30-Second Head-to-Toe Tool in Pediatric Nursing

Cultivating Safety in Handoff Communication

Debbie Popovich, MSN, CPNP


Pediatr Nurs. 2011;37(2):55-60. 

In This Article

Abstract and Introduction


Efforts to improve handoff practices among providers during shift changes are needed to augment patient safety, particularly among pediatric patients. To this aim, nurse faculty developed and enhanced a tool to standardize a thinking process for students during their pediatric clinical experience. The 30-Second Head-to-Toe checklist allows for rapid assessment of a child's condition and environment. It offers both students and nurses a consistent system for reducing errors attributable to incomplete or inaccurate information during this critical transition. Students completed checklists for 352 pediatric patients over a period of two years. Identified discrepancies were analyzed. Findings confirmed the importance of a standardized system during shift changes to reduce errors and achieve accurate, consistent communication. Students also reported that using the tool and reviewing it with instructors helped them overcome initial feelings of anxiety and fostered confidence


Handoffs in patient care occur at a variety of routine and non-routine times. A handoff in care occurs when accountability and responsibility for a patient are transferred from a) one health care provider to another (such as shift-to-shift report or cross-coverage for staff breaks), b) one service or program to another (such as inpatient to medical service or diagnostic areas), or c) one organization to another (such as tertiary center to a community facility) (Streitenberger, Breen-Reid, & Harris, 2006). The function of the handoff is to communicate patient information to provide safe, continuous care. In the hospital pediatric setting, continuity of care is particularly important because children are generally unable to provide nurses with important or even critical details about their symptoms. Thus, pediatric nurses communicate to each other about children's progress via a report at shift's end.


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