I PASS THE BATON Nursing Handoff and I-PASS: What Each Letter Means

I PASS THE BATON is the handoff mnemonic in AHRQ's TeamSTEPPS 2.0 Pocket Guide: Introduction, Patient, Assessment, Situation, Safety concerns, Background, Actions, Timing, Ownership and Next. I-PASS, from the I-PASS Study Group, has five elements: Illness severity, Patient summary, Action list, Situation awareness and contingency planning, and Synthesis by receiver. AHRQ's 2023 pocket guide lists I-PASS instead.

Both mnemonics exist for the same moment: when responsibility for a patient passes from one person to another, often at shift change. This guide gives every letter as the official sources define it, shows one fictional nurse-to-nurse handoff in both formats, and explains where handoff appears in the 2026 NCLEX test plans: Management of Care on the NCLEX-RN and Coordinated Care on the NCLEX-PN.

Your program's or unit's handoff format comes first. AHRQ advises that each facility choose a standard handoff protocol and make it known to everyone.

What a Handoff Is and When Nurses Give One

AHRQ's TeamSTEPPS curriculum defines a handoff as a standardized method for transferring information, along with authority and responsibility, during transitions in patient care. Authority and responsibility move with the information, and the curriculum says the handoff strategy maintains continuity of care despite changing caregivers and patients.

The TeamSTEPPS 2.0 pocket guide gives examples of transitions in care: shift changes; transfers of responsibility between and among nursing assistants, nurses, nurse practitioners, physician assistants and physicians; and patient transfers. A handoff is one of the many conversations that make up a nurse's day, as What It Means to Be a Nurse describes.

Whatever mnemonic you use, the TeamSTEPPS 3.0 pocket guide lists five parts of a proper handoff:

• transfer of responsibility and accountability;
• clarity of information;
• verbal communication of information;
• acknowledgment by the receiver;
• an opportunity to ask questions and review.

The last two involve the receiver. On acknowledgment, AHRQ is explicit: until it is acknowledged that the handoff is understood and accepted, the person handing off cannot relinquish responsibility.

Why Handoffs Matter for Patient Safety

The Joint Commission devoted its Sentinel Event Alert 58 (2017) to inadequate hand-off communication. The alert explains that potential for patient harm, from the minor to the severe, is introduced when the receiver gets information that is inaccurate, incomplete, not timely, misinterpreted or otherwise not what is needed. The Joint Commission's sentinel event database includes reports of inadequate hand-off communication causing adverse events, including wrong-site surgery, delay in treatment, falls and medication errors.

Handoffs are also frequent. The alert estimates that a typical teaching hospital may experience more than 4,000 hand-offs every day, citing a 2006 count from one institution, and AHRQ's TeamSTEPPS 3.0 curriculum notes that transitions in care are the times when most communication breakdowns occur.

The alert's suggested actions are addressed to health care organizations. Three of them describe how report should be given: face to face, in a location free from interruptions, with multidisciplinary team members and the patient and family included as appropriate; with ample time and opportunities to ask questions; and with a mnemonic such as I-PASS treated as only a framework, supported by other elements such as training and cultural change.

I PASS THE BATON in Nursing: What Each Letter Means

I PASS THE BATON is a TeamSTEPPS mnemonic, defined in the TeamSTEPPS 2.0 Pocket Guide. That guide was developed for the Department of Defense Patient Safety Program in collaboration with AHRQ, was revised in December 2013 and is still online at AHRQ. It lists I PASS THE BATON under Handoff, a "strategy designed to enhance information exchange during transitions in care." The descriptions below are the pocket guide's own wording.

Two details are easy to miss. The introduction includes the patient, and ownership can include the patient and family members as well as staff.

AHRQ's Comprehensive Unit-based Safety Program (CUSP) toolkit, in facilitator notes from December 2012 that are still online, describes I PASS THE BATON as an option for structured handoffs that helps frontline providers share patient information during critical transition periods, huddles and team rounds.

What Changed in TeamSTEPPS 3.0

AHRQ updated TeamSTEPPS in 2023. The TeamSTEPPS 3.0 Pocket Guide, which replaces the 2013 edition, does not include I PASS THE BATON. Its handoff tool is I-PASS, which it calls "the preferred handoff tool for patient transitions in care." The 3.0 curriculum puts it more cautiously: I-PASS has become the preferred handoff tool in many organizations and is an example of an evidence-based option for a structured handoff.

If your program or unit uses I PASS THE BATON, the table above is AHRQ's version of it.

I-PASS: What Each Letter Means

I-PASS was developed by the I-PASS Study Group for the handoffs of resident physicians and described in the journal Pediatrics in 2012. The name works twice: it is the verbal mnemonic and also the acronym of the research study, IIPE-PRIS Accelerating Safe Sign-outs.

The element names below are the study group's. The prompts under each come from AHRQ's TeamSTEPPS 3.0 Pocket Guide.

The study group built I-PASS around gaps it had seen. In its pilot, faculty observers noted that illness severity assessment, contingency planning and read-back by the receiving resident were the elements most often missing from resident handoffs. The group considered TeamSTEPPS's IPASSTHEBATON, but chief residents asked for a mnemonic that was shorter, easier to remember and had discrete elements without overlap.

The authors also reported interest in I-PASS from nurses and physicians of other specialties at their study institutions, and wrote that it can readily be adapted for use beyond pediatrics.

What the I-PASS Study Found

In 2014, the New England Journal of Medicine published the I-PASS Study Group's prospective intervention study of a resident handoff-improvement program in nine hospitals. The program was more than a mnemonic: it also included handoff and communication training, a faculty development and observation program, and a sustainability campaign.

Across 10,740 patient admissions, the medical-error rate decreased by 23% (24.5 to 18.8 per 100 admissions) and the rate of preventable adverse events by 30% (4.7 to 3.3), with no significant change in the duration of oral handoffs or in resident workflow.

The authors conclude that implementing the program was associated with fewer medical errors and preventable adverse events and with better communication, without a negative effect on workflow. Keep two limits in mind when you repeat these numbers: the handoffs studied were residents', and the results describe the whole program, not the five letters alone.

For nurses, a 2017 study in BMJ Quality & Safety tested the I-PASS Nursing Handoff Bundle on a pediatric intensive care unit. Its abstract reports that implementation was associated with widespread improvements in the verbal handoff process without a negative impact on nursing workflow.

I PASS THE BATON vs. I-PASS: Which One Should You Use?

Use the one your facility or program has adopted. AHRQ's TeamSTEPPS curriculum says that no handoff tool is perfect for every organization, and that choosing one standard approach that all staff understand and use is preferable to having multiple handoff tools in active use. In clinicals, that means the format on your unit's report sheet or the one your instructor teaches.

For the NCLEX, the letters matter less than what you say and do with them.

Example: One Nurse-to-Nurse Handoff in Both Formats

Example only. The patient, the details and the times below are invented to show the structure of a report. They are not clinical guidance, and your unit's policy and report sheet come first.

Dana, the day-shift nurse on a medical-surgical unit, hands off Mr. Ortiz to Luis, the night-shift nurse, at the bedside at 1900.

In I PASS THE BATON

• I: Introduction. "Mr. Ortiz, this is Luis, your night nurse. Luis, I'm Dana, his day nurse."
• P: Patient. "James Ortiz, 68, room 412. ID band checked."
• A: Assessment. "Admitted yesterday with community-acquired pneumonia. Productive cough and crackles at the right base; his fever broke this afternoon, and his latest vital signs are charted."
• S: Situation. "Full code. The team says he's improving; he's still on oxygen as ordered. The sputum culture is pending, and the provider will review his antibiotic when it's back."
• S: Safety concerns. "Penicillin allergy. Fall-risk alert: he was dizzy the first time he stood today, so the unit's fall precautions are in place."
• B: Background. "COPD and type 2 diabetes; his home inhaler is ordered. Second pneumonia this year."
• A: Actions. "His evening IV antibiotic was given on schedule. He was up to the chair at 1700 with staff help, per his fall precautions."
• T: Timing. "Two things are time-bound tonight: the culture result, which the provider wants called in as soon as it's back, and the blood glucose check ordered for 2100."
• O: Ownership. "You have the culture call and the 2100 glucose check. Respiratory therapy has his 2000 treatment. He and his wife know he calls before getting up."
• N: Next. "The team plans to reassess his oxygen tomorrow. His orders list when to call the provider about his breathing or oxygen saturation."

Luis then repeats the key points back and asks when the last oxygen saturation was checked.

The Same Handoff in I-PASS

• I: Illness severity. Dana: "He's a watcher."
• P: Patient summary. Dana: "James Ortiz, 68, COPD and type 2 diabetes, admitted yesterday with his second pneumonia this year. IV antibiotics and oxygen as ordered; fever broke this afternoon. Penicillin allergy, full code."
• A: Action list. Dana: "Culture result due tonight: the provider wants a call when it's back, and that's yours. Glucose check ordered for 2100. Respiratory therapy has the 2000 treatment."
• S: Situation awareness and contingency planning. Dana: "Fall-risk alert after today's dizziness; precautions are on. If his breathing changes, his orders list when to call the provider."
• S: Synthesis by receiver. Luis: "A watcher with pneumonia, a penicillin allergy and full code. I call the provider with the culture, do the 2100 glucose, keep the fall precautions on and follow his call orders if his breathing changes. When was his last saturation checked?"

The content barely changes. The order and the emphasis do: I-PASS opens with how sick the patient is and makes the receiver's summary a step of its own.

Handoff on the NCLEX: Management of Care and Coordinated Care

Handoff is written into both 2026 NCLEX test plans, which are effective April 1, 2026, through March 31, 2029.

On the NCLEX-RN, it sits in the Management of Care subcategory: "Providing and directing nursing care that enhances the care delivery setting to protect the client and health care personnel." Management of Care represents 15–21% of the NCLEX-RN Test Plan, and its activity statements include "Provide and receive handoff of care (report) on assigned clients."

On the NCLEX-PN, the matching subcategory is Coordinated Care: "The LPN/VN collaborates with health care team members to facilitate effective client care." It represents 18–24% of the NCLEX-PN Test Plan, and its activity statements include "Provide and receive report."

Both plans list related content under Continuity of Care:

The PN plan's confidentiality content also includes "Identify staff actions that impact client confidentiality and intervene as needed," with change-of-shift reports among its examples.

Neither plan names I-PASS, I PASS THE BATON or any other handoff mnemonic. They describe the skill, so study what a safe report contains and what you do with it: what to pass on, what to follow up, which client to see first, and what must stay confidential.

Prioritization is part of the same subcategory. NCSBN's sample item for Management of Care in the 2026 RN plan is a question in which the nurse has been made aware of four client situations and must decide which client to assess first. Practice that decision after every report you take. The NCLEX Clinical Judgment Model guide shows how to move from cues to priorities, the NCLEX test-taking strategies guide covers priority frameworks in questions, and the 2026 NCLEX study roadmap turns the test plan into a weekly routine.

Frequently Asked Questions

What does I PASS THE BATON stand for?

Introduction, Patient, Assessment, Situation, Safety concerns, Background, Actions, Timing, Ownership and Next. THE has no element of its own. The definitions come from AHRQ's TeamSTEPPS 2.0 Pocket Guide.

What does I-PASS stand for in nursing?

Illness severity, Patient summary, Action list, Situation awareness and contingency planning, and Synthesis by receiver, as the I-PASS Study Group defines them. AHRQ's TeamSTEPPS 3.0 Pocket Guide lists the same five elements.

Is I-PASS on the NCLEX?

Not in the test plans. Neither 2026 test plan names I-PASS, I PASS THE BATON or another handoff mnemonic. The NCLEX-RN plan lists "Provide and receive handoff of care (report) on assigned clients" under Management of Care, and the NCLEX-PN plan lists "Provide and receive report" under Coordinated Care. Looking for your exam result instead? NCLEX Quick Results explains how and when it reaches you.

Did TeamSTEPPS replace I PASS THE BATON with I-PASS?

In its pocket guide, yes. The TeamSTEPPS 3.0 Pocket Guide (2023), which replaces the 2013 TeamSTEPPS 2.0 edition, includes I-PASS and not I PASS THE BATON. Older AHRQ material is still online: the 2013 pocket guide, and CUSP toolkit notes from 2012 that call I PASS THE BATON an option for structured handoffs. AHRQ's current curriculum advises each facility to choose one standard approach.

What is the difference between I-PASS and SBAR?

TeamSTEPPS describes SBAR as a technique for communicating critical information that requires immediate attention and action concerning a patient's condition. I-PASS is a handoff tool for transferring care. The I-PASS Study Group noted that SBAR has been extended to handoffs but has limitations for complex patients who require broader information and context.

Should the patient be part of the handoff?

When appropriate, yes. The Joint Commission suggests face-to-face hand-offs that include the patient and family as appropriate, and the I in I PASS THE BATON includes introducing yourself to the patient. The same alert cautions against relying on the patient or family to pass on vital information about their care on their own.

Before Your Next Report

A handoff decides what the next nurse knows. Whichever format your unit uses, the same habits carry it: say how sick the patient is, what is pending and who owns it, what to do if things change, and let the receiver say it back. Explore ExamReady NCLEX preparation when you want a structured place to practice.

Official resources

• AHRQ: TeamSTEPPS 2.0 Pocket Guide (PDF, I PASS THE BATON)
• AHRQ: TeamSTEPPS 3.0 Pocket Guide (PDF, I-PASS)
• AHRQ: TeamSTEPPS 3.0, Tool: Handoff
• AHRQ: TeamSTEPPS 3.0, Tool: I-PASS
• AHRQ: CUSP Toolkit, Implement Teamwork and Communication (2012)
• Starmer et al., "I-PASS, a Mnemonic to Standardize Verbal Handoffs," Pediatrics, 2012
• Starmer et al., "Changes in Medical Errors after Implementation of a Handoff Program," NEJM, 2014 (PubMed)
• Starmer et al., "Effects of the I-PASS Nursing Handoff Bundle on Communication Quality and Workflow," BMJ Quality & Safety, 2017 (PubMed)
• The Joint Commission: Sentinel Event Alert 58, Inadequate Hand-off Communication
• NCLEX: Test Plans
• 2026 NCLEX-RN Test Plan (PDF)
• 2026 NCLEX-PN Test Plan (PDF)

Educational note: This article explains handoff frameworks for study purposes. The example is fictional. It does not provide patient-specific clinical advice and does not replace your facility's handoff policy, current nursing standards or professional judgment.