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

Strategies for Improving Handoffs

Applied to the hospitalized pediatric patient, the strategy of assessing the current status of the environment or system by Patterson at al. (2004) involves a process in which the nurse assuming responsibility for the child also verifies that child's surrounding. This calls for not only a rapid determination of the child's condition and current/pending treatments, but it prompts the nurse to ensure crib safety and armbands, as well as identify obstacles hazardous to health care, and provides day/date/RN information. Patterson et al. (2004) also recognized there were potential benefits to handoffs. For example, the person accepting responsibility has a fresh perspective, and this provides a point of verification and opportunity to increase detection of errors using simple techniques such as those described by Keyes (2000). These techniques include accountability of completing important aspects of patient care, and communicating clinical findings and relevant test results.

Nurses are always exploring ways to streamline activities to ensure safety, efficiency, and quality of care. In a hospital in South Florida, medical-surgical staff nurses were concerned about emergency department transfers to their unit. Safety issues (such as lack of armbands and emergent orders not completed prior to transfer) resulted in staff nurses' complaints and incident reports. The clinical educator for emergency services implemented a bedside report at shift change. The goal was to improve patient safety and enhance previous shift accountability/responsibility for care, which would allow the next shift nurse to address any issues or concerns related to the patient's care. Both outgoing and incoming nurses verified that armbands/allergy bands were correct and in place, intravenous fluid rates were accurate, and cardiac monitors were functioning within the proper parameters. The clinical educator believed staff morale improved because nurses were working together to ensure patient safety rather than blaming each other for mistakes and errors of omission ("Stop Errors," 2006).

Gregory (2006) calls for identifying times when handoffs take place (or are needed) and assessing the process to determine effective approaches in diverse situations. A scripted handoff should communicate details to standardize the process and eliminate missing information (Gregory, 2006). Checklists and scripts are used routinely in the aviation industry to reduce variability and enhance coordination, particularly during periods of increased activity or stress (Degani & Wiener, 1990). Similarly, in the health care industry, a handoff checklist serves as a guide for remembering and documenting (Streitenberge et al., 2006), increases confidence that necessary and accurate information has been communicated, and minimizes risk associated with human error. In this vein, the 30-Second Head-to-Toe (HTT) checklist, along with a structured follow-up process, teaches students the importance of using a standardized process when assuming responsibility for pediatric patients; its value is certainly not limited to students.


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