A Handover Note That Could Harm the Patient
A staff nurse at the end of a night shift writes the following entry in the ward handover book: 'Patient in bed 12 was given antibiotic at 2 am and was better. Doctor visited late and said dressing should be done daily but it was not changed because it was not required according to the night nurse. Vitals were checked half hourly then stopped. Patient's attendee is not happy about something and wants to meet the doctor, maybe about the bill, please see.' The day nurse reads this at 08:00 and has five minutes before the ward round begins. The patient is a 58-year-old man on intravenous antibiotics for a diabetic foot ulcer. The night nurse who wrote the entry is a trainee in her third week, and the ward uses the entry as the legal record of the night.
1. Rewrite the entry as a clear, factual handover in no more than 60 words, keeping every clinically relevant fact and dropping every fact that cannot be verified.
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Model rewrite (54 words): 'Bed 12, 58-year-old man, diabetic foot ulcer on IV antibiotics. Antibiotic given 02:00; temperature 37.4 °C at 04:00, down from 38.9 °C at 22:00. Dressing not changed overnight - surgical team has ordered daily changes; please confirm at ward round. Vitals half-hourly 00:00–04:00, stable, then 4-hourly. Attendant wants to speak to a doctor; reason not yet established.'
Why this version works:
- Every claim is sourced and timed. 'Better' becomes a temperature with a number and a time; 'late' becomes nothing at all.
- The action that is still pending is stated as pending - the dressing - so it cannot be misread as done and cannot be dropped.
- The attendant's concern is recorded as unknown. Speculation about the bill has been removed; a real concern and a wrong guess look identical in a record and only one of them is safe.
- It is shorter than the original while carrying more usable information. Length is not the measure of a handover; testability is.
2. Identify every place where the original entry is ambiguous or unverifiable, name the exact word or phrase causing the problem, and say what should have been recorded.
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1. 'was better' - an impression with no criterion attached. Better in what respect: temperature, pain, appetite, mobility? Record instead: a measurement with a time, e.g. temperature 37.4 °C at 04:00.
2. 'Doctor visited late' - 'late' is a judgement about someone else's conduct, is unverifiable, and reads as a complaint rather than a record. It also names nobody. Record instead: 'Surgical registrar reviewed at 01:40.'
3. 'it was not changed because it was not required according to the night nurse' - three faults in one clause. The pronoun 'it' could refer to the dressing or to the change; the authority is unclear (did the night nurse decide the dressing was unnecessary, or did she believe the order started later?); and 'according to the night nurse' attributes a clinical decision to a trainee in her third week. Record instead: 'Dressing not changed overnight. Order is daily change; timing of first change not clarified - for ward round.'
4. 'Vitals were checked half hourly then stopped' - 'stopped' implies they ceased altogether, and there is no time for the change. Record instead: 'Half-hourly until 04:00, then 4-hourly as ordered.'
5. 'not happy about something … maybe about the bill' - speculation presented alongside fact, with no way to tell them apart later. Record instead: 'Attendant requests to speak to a doctor; concern not stated.'
The through-line is that the entry records impressions and omits measurements, times and names - exactly the elements that make a note usable at 08:00 and defensible at an enquiry six months later.
3. The sentence 'Doctor visited late and said dressing should be done daily but it was not changed because it was not required according to the night nurse' is grammatically and stylistically faulty. Identify the faults and produce a corrected version. Then comment on the word 'attendee' as used in the original entry.
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Faults identified:
- Missing articles: 'Doctor' and 'dressing' need 'the' - 'the doctor', 'the dressing'.
- Two pronouns, one form: 'it was not changed' and 'it was not required' - the first 'it' is the dressing, the second could be the dressing or the change. The reader cannot tell which.
- Misplaced attribution: 'according to the night nurse' sits at the end and appears to modify 'not required', but it could equally attach to 'was not changed'. Word order has made the source of the decision ambiguous.
- Reported speech without backshift or precision: 'said dressing should be done daily' loses both the speaker's name and whether the instruction was new, repeated, or a clarification.
- Judgement word in a factual record: 'late'.
Corrected version: 'The surgical registrar reviewed the patient at 01:40 and ordered the dressing to be changed daily. The night nurse did not change it, as she understood the order to begin with the morning round.'
Two sentences, two clear agents, one unambiguous pronoun referent, and the uncertainty is named as uncertainty rather than hidden.
On 'attendee': in Indian hospital usage 'attendee' means the patient's relative or bystander. In standard English, an attendee is a person present at a meeting or event, so an external reader - a medical board, an auditor, a patient's family - will misread the sentence. 'Attendant', 'relative' or 'bystander' is unambiguous. The wider point: passive constructions and shorthand are not neutral. They conceal who decided what, which is precisely the information a handover note exists to preserve.