# A nurse is adopting the I-PASS structured handoff tool for end-of-shift report. Which elements should be included in an effective I-PASS handoff? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372862&lang=en  
> language: en  
> subject: Management of Care  
> category: MOC

## Question

A nurse is adopting the I-PASS structured handoff tool for end-of-shift report. Which elements should be included in an effective I-PASS handoff? Select all that apply.

1

Illness severity — explicitly state whether the patient is stable, "watcher," or unstable so the receiving nurse can prioritize.

2

Synthesis by the receiver — the receiving nurse summarizes back, asks questions, and confirms the plan before the handoff is complete.

3

Action list — clearly defined to-dos with the responsible person and timeframe (for example, "RN to draw 0700 trough").

4

Patient summary — concise overview including diagnosis, key events of the shift, and current plan of care.

5

Personal opinions about the patient or family that the receiving nurse may find useful, even if not part of the chart.

## Explanation

I-PASS = Illness severity, Patient summary, Action list, Situation awareness/contingency planning, Synthesis by receiver. Choice 5 (personal opinions) is unprofessional and outside structured handoff — handoffs convey clinical facts, not unverified judgments about patients/families. The closing synthesis is what makes I-PASS evidence-based: studies show a 30% reduction in preventable adverse events when receivers actively read back and synthesize.

## In-depth explanation

I-PASS was developed at Boston Children's and validated in a multi-center trial showing 23-30% reduction in medical errors and adverse events. The most under-used component is "Synthesis by Receiver" — the receiver summarizes back, which catches misunderstandings before they harm patients.

## Clinical scenario

The medical-surgical unit has adopted **I-PASS** as a structured handoff tool to reduce omitted information and adverse events at shift change. The nurse is preparing the first I-PASS report for the oncoming nurse.

## Key concepts

- **I-PASS** — Mnemonic: Illness severity, Patient summary, Action list, Situation awareness/contingency, Synthesis by receiver.
- **Synthesis by receiver** — Receiver verbalizes back the key points, asks clarifying questions, and confirms the plan before handoff ends.
- **Joint Commission handoff goal** — National Patient Safety Goal requiring standardized communication during handoff to prevent omissions.

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