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Change in condition and handoff: the steps to remember

The short step lists from each lesson of Change in condition: notice it, describe it and hand it off, on one page. Print it for the station or the break room. Each list points back to its lesson, where the sources are linked.

Open the coursePrint a poster with a QR code

Lesson 1

Start with the person’s usual pattern

On every shift you decide whether what you see is new for this person. "Normal" is different for each person, so you compare with this person’s usual pattern. This lesson prepares the first step of every handoff: a plain description of what changed, with no guess about why.

  1. Know the plan and this person’s usual pattern
  2. Say what changed, not what you think caused it
  3. Say when it began and if it is getting worse
  4. Give a number only if you measured it
  5. Report a sudden change, even with a known condition

Lesson: alwbeta.com/training/courses/change-in-condition-and-closed-loop-handoff#lesson-baseline

Lesson 2

Use the plan and the procedure to set urgency

When you see a change, you decide how fast to raise it. You do not decide that alone: the person’s plan and your site’s procedure set the path. This lesson shows how to follow that path, and why a handoff tool never comes before emergency action.

  1. Emergency: start the site’s emergency process; call 911 when it applies
  2. Urgent or routine: follow the plan and the current procedure
  3. If the procedure says call now, call now
  4. No answer: use the approved backup
  5. Write down whom you tried and whom you reached

Lesson: alwbeta.com/training/courses/change-in-condition-and-closed-loop-handoff#lesson-urgency

Lesson 3

Build a handoff the listener can act on

When you hand off a change, you decide what to say and what to leave out. The listener needs the concern, the context that matters and a clear request. They do not need the whole history of the day. SBAR gives you an order to follow.

  1. Situation: what changed, and is the person safe?
  2. Background: what does the listener need to know?
  3. Assessment: what did you see, hear or measure, and why does it worry you?
  4. Request: what do you need, and by when?
  5. Direction: write their words and read the key details back

Lesson: alwbeta.com/training/courses/change-in-condition-and-closed-loop-handoff#lesson-structured-handoff

Lesson 4

Confirm that the message arrived

A message that was sent is not the same as a message that was understood and owned. Before you move on, you decide whether the loop is closed: someone got the message, someone owns the next step, and there is a time to review it.

  1. Sent is not received: confirm it arrived
  2. Ask the listener to repeat the key details
  3. Write the next action, its owner and the review time
  4. Silence, refusal or conflict: go up the approved chain
  5. At shift change, name what is still open

Lesson: alwbeta.com/training/courses/change-in-condition-and-closed-loop-handoff#lesson-check-back

Lesson 5

Write the note the next person will continue from

When you write the note, you decide what the next person will know. A good note lets them act without guessing which part was observation, which was instruction and which is still unfinished.

  1. Time, change and usual pattern
  2. What you did and whom you told
  3. Your observation, their words and the nurse’s direction, kept apart
  4. Failed contacts and the backup you used
  5. Next check: what, who and when
  6. Fix errors openly; never backdate or erase

Lesson: alwbeta.com/training/courses/change-in-condition-and-closed-loop-handoff#lesson-document-and-follow

Beta’s ALW team, course version 2026.10.3, text checked against its sources on September 4, 2026. Educational only. Not continuing-education, licensure or regulatory credit. Follow your employer’s current procedure and the person’s current plan. Call 911 for a medical emergency.

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