Patient admitted to Medical Unit at 0300 from Emergency Department. On oxygen therapy of 2 liter flow by nasal cannula with SpO2 of 89%. Intravenous fluids of D 5 ½ NS with 20 mEq KCl at 75 ml/hr infusing in right forearm. IV site clear without redness or edema. Labored and shallow respiratory effort with use of some accessory muscles. Bilateral breath sounds coarse. Tachypneic. Productive cough of thick yellow sputum. Sputum gram stain, culture and sensitivity pending. Chest x-ray results reveal generalized hyperinflation and right middle and lower lobe infiltrates. Tachycardic. Patient sleeping intermittently. 0500 lab tests drawn. ABG: ph 7.33, PaO2 70, PaCO2 47, HCO3 26, SpO2 92%. 0715 vital signs: T 102F, BP 168/94, P 112, RR 32, SpO2 85% in room air. Patient removed nasal cannula. What questions would you ask the outgoing nurses to obtain needed information that was not identified in the report?

The following are the information I need to ask from the outgoing nurse that are not included during the report. 

1. What is the patient's identity, such as name, age/birthday and MRN .
2. Ask also about patient's situation such as why he/she was admitted and patient's diagnosis or primary health problem. 
3. Any Background information such as any past medical history, or any known allergies or relevant social issues that pertains to patient. 
4. Has the patient manifest any unusual occurrence throughout the shift and during the care period?
5. Ask any Recommendations or significant actions as well needed after the shift report or handoff. 
6. With regards to the patient's IVF status, ask when it was given/started such as time and date and current level. 
7. Ask also for the patient's intake and output since it was mentioned patient was given potassium chloride. 
8. Ask about the patient's medication: STAT/PRN medication and to start medications.
9. Ask also for any anticipated changes that are significant to the patient such as pain, if patient is in pain that can be measured by pin scale. 
10. Ask also for other required treatment/care or laboratories that has not yet done. 
11. Ask patient's current progress with the interventions. 

Step-by-step explanation

It is known that Hand-off reports is used and performed during end of shift to provide good quality of continued care of the patients to the next shift.  It may be change of shift report or transfer report. Change of shift report is any significant assessment , intervention and needed care for the patient for example should be relayed properly and concise to the next staff on duty. It includes patient's up to date information regarding his/her condition, treatments, necessary care needed or medications. However transfer report is done when the patient was transferred to other unit or department. In this case scenario we are just focusing on CHANGE SHIFT REPORT .  

1. Base on the scenario above, those questions I answered are the information I need to know that were not identified during the handoff report or shift report. It was noted that the one reporting did not identify who the patient was, just even the patient's name, birthday/age or MRN. This is important to make sure that proper care and treatment was given duly to the appropriate and correct patient. 
2. Patient's primary condition is important to be relayed to the next shift to ensure that the staff are on the right tract on giving the proper care basing on the patient's primary health condition. 
3. Past medical history of the patient is needed since we can also base our care here. For instance the patient has allergic reaction to certain food, at least we can be aware ahead of time that the patient has allergic reactions and prevent giving him/her food or medicine that can aggravate his/her current condition and can create further health problems. Knowing PMH can be one of the healthcare provider's guide for the patient's current treatment. 
4. Any unusual occurrence on patient's health status should be noted so that if this would have re-occurrence the nurse on duty for the next shift already know ahead of time how to address it. 
5. Outgoing nurse should inform the incoming nurse on duty any interventions that need to be done to the patient during the incoming shift. With this the incoming nurse will be able to anticipate any nursing care a patient might need during his/her shift. 
6. During shift report the IV status should be included and it should have a complete report. Time and date the IVF was started and the current level of the IVF should be discussed to alert the incoming nurses when to change it or are there any IVF that was ordered that is for to follow. Availability of the said IVF should also be reported so that the incoming nurse will anticipate ahead of time to obtain another IVF for the next cycle. 
7. Patient's intake and output should be reported in every end of shift to allow the incoming nurse be aware to assess any unusual occurrence such as fluid overload that may relate to the patient's respiratory and cardiac status, since patient manifests also tachypnea and tachycardia.
8. Medication was not mentioned during the shift report. Discuss medications that were given during the previous shift, medication that is about to start, as well as STAT and PRN medications. Medication should be reported to prevent delay in administration and to alert the incoming nurse the medications being ordered. With this, the incoming nurse has the chance to evaluate why such medication was ordered. Also to make the incoming nurse be alerted not to delay due medications and medications that are still TO START including STAT and PRN. 
9. Inquire any changes that are maybe anticipated such as if patient is in pain that needs pain scale. With this the nurse may able to plan ahead of time possible interventions needed for the patient if there are significant changes. 
10. Due laboratories and when it will be done should be reported as well, since we know laboratory results are important in managing patient's treatment. If patient has schedule for laboratories this also should be reported. Aside from that , any required treatment that is to be done should also be included in the report. 
11. Also patient's current status is important to report, to let the incoming nurse be aware if the patient responded a good progress or not to the treatment being provided to the patient from the previous shift.