You’re only as good as your handover part III: The system

This is the final post in our series about handover.

There are lots of good systems around. This isn’t necessarily the best one, but it’s one lots of people use. It’s easy to remember, it’s flexible, it matches most hospitals and most of all it’s thorough.

All you need to do, is twist it to suit your case.

It’s called I-MIST-AMBO

It works as follows:

I– Identity of patient: Usually name and age. Some places will want a DOB as well. It often works to add a one sentence summary of the presenting problem here as well.

M– Mechanism/ medical complaint: How did the patient end up the way that they are? Don’t be afraid to spend a bit of time here.

I– Injuries sustained or information related to the medical complaint. This usually includes what they were doing when it happened, their position, initial feeling, loss of conciousness, etc.

S- Signs and symptoms: Pain? Altered sensation? Hypotensive? Photophobic? Chuck it in there.

T- Treatment and trends: Talk about what you have (or haven’t done) and what the effect of that intervention was. Has the patient improved or is there no change?

A– Allergies

M- Medications (what the patient usually takes, adherence, if there’s been changes etc.)

B- Background. This one can often be moved higher in the order depending on needs (for example a pregnant patient it’s worth stating that her last delivery was by emergency caeser) . Some times it’s worth splitting as well, most important stuff early on, and then other things further down the track.

O– Other- Those bits of information that don’t fit anywhere else

Remember, handover is communication and therefore it’s a two way street. Don’t be afraid to make it a bit more of a conversation if necessary and be flexible with moving things around.

Here’s an example:

This is Phil Jones, 70 YOM, Acute Pulmonary Odema.

Phil woke from bed at 0300HRS short of breath, dizzy and called us. No abnormal routine before bed.

Phil was found sitting on his bed, dizzy, nauseas, distressed, poor tidal volume, pale, weak. GCS 14 with confusion, BP 180/104, HR 65, SPo2 84% Temp 36.4 BGL 6.0, ECG no changes, resp rate 32, coarse crackles both fields.

Over the last 20 minutes we’ve given total 1200mcgs GTN good effect, running 15 LPM brought sats up to 91% and then had him on CPAP for the last 10 minutes. 18g cannula left Cubital Fossa

Last BP 140, SPo2 95%.

No known allergies.

Patient doesn’t know what medication they are on, we looked around the house and couldn’t find any.

Phil has a complex cardiac history including AMI’s and stenting. He has been seeing his GP and a cardiologist regularly but his wife is unsure of the reason, last hospital admission was over a year ago for hip replacement, no ICU admissions. His wife will be here within the next 10 minutes and can provide further information.

Any Questions?

 

What system do you use?