Session 4 · Interactive Scenarios · run live
Pose the brief · work each prompt · branch on their answers
2.1 · Write the note
2.2 · Hand it over
2.3 · The vague handover
Scenario 2.1

Write the note

Brief — read aloud

Mrs Ellen Carter, 74, day 1 post-op. At 1450 she becomes breathless. You assess: RR 26, SpO₂ 89% on room air, HR 108, BP 138/86; she looks anxious and says "I can't catch my breath." You apply O₂ 2 L via nasal prongs and SpO₂ rises to 95%. You escalate to the MO, Dr Ahmed, at 1455, who reviews at 1505 and charts an antibiotic. The class drafts the progress note live.

How to run: draft the note together on the board or in the box below. Work each prompt, then reveal the model and compare for completeness.

Decision points

1 · What is objective vs subjective here — and how do you record each?
Listen for — Subjective = the patient's own words, in quotation marks: "I can't catch my breath." Objective = measured / observed: RR 26, SpO₂ 89%, HR 108, BP 138/86, O₂ applied, SpO₂ → 95%.
Teaching point — "Looked short of breath" is opinion, not data. Quote the patient; give the numbers.
If they're vague → a candidate writes "patient distressed / SOB" — push: what did she say, and what did you measure?
2 · Show the correct way to fix a wrong word on a paper note.
Listen for — A single line through the error, the correct word written beside it, then initial + date/time. The original must stay legible.
SpO₂ 89% 98%  — single line, correct value, initial + time: JS 1452
If they reach for correction fluid / scribble it out → that obscures the original and destroys the legal integrity of the record. Never white-out, never erase.
3 · Did the entry capture who was notified, when, and the outcome?
Listen for — "Dr Ahmed (MO) notified at 1455; reviewed at 1505; antibiotic charted." Who, when, and what happened.
Teaching point — Escalation only counts as evidence if it's recorded. No name + time + outcome = it didn't happen.
If they write "escalated / notified MO" → push for the name, the exact time, and the outcome of the review.

Draft the note live

Model note · DAR
22/06/2026 · 1450
D: Patient acutely breathless. States "I can't catch my breath." RR 26, SpO₂ 89% RA, HR 108, BP 138/86; appears anxious.
A: Applied O₂ 2 L via nasal prongs — SpO₂ improved to 95%. Dr Ahmed (MO) notified at 1455.
R: Reviewed by MO 1505; antibiotic charted (see medication chart). Patient settled — RR 20, SpO₂ 95% on 2 L. Continuing close monitoring.
— [Name], RN
Scenario 2.2

Hand it over

Brief — read aloud

End of shift. Hand over Mr George Walsh, 81, DOB 11/01/1945, MRN 308221, Bed 7. Admitted with a UTI; new confusion over the past day. Falls risk (confusion + age). Penicillin allergy — anaphylaxis. Obs: BP 118/72, HR 96, Temp 37.9, EWS 2. On IV fluids and a non-penicillin antibiotic. Pending CT head this evening. Hand over to the night RN.

How to run: have a candidate deliver the handover aloud; tick each ISOBAR letter as they cover it. Work the prompts, then debrief the most-dropped letter.

Decision points

1 · Run the full ISOBAR — which letter is most often dropped?
Most-dropped — A (Assessment / clinical judgement) and the explicit R (transfer of responsibility). Candidates reel off data (O and B) but skip what they think is happening and the actual handoff.
Teaching point — the receiver needs your interpretation and an explicit "I'm handing responsibility to you" — not just a data dump.
2 · How do you confirm the patient AND the receiver?
Listen for — Patient via two identifiers (full name + DOB or MRN) against the armband; confirm the night RN's name and role; flag the anaphylaxis allergy band.
If they skip identification → stop them: this is an automatic NYS. No handover starts without it.
3 · Which risks must transfer with the patient tonight?
Every one of these must transfer — falls (confusion + age) · delirium · penicillin anaphylaxis (allergy alert) · the pending CT head (must happen + chase the result) · sepsis / deterioration (UTI, temp 37.9). Drop any one and it's an omitted-risk failure.

Track the handover live

ISOBAR letters covered
{{ isoProgress }}
✓Identify name · 2 IDs · receiver
✓Situation UTI + confusion
✓Observations obs + EWS
✓Background allergy · meds · CT
✓Assessment often dropped
✓Responsibility risks + handoff
Risks transferred
{{ riskProgress }}
✓Falls risk (confusion + age)
✓Delirium (new confusion)
✓Penicillin anaphylaxis alert
✓Pending CT — do it + chase result
✓Sepsis / deterioration (temp 37.9)
Scenario 2.3

The vague handover

Brief — read this out, deliberately badly

"Yeah, bed 4… he's fine, obs are okay, had a good day, nothing much to report. See you tomorrow."

How to run: read it cold, let it land, then have the class dismantle it against ISOBAR and rebuild it together.

Decision points

1 · List everything missing against ISOBAR. Tick as the class names each.
{{ missProgress }} named
✓Identify — no name, no two identifiers, no receiver confirmed.
✓Situation — why is he even admitted? Not stated.
✓Observations — "obs are okay" gives no numbers and no EWS.
✓Background — no history, allergies, medications or pending tests.
✓Assessment — no clinical judgement of how he's tracking.
✓Responsibility — no risks, no tasks, no explicit transfer.
2 · What is the safety consequence of each omission?
No identification → care or medication given to the wrong patient.
No observations → a deteriorating patient is missed overnight.
No background / allergy → a harmful or fatal medication is given.
No assessment → the receiver can't prioritise or anticipate.
No risks / responsibility → falls happen, tasks fall between shifts, no one owns the patient.
3 · Rebuild it correctly as a class.
Rebuilt — a complete ISOBAR
I — "I'm [name], RN, handing over to you, [night RN]. Bed 4 is Mr Tom Reilly, DOB 03/05/1957, MRN 220148 — confirmed on his armband. No known allergies."
S — "Day 2 with cellulitis to the left lower leg, on IV antibiotics; clinically improving."
O — "1600 obs: BP 126/78, HR 80, RR 16, SpO₂ 97% RA, Temp 37.2, EWS 0. Pain 2/10."
B — "Admitted 18/06; T2DM, otherwise well. IV flucloxacillin 6-hourly, next dose 1800. Morning bloods unremarkable."
A — "Responding well — leg erythema reducing. Stable."
R — "Risks: IV cannula day 2, watch for fever. Next antibiotic 1800, continue 4-hourly obs, no outstanding tasks. I'm handing responsibility to you — any questions?"