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

Rationale for Change

Dracup (2008) states that "although some of the elements [may be] challenging because of our sometimes chaotic physical environments…it is critical that we adopt practices used religiously in other high-risk settings" (p. 97). She points to strategies used by NASA to teach students how to conduct safe handoffs before they arrive at the clinical arena with structured information. Along with helping students identify potential errors with the fresh perspective described by Patterson et al. (2004), the HTT has been useful as an organizing structure for students who frequently perceive first handoff encounters with pediatric patients as chaotic. Using a standardized system to attend to basic safety issues during shift changes helps all nurses, particularly student nurses, to accurately document and effectively communicate critical aspects of care while augmenting efforts to engage multidisciplinary personnel for complete care continuity.

In short, HTT empowers students to better plan for and provide competent, focused, quality care by addressing specific pediatric risk factors related to fluid volume status, intravenous access and patency, oxygen administration, monitors, and age-appropriate parameters. It verifies the transfer of information at handoff and provides a fresh perspective that can intercept potential problems at the beginning of a shift. The large number of errors identified in this process reinforces the need for a systematic checklist method that can be used at time of shift change.

Human factors, such as stress, distraction, and communication problems, increase the risk of errors during routine shift changes; therefore, it is critical for nurses to employ strategies ensuring timely communication of complete and accurate patient information. It seems obvious this is essential for reducing errors and patient harm associated with this daily transitional fact of nursing life. Teaching students techniques for verifying information at the time of handoff can raise their awareness of potential errors attributable to incomplete or inaccurate information. The HTT offers a common language and a standardized routine system for reducing errors during handoffs, and is based on hospital policy. These attributes have contributed to incorporation of the 30-Second Head-to-Toe into orientation of all new pediatric nurses in a large teaching hospital in North Central Florida.


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