INTRODUCTION TO IPASS FOR RESIDENTS A BRIEF INTRODUCTION TO HANDOVER TECHNIQUES FOR YOUR PEDIATRIC ROTATION

2017

WELCOME TO MACPEDS!

The goal of this presentation is to introduce you to the concept of I-PASS before

your first pediatric handover experience. I-PASS format is the standard for handover

in the MacPeds program.

During your orientation day, you will receive another brief review of I-PASS.

Thank you in advance for taking the time to review this presentation!

WHY IS HANDOVER IMPORTANT?

Effective communication is essential for patient safety!

- Communication is the lead cause of

sentinel events.

- Shorter work hours have led to

increased handovers.

- We work as a team and not as

individuals when caring for patients

SHARED MENTAL MODEL

In order for a team to function effectively, all individuals

on the team must be aware of what is going on at all

levels: Staff, Residents, Clerks, Allied health, Patient/Family

In our current night float system, it is likely that the

overnight residents will not know anything about the

patients’ they are covering overnight.

Patient safety can be achieved when these teams (day

team and night team) have a shared mental model.

HANDOVER ON PEDIATRICS

Morning handover takes place either at 7:15 or 7:35am depending on the day and your CTU team.

Evening handover takes place either at 16:40 or 17:00 depending on the day and your CTU team.

You will receive more information about the timing of handover on your orientation day.

Handover takes place in a quiet room designated specifically for handover.

If your team is not handing over, we recommend waiting outside of the handover room until your turn. If you choose to sit quietly in the handover room, please refrain from having separate discussions while handover is taking place.

CTU teams are expected to bring 2 updated handover lists to evening handover (1 for the night senior, 1 for the junior resident)

WHAT IS I-PASS?

I-PASS is the structure used to handover an individual patient:

I – ILLNESS SEVERITY

Patients are either “Stable” or a “Watcher” when they are admitted to the Pediatric

CTU ward.

In areas with more acute patients, the illness severity continuum encompasses

“Stable” “Watcher” or “Unstable”

A watcher is someone that the team feels requires close monitoring overnight for

concern of deterioration

P – PATIENT SUMMARY

Highlight the following information:

Reason for admission (summary statement)

Relevant events leading to admission

Brief hospital course

Ongoing assessment

Plan for hospitalization

STABLE

2yo with ________

Presented with _______

Treated with _____, improved

1. Issue – assessment, plan

2. Issue – assessment, plan

3. Issue-assessment, plan

A – ACTION LIST

To Do List for the accepting team

Include specific elements:

Timeline (ie. what time will the bloodwork be drawn?)

Level of priority

Relevant information for interpretation of lab work/imaging etc.

If no action items anticipated, please clearly specify “Nothing to do overnight”

S – SITUATIONAL AWARENESS & CONTINGENCY PLANNING

Patient Level

Know what is going on with your patient

Status of patients’ disease process

Team members role in the patients’ care

Environmental factors

Progress toward goals

Team Level

Know what is going on around you

Status of patients

Team members

Environment

Effective Contingency Planning

Identify concerns

Articulate what might go wrong

Define the plan!

List interventions that have/have not worked

Identify resource for assistance

For stable patients “I don’t anticipate anything

will go wrong”

S – SYNTHESIS BY RECEIVER

Brief re-statement of essential information to demonstrate understanding

Opportunity for receiver to clarify elements of the handover

“Check back”

TIME FOR SOME EXAMPLES….

EXAMPLE 1: STABLE, NON ACTIVE PATIENT

I: A.B is stable

P: He is a previously healthy 8 month male with bronchiolitis who was admitted 2

days ago for respiratory distress requiring supplemental oxygen. He has been

tolerating room air for the past 12 hours with no WOB. He is feeding well with no

IVF.

A: There is nothing to be done overnight.

S: I don’t anticipate anything happening overnight and this patient will likely go home

in the morning if no oxygen is required overnight.

EXAMPLE 2: STABLE PATIENT WITH ACTIVE ISSUES

I: A.B is stable

P: She is a 6yo female, previously healthy, admitted for gastroenteritis and moderate

dehydration last night. She had 24h of ongoing diarrhea, vomiting and fever prior to

presentation. Her vomiting has resolved with anti-emetics. She is tolerating some po intake

with IVF running at ½ maintenance.

A: She has a set of lytes to be checked at 18:00. We are following up her potassium level as

she is currently running D5NS with no K+. I would like you to check her ins/outs in the

evening to ensure she had adequate po intake, and adjust her IVF accordingly.

S: I do not anticipate any issues overnight.

EXAMPLE 3: WATCHER

I: A.B is a watcher.

P:

She is a 6mos F with a past medical history significant for a VSD and presented in congestive heart failure with intercurrent

viral illness. She was admitted for worsening tachypnea and difficulty feeding.

From a cardiac standpoint, she has been tachycardic in the 150s with normal blood pressures and good CRT. Her current

cardiac regimen includes Lasix, metoprolol and captopril. She is in moderate heart failure with a liver 3cm BCM. Her Lasix

dose was increased to 3mg TID today.

From a respiratory standpoint, she is currently on 1L via NC maintaining sats >90%. I am most concerned about her work

of breathing. Her RR have been 60-80/min with nasal flaring. She was PACED this afternoon but felt safe to stay on the

ward. She requires ongoing reassessment as she may need HFNC if symptoms progress.

She is currently NPO for tachypnea with a TFI of 130cc/kg/d via NG.

A: I would like you to follow up her fluid balance at 20:00 and consider an extra dose of Lasix (3mg) if she is

>200cc positive with a corresponding clinical exam.

S: Monitor her respiratory status closely with a low threshold to PACE.

COMPLEX PATIENTS

For patients with multiple system issues. It is helpful to present their active issues in a systems based manner.

CNS -

CVS -

Resp -

GI/Feeding/Nutrition -

GU -

Heme -

ID –

Any POST? (Goals of care ie. NO CPR)

EXAMPLE OF THE HANDOVER LIST

TRANSLATION TO VERBAL HANDOVER

TIPS FOR PREPARING FOR HANDOVER

If you have time before handover, practice handing over some of your patients with

the SPRs or teaching resident for feedback.

If you are away in the afternoon, ensure the SPR or staff update you on the status of

your patients’ before attending handover.

Ensure the handover list is updated with the most relevant and important

information for the night team

Seek feedback from your SPRs after handover.

WE HOPE YOU ENJOY YOUR PEDIATRIC ROTATION!