How the PSA Handoff Form Works

By Melinda Young

This is how the Patient Safety Attendant Handoff Form works:

• Main information. The form includes six boxes of information for PSAs to complete. The first two boxes contain the handoff nurse’s name, a nurse phone number, and instructions for nurses to perform handoffs with prior and current PSAs present and check in with the PSA every two hours.

• SBAR boxes. The other boxes each correspond to SBAR: a box for Situation, one for Background, a third for Assessment, and the fourth for Recommendation.

- The situation box asks for the patient’s name, code status, medical history, and language barriers.

- The background box asks why a PSA is required and what precautions need to be taken, such as isolation, suicide, and fall risk.

- The assessment box asks for the patient’s activity level; routine and schedule of therapy, vitals, and meds; and medications the nurse handles.

- The recommendation box addresses the patient’s triggers to avoid; de-escalation techniques; things the patient enjoys, such as food, TV shows, and more; and expectations of the PSA.