The Physiotherapist's Referral Handover Checklist

This library ends each clinical series with its handover, and this one has the most physical stakes of the set: it is the document that lies between a new support worker and the transfer that was wrong, the program that was thrown away, the equipment that has drifted, the fall and weeks of unreported precursors to it.

The components have been written in this series: the program, the transfer page, the falls brief, the maintenance floor, the equipment brief, the pathway to participation, and the handover is their assembly: one document, written by the physio, that makes any competent worker safe and useful with this person's body from the first shift. Here is the format.

The checklist

The person, moving. Two or three sentences about who this is and what movement means to them, the garden he is working toward, the independence she defends with fierce passion, the pace that respects, rather than patronises. In a document about bodies the body remains a person's.

Status of movement, in doing-language. What the person does independently, how much assistance is needed, and how far the person is able to walk during the day in the actual sequences: the person walks independently in the house, tires after roughly twenty minutes upright, and needs standby on the back step. This series is graded-contribution all the way; what they do is as important as what they need, which is the therapy.

Transfers and manual handling. The transfer page of article two, embedded or attached: setup, sequence, contribution, technique, equipment settings, never-items with one-line-reasons, gate requirement stated: no unsupervised transfers before demonstration standard is met.

The program and floor. Current programme as one-page worker sheet, completion reporting frame, what the dosage floor means, and for maintenance phase patients, what dropping below the dosage floor means.

The use of equipment, settings and watching. Article five's page: location of items in the routine, marked and photographed specifications, report-list for drift and selective abandonment.

Falls and safety choreography. Risk moments and risk management, environmental checklist, observation in plain language: watch-list of precursors, balance line: protecting activity, not preventing movement.

The reporting frame and review triggers. Where it goes, and what changes should lead to contact: new pain, near misses, hardening or changes to the specific trigger for this condition, and the number that answers.

The assembly discipline

The document is usable thanks to two rules. It is one artefact, not seven attachments, the parts fit into three to four pages max, because the worker reads it in the car, and the reading is the safety mechanism, and anything else is kept in the clinical record and this library's genre rules keep it there. Reviewed at each clinical review, re-issued at each significant change, program progression, new equipment, post-fall, post-admission, and with the re-brief gate applying, because a handover detailing last season's capacity misguides this season's risks.

How this plays out in practice

Imagine this document does not exist: a participant that suffers from motor neurone disease, his regular worker is suddenly hospitalised and a replacement is coming in starting tomorrow morning. If there were no handover, tomorrow would be an archaeology project on a progressive state: transfers are guessed, the program is not known, the settings of the equipment are a mystery, the watch list is not there. With it: his person, his pace, his current transfer standard with photographs, the program as it is at its current grade, the never-items (the ventilator among them) and reasons, and the triggers for the fortnight. The shift in the morning is safe, on standard and personal, and the three line report on Friday arrives at the physio as if nothing has changed, operationally nothing has. The handover carried at the highest physical stakes, which is the point of the genre.

Next steps

This month, compile the handover of your most complicated supported patient that you've been writing pieces of in this series. Limit to 4 pages, take a picture of the settings and place the review triggers on the last page where a worker's thumb will locate them.