterine growth restriction [IUGR] infants).

• Feeding status: Current method of feeding (oral, nasogastric tube, or parenteral nutrition) and any challenges (e.g., feeding intolerance, aspiration risk).

• Breastfeeding or bottle-feeding: Any attempts or challenges with breastfeeding or bottle-feeding, including infant readiness for feeds and progress with transitioning to oral feeding.

6. Laboratory and Diagnostic Results:

• Recent labs: Summary of any recent lab results (e.g., blood gas results, complete blood count [CBC], metabolic panels, bilirubin levels, cultures) and their clinical implications.

• Imaging results: Any relevant imaging (e.g., chest X-ray, cranial ultrasound, echocardiogram) and its impact on treatment or diagnosis.

• Infection status: Whether the infant is undergoing antibiotic treatment, any cultures taken, and concerns about potential infections (e.g., sepsis, necrotizing enterocolitis [NEC]).

7. Challenges and Concerns:

• Complications or risks: Any complications such as ventilator-associated pneumonia (VAP), necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), or patent ductus arteriosus (PDA), and any immediate concerns.

• Deterioration or improvement: Noting any unexpected changes (deterioration or improvement in condition) that require attention or may impact future management.

• Parent concerns or involvement: Any updates on family involvement, parental questions, or emotional concerns, as family support is critical in the NICU setting.

8. Plan for Continuing Care:

• Next steps in management: Plans for upcoming interventions or treatments, such as extubation, weaning from CPAP, adjustments in medication, or diagnostic follow-up.

• Goals for the next 24 hours: Developmental milestones, feeding targets, respiratory goals, or any changes expected in medical management.

• Follow-up assessments: Any planned assessments (e.g., follow-up cranial ultrasound, echocardiogram, or lab draws) and when they should occur.

• Discharge planning: If appropriate, updates on discharge planning, including milestones for readiness, home oxygen requirements, or follow-up appointments.

9. Critical Information or Alerts:

• Immediate concerns: Urgent matters that require immediate action, such as ventilator alarm settings, acute deterioration in condition, or medication administration requirements.

• Pending test results or procedures: Information on any tests or procedures still awaiting results that could affect treatment or decision-making.

Pro Tip:

Conducting handoff reports at the bedside in the NICU is crucial for improving patient safety, communication, and team collaboration. It ensures that the healthcare team has direct access to the infant for immediate physical assessment, allowing them to verify clinical status and identify any changes or discrepancies in real-time. This hands-on interaction enhances the accuracy and completeness of the information being exchanged, reduces the risk of errors, and fosters a collaborative environment where team members can ask questions, clarify concerns, and make timely adjustments to the care plan. Bedside reports also promote transparency and allow parents to be actively involved in the care process, reducing their anxiety and building trust. Additionally, the practice facilitates education for less experienced team members, reinforcing critical thinking and clinical skills. Ultimately, bedside handoff reports improve the quality of care, enhance communication, and ensure that both the healthcare team and families are aligned in the management of the infant’s care.

There is no test for this module.