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UF Health NICU Pediatric Resident Sign-out AssessmentHandoff Assessment ToolResident: _____________________PGY level: _____Date of observation: ____________Observer: _____________________Overall grade:StellarAbove averageAverageBelow AverageInadequateFeedback/Suggestions: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________StellarAverageInadequateCommunicated all important issues (medical and relevant social)Communicated most but not all important issuesOmitted many important issuesProvided accurate clinical information on all patients, including arterial/central venous lines, respiratory support, and current medicationsDid not provide all pertinent information or provided inaccurate clinical information on a few patients, including arterial/central venous line access, respiratory support, and current medicationsProvided incomplete or inaccurate clinical information on more than a few patients, including arterial/central venous access, respiratory support, and current medicationsAnticipated most critical issues Failed to anticipate most likely issue in a few patientsFailed to anticipate most likely issue in more than a few patientsProvides anticipatory guidance by detailing “if, then” statements in all applicable casesProvides anticipatory guidance by detailing “if, then” statements in most applicable casesProvides anticipatory guidance by detailing “if, then” statements in fewer than most applicable casesCommunicated the anticipated plan of care in all patientsCommunicated the anticipated plan of care in most patients`Communicated the anticipated plan of care in fewer than most patients`Check listener’s understanding of key issues and answered questions thoroughly Answered listener’s questionsToo hurried to check listener’s understanding or to answer questions, concern for patient safety with such a sign outClearly mentions things to do and follow: labs, drug levels, X-rays, Consent forms etc. for the next person for ALL the patientsPartially mentions things to do and follow for the next shift person in MOST patientsFails to mention important things to do/follow for ALL patients Definitions:ALL95-100%MOST75-95%FEWER THAN MOST<75%FEW5-25%MORE THAN A FEW>25% ................
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