Comparison of a Nurse-Nurse Handoff Mnemonic with Real-World Handoffs

Background: Communication failures, including clinical handoff or clinical handover errors, contribute to 80% of all serious preventable adverse events each year. The N-PAS, N = Nurse, P = Patient Summary, A = Action Plan, and S = Synthesis, is a flexible standardized clinical handoff tool for nurses. Purpose: The purpose of this study was to determine the proportion of N-PAS core components present in real-world patient handoffs. Methods: A mixed-methods design was used to analyze secondary data. Patient handoffs (n = 138) were transcribed into statements and then independently coded by 2 research assistants. Results: Of all handoff statements, 63.2% were coded as Patient Summary and 13.6% were coded as Action Plan, whereas Synthesis was not coded in any handoffs. Three new Patient Summary elements and 1 new Action Plan element were identified. Conclusion: Patient Summary and Action Plan are critical data reported during clinical handoff. A handoff synthesis is a critical step to include in handoff training.