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REVIEW OF IPASS
Robin Mackin PGY-3
GOALS OF THE PRESENTATION:
Familiarize with IPASS format
Emphasize importance of following IPASS
WHY IPASS?
IPASS
Miscommunication is the leading cause of adverse events
As a result of decreased duty hours, there is an increased frequency of handovers
IPASS came from a prospective systems based intervention study on inpatient units across 9 children hospitals
Implemented IPASS handoff bundle (written and oral) to resident physicians.
The medical-error rate decreased by 23% from the preintervention period to the postintervention period
Rate of preventable adverse events decreased by 30%
Avg time per patient pre intervention 2.4min, post 2.5 min
ARRIVING TO HANDOVER
The Senior Resident (or delegate) should introduce their team with the following
information:
Number of Patients on their team
Number of Watchers on their team
Proceed with handing over the Watchers
Continue with handing over the rest of the patients in order of the team’s list
Pearl: Think to yourself, what information would I require if I were receiving this
patient to care for overnight
IPASS – HOW TO HANDOVER PATIENT INFORMATION
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.
Specific directions
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”
Determine who should be doing the synthesis
before handover (junior resident vs senior resident)
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
IV.
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, but she is still having diarrhea.
She is tolerating some po intake so her IVF were decreased to ½ maintenance at noon.
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 *HAND THIS PATIENT OVER FIRST
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 and her u/o has been about 5cc/kg/hr.
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. PACE is
still following.
She is currently NPO for tachypnea, previously TFI of 130cc/kg/d via NG. While NPO she is running IVF D5NS + 20KCl @ 3/4M.
A: From a respiratory standpoint, she requires ongoing reassessment as she may need HFNC if symptoms progress. 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. If her tachypnea significantly improves, consider restarting feeds and stopping IVF.
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
HANDOVER ETIQUETTE
Create a positive, respectful environment!
Zero tolerance policy for “eye rolling” culture
Minimize distractions to handover
No side conversations should be taking place in the handover room
If your team is not presenting, it would be optimal to wait outside of the room until the other team is
finished.
Minimize interruptions of junior learners
Wait until they are finished presenting to add pertinent details
If a junior learner was away in the afternoon for teaching, ensure they know the updates about their
patients if you are expecting them to present at handover.
GENERAL REMINDERS FOR RESIDENTS
Senior residents should model handover of the clerk’s patient on their first day of CTU
Try to make time to run the list before the end of the day so everyone is on the same
page and the list is up to date
Try to practice handing over patients with junior learners prior to handover (Float &
CTU) & provide feedback after handover
Encourage standardization of the handover list
Attempts to keep templates on the bottom of the list
Delete irrelevant information (ie. lab work)
THANK YOU FOR LISTENING!