Patient Handover

This document discusses the case of Mr Lewis, a FIFO worker who sustained partial thickness burn injuries in both lower limbs and feet involving the joints. The document covers the identification, situation, background, assessment, and recommendations for Mr Lewis. It also highlights the importance of ISBAR and nursing standards in patient care. The document is relevant for healthcare professionals and students studying nursing and related fields.

Running head: PATIENT HANDOVER 1
Patient Handover
Students Name
Institutional Affiliation

PATIENT HANDOVER 2
Patient Handover
Part 1
Identification
My name is Nurse Dawn, a general nurse practitioner. Today I received Mr Lewis,
who is a FIFO worker as a transfer inpatient after sustaining a burn injury.
Situation
Mr Lewis is a male patient whose chief complaint is sustaining partial thickness burn
injuries in both lower limbs and feet involving the joints. I am referring this patient since he
can benefit adequately at the burns’ unit. Vital signs measured at 1400hrs depict that he is
currently stable but needs urgent transfer to a burns unit via Queensland Ambulance Services
(QAS).
Background
Mr Lewis is a 22-year-old male patient who stays in Wally. He is a FIFO worker who
was a victim of a gas bottle explosion. The patient was transferred to the hospital from Fraser
Island. After the burn injury, the patient walked into a police station for assistance but
collapsed on arrival. The patient sustained a mixed burn injury to both limbs (Petrol on
BBQ), had a cervical collar placed due to suspected neck injury and is waiting on transfer to a
burns unit. The patient has no history of chronic illnesses or previous hospital admissions.
The patient reports no known drug or food allergies.
Assessment
Mr Lewis is under the following treatment; Paracetamol 1g PRN, ibuprofen 400mg
TDS, Morphine 5mg PRN, Multivitamin, topical antibiotic cream and 0.9% normal saline.
Vital signs taken are as follows; temp-37.9⁰C, pulse- 98 beats/min, BP- 128/75 mm Hg,

PATIENT HANDOVER 3
Spo2- 98 RA, RR- 20 breaths/min and a pain score of 3. The vital signs are within normal
ranges apart from the temperature of 37.9⁰C, which is high compared to normal ranges of
36.5-37.5⁰C (Ljunggren et al., 2016 pp 21). Mr Lewis can move his head and neck with no
pain or stiffness ruling out any injuries when he collapsed, but he still has the soft collar
insitu.
Mr Lewis reports pain on both feet, the wound is moist and evidence of swelling and
oozing of fluid from the breaking blisters. There are blisters at the ankles and towards the
toes on the dorsum part of the feet and the wound is red but blanches when pressure is
applied. In the calculation of total surface area burnt using the rule of nines, Mr Lewis has
sustained burns to both feet involving the joints. A burn on the anterior feet adds up to 13/4%
as well as the posterior. Hence the total surface area burnt is 3.5% of the entire body surface
area (Harish et al., 2015 pp 91-99). CT scan of the head and neck has been done awaits
reporting to confirm any soft tissue damage.
Recommendations
Mr Lewis has received fluids, IVC boluses of 0.9% normal saline, pain medication,
topical antibiotic cream applied. The patient is for insertion of the urinary catheter to monitor
urine output giving a picture of the kidney function (Prowle, Kirwan, Honoré, Jacobs and
Spapen, 2019 pp 209-214). Before transferring the patient, I would repeat the vital
observations and physical assessment to monitor for any signs of complications. The patient
needs an urgent senior review to prevent compartment syndrome. Aseptic technic is required
in the handling of the wound to promote healing and to avoid infection. The wound is to be
covered by bluey before transfer; hence, RBWH needs to initiate dressing with silver
sulfadiazine to prevent contamination.

PATIENT HANDOVER 4
Importance of ISBAR
ISBAR tool is applied in the clinical setting in everyday situations. It majorly applies
in the clinical handover of patients, referrals, giving ward reports, distribution of emails and
Memos and in personal interactions among a clinical setting. It ensures continuity of
information and completeness. By use of this tool, one ensures all aspects of information
regarding a patient is indicated hence enhancing patient care. It ensures no patient
information is left out when giving out patient report during a patient hand over or referral.
Communication among clinicians is made efficient by the use of ISBAR (Kostoff, Burkhardt,
Winter and Shrader, 2016 pp. 157). While applying the tool, information is organised
precisely stating the critical details on the condition of the patient and the management
already implemented. It indicates the needs of the patient to the other clinician hence
promoting teamwork among medical practitioners, thus effective patient care.
In the application of ISBAR in a clinical setting, it enables the medical practitioners to
be aware of the critical information that should be passed on while handing over a patient. It
identifies the patient and the participating clinician explaining the patient condition to ensure
continuity of care with no missed findings (Pang, 2017 pp 01019). Time is an important
aspect when it comes to patient care, ISBAR tool is time-bound hence can help communicate
the urgency of a situation. A deteriorating patient as from the assessment can imply that the
clinician receiving the patient needs to act promptly. ISBAR promotes quality and safely care
for patients in between the change of primary care provider or during patient transfer.
Part 2

PATIENT HANDOVER 5
Nursing standards (NSQHS) aim to ensure quality healthcare standards are
maintained in the clinical setting and protect the general and key population from ill-treat
(Flanigan, 2016 pp 23). They yield a guarantee that effective mechanisms of operation are
achieved and quality standards of care are applied. Based on the standard of clinical
governance, I should have assessed patient airway, c spine and breathing due to suspected
neck injury. In the airway assessment, I should check for the presence of snoring, stridor or
increased secretions (Donaldson, 2018 pp 1-16). Apart from counting the respiratory rate, I
should have checked the chest expansion, use of accessory muscles, auscultate for abnormal
breathe sounds to document breathing effectively.
Blood circulation is vital in providing nutrients and oxygen to tissues and eliminating
wastes. In assessing for circulation, I should use the 5Ps; pallor, pain, pulse, paralysis and
paraesthesia. In reference to blood management standard, I should ensure the safety of
patients' blood and efficiency (Meybohm et al., 2017 pp 62-71). I should observe the colour
of extremities and capillary refill of the patient to conclude the circulation status. I should
assess the mental state of the patient majoring on the GCS and 4AT to determine the
probability of disability that might indicate impending complications. Checking for alertness,
orientation gives light to the probability complications as stated by the standard of
recognising and responding to acute deterioration (Anstey, Bhasale, Dunbar and Buchan, 201
9 pp. 1-7). The mental test enables one to anticipate the probability of trauma to the brain
during the fall.
Based on the comprehensive care standard, I should have been at per timeline with
documentation of vital signs (Fealy et al., 2019 pp 80-88). In the emergency scenario like in a
patient with a burn injury, I should record vital signs hourly and interpret in reference to
normal ranges. This ensures continuity in care and prevention of complications. The patient
tends to lose lots of fluid due to broken skin; hence, I should put in place a catheter for

PATIENT HANDOVER 6
monitoring output to assess the kidney function to avoid chances of acute kidney injury. At
the same time, I should evaluate the patency of the catheter to prevent blockage, trauma to the
patient and also avoid contamination.
Infection prevention is a crucial aspect in the clinical setting. In the case of a burn
injury, the wound should be dressed aseptically using Aseptic Non-Touch technique. This is
in line with the nursing standard of preventing and controlling healthcare-associated
infections. A series of infections can lead to reduced microbial susceptibility to
antimicrobials (Shaban, Macbeth, Vause and Simon, 2016 pp. 51-61). As emphasized by the
nursing standard of communicating for safety, I should document the interventions
implemented and evaluate the patient. This helps during a patient hand over to prevent
overdosing or under-dosing (Steel, 2016 pp 26). Documentation of interventions and total
patient score enable the next clinician to get a clear definitive picture of the patient hence
promoting patient care.

PATIENT HANDOVER 7
References
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