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

The 30-second Head-to-Toe Tool (HTT)

Over time, the clinical faculty perception of what constitutes a 30-Second HTT was quite different from students' perceptions. To avoid perpetual frustration with this lack of congruence, a checklist was developed for students to complete. Initial development of the HTT was based on literature that detailed common mistakes in pediatrics, along with established best practices related to activities such as labeling intravenous lines and tubes. The tool was then revised and refined to make the process efficient and inclusive. Finally, over time, it evolved to include hospital policy, student recommendations, and areas of care frequently overlooked (see Figure 1).

Figure 1.

30 Second Head-to-Toe (Lined Items Are to Be Completed)

Over the past two years, the HTT evolved from a tool for teaching students routine assessment to a valuable inclusive tool for use by both nurses and students to ensure that accurate, consistent communication occurred during handoffs. The HTT is based on evidence of frequent pediatric errors in the literature and institutional policy practice routines. For example, it is currently routine practice to highlight and post preprinted weight-based pediatric resuscitation drug forms at each child's bedside. This practice was first described by Gammage (1984), who was in charge of an Air Force hospital pediatric intensive care unit. Erasable laminated boards with resuscitation drugs and dosages calculated for each child were posted at the bedside. The current modified technique has been streamlined and augments practice to ensure safety, efficiency, and quality of care on the pediatric clinical unit.

With a simple baseline activity to assure accurate transfer of information at report from the outgoing shift to the new nurse, the student nurse performs a validation exercise to enhance care and safety of the patient at handoff. This technique mirrors strategies described by Patterson et al. (2004) in maintaining safe operations in potentially high-risk environments, such as transfer of responsibility in Space Shuttle Mission Control and nuclear power plants (see Table 1, # 9 and #15). The potential for serious errors in pediatrics can be viewed as equally critical, considering that one failed interpersonal communication can result in catastrophic outcomes. If students are initially socialized to ensure clear communication/handoffs through the use of a standardized tool, they are more apt to make an important contribution to the culture of safety in hospital environments in the future.

In the author's setting, students also received a handoff report from the night shift nurse and were then expected to go directly to the bedside to assess the child and environment. In the past, this process has been described as "doing your 30-Second Head-to-Toe." Information learned by students in report had to match what they evaluated in the child's room during brief interaction and systematic observation. Examples of observable features in students' assessments included correct intravenous (IV) fluids, rate, expiration date, time labels, and IV pump settings; oxygen humidified the appropriate percent; and no nasal mucosal irritation. After assessments were completed, the clinical day commenced for students.


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