Key Takeaways
- Continuity of care ensures patients receive consistent, coordinated care across settings and providers
- Handoff communication must be complete, accurate, and include critical information about patient status
- The LPN/LVN participates in shift reports, transfers, and discharge planning under RN supervision
- Effective care transitions reduce errors, readmissions, and patient harm
- Documentation serves as the primary tool for maintaining continuity across care episodes
Continuity of Care
Continuity of care refers to the coordination and consistency of healthcare services as patients move between providers, settings, and over time. The LPN/LVN plays a vital role in maintaining this continuity through accurate documentation, effective handoff communication, and participation in care transitions.
Types of Care Transitions
| Transition Type | Examples | LPN/LVN Role |
|---|---|---|
| Shift change | Day to evening shift | Give/receive report, ensure task completion |
| Unit transfer | Med-surg to ICU | Accompany patient, provide report |
| Facility transfer | Hospital to SNF | Prepare documentation, communicate status |
| Discharge | Hospital to home | Reinforce teaching, prepare materials |
| Provider change | One nurse to another | Complete handoff, update care plan |
Handoff Communication
Effective handoffs prevent errors. The Joint Commission identifies communication failures as a leading cause of sentinel events.
Essential Handoff Elements:
| Category | Information to Include |
|---|---|
| Patient identification | Name, room, age, diagnosis |
| Current status | Vital signs, pain level, recent changes |
| Recent interventions | Medications given, procedures done |
| Pending tasks | Labs due, medications scheduled |
| Safety concerns | Fall risk, allergies, isolation |
| Family/social | Visitors, family concerns, code status |
I-PASS Handoff Method
The I-PASS framework is an evidence-based handoff tool:
| Element | Description | Example |
|---|---|---|
| I - Illness Severity | Stable, watcher, or unstable | "This patient is a watcher" |
| P - Patient Summary | Brief clinical summary | "72-year-old with CHF exacerbation" |
| A - Action List | Tasks to be done | "Next dose of Lasix due at 1800" |
| S - Situation Awareness | What to watch for | "Monitor for increased respiratory distress" |
| S - Synthesis | Receiver summary | "So the main concern is his breathing" |
Shift Report
Giving effective shift report:
- Organize information - Use consistent format
- Prioritize concerns - Lead with urgent issues
- Be concise - Avoid unnecessary detail
- Encourage questions - Ensure understanding
- Walk-through when needed - Bedside report for complex patients
Receiving shift report:
- Take notes - Write key information
- Ask questions - Clarify unclear points
- Verify critical data - Confirm allergies, code status
- Plan your assessments - Identify who to see first
Transfer Documentation
When patients transfer between units or facilities, the LPN/LVN helps ensure:
| Documentation | Purpose |
|---|---|
| Transfer summary | Overview of hospital course |
| Current medications | Reconciliation list |
| Allergies | Verified allergy information |
| Recent vitals and labs | Baseline data for receiving unit |
| Special needs | Equipment, precautions, preferences |
| Family contact | Emergency contact information |
Discharge Planning
The LPN/LVN contributes to discharge planning by:
- Reinforcing education provided by the RN
- Gathering information about home situation
- Identifying barriers to care at home
- Preparing materials for patient to take home
- Reporting concerns about readiness for discharge
Never discharge without RN or provider authorization.
Documentation for Continuity
Good documentation ensures continuity:
| Documentation Principle | Why It Matters |
|---|---|
| Accurate | Others rely on your information |
| Complete | Gaps lead to missed care |
| Timely | Delayed documentation may be forgotten |
| Legible | Unreadable notes are useless |
| Objective | Subjective opinions can mislead |
Common Continuity Failures
| Problem | Consequence | Prevention |
|---|---|---|
| Incomplete handoff | Missed medications or tasks | Use structured handoff tools |
| Medication discrepancies | Wrong doses, duplications | Medication reconciliation |
| Lost information | Repeated tests, delayed care | Complete documentation |
| Poor communication | Misunderstandings | Read-back, clarification |
On the NCLEX-PN
Expect questions about:
- What information must be included in handoffs
- The LPN/LVN role in discharge planning
- When to escalate concerns during transitions
- Documentation requirements for continuity
During shift report, the outgoing LPN states that a patient's blood glucose was 45 mg/dL this morning. What should the incoming LPN do first?
An LPN is preparing a patient for transfer to a skilled nursing facility. Which action is most important for ensuring continuity of care?