NU651 Unit 4 I-PASS Handoff, Febrile Neutropenia Example

Reviewed by Elspeth Marlowe, MSN, RN AGACNP Introduction to Acute Care Management Clinical I Purdue University Global Free custom sample in 24 to 48h

This NU651 Unit 4 sample is a structured handoff note in I-PASS format for a 54-year-old woman on chemotherapy with a fever of 38.6 and a neutrophil count of 300. It was written for Purdue Global NU 651, AGACNP Introduction to Acute Care Management Clinical I, taken in the MSN acute care nurse practitioner program. She is labeled a watcher, and the note explains why in one clause. Her summary is three sentences, including a MASCC score of 16 and cefepime given within the hour. The action list gives the next dose time, and the contingency section turns five possible overnight events into condition-and-response lines. The receiver's read-back is quoted, and a closing paragraph cites the I-PASS study.

CourseNU651 AGACNP Introduction to Acute Care Management Clinical I
UnitUnit 4
Paper typeStructured handoff note (I-PASS)
LengthAbout 520 words, 4 pages double-spaced
FormatAPA 7 student paper
SchoolPurdue University Global
ProgramMSN
UpdatedSeptember 2026

Free sample paper for NU651 Unit 4

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Watcher, Not Stable: An I-PASS Handoff for a 54-Year-Old on Chemotherapy With Fever and a Neutrophil Count of 300

[Student Name]

Purdue University Global

NU651: AGACNP Introduction to Acute Care Management Clinical I

Unit 4 Structured Handoff Note

[Instructor Name]

[Date]

The patient is composite; times, doses and counts are bracketed, and the note is written to be read aloud in about ninety seconds.

What this part is doingSeverity comes first because it tells the night clinician how closely to watch before anything else is said.
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I: Illness Severity

Watcher. She is stable now, but an infection with no source yet could declare itself overnight, and neutropenic patients can move from stable to septic shock within hours.

P: Patient Summary

Mrs. [T.] is a [54]-year-old woman with stage [II] breast cancer, day [ten] after her [third] cycle of chemotherapy, admitted at [17:30] with a temperature of [38.6], an absolute neutrophil count of [300] and no clear source on examination. Her MASCC score is [16], below the threshold of 21 that marks low risk (Klastersky et al., 2000), so she was admitted rather than considered for outpatient care. Blood cultures from her port and a peripheral vein were drawn at [18:00], and cefepime [2 g] was given at [18:25], within the hour.

A: Action List

1. Cefepime [2 g] every [eight] hours; next dose at [02:25]. Confirm it is given on time.

2. Recheck temperature, heart rate and blood pressure every [two] hours overnight.

3. Morning complete blood count with differential, basic metabolic panel and lactate at [05:00].

4. Follow up the urinalysis and chest radiograph ordered at [18:00]; both are pending.

S: Situation Awareness and Contingency Planning

Each line is written as a condition followed by the response, so nothing has to be decided from scratch at 3 a.m.

1. If systolic pressure falls below [90] or lactate is above [2]: give a [1,000] mL crystalloid bolus, add vancomycin, call the rapid response team and the attending.

2. If blood cultures grow gram-positive cocci: add vancomycin, which the IDSA guideline reserves for specific indications such as a positive gram-positive culture, suspected catheter infection or hemodynamic instability (Freifeld et al., 2011).

3. If the port site becomes red, tender or draining: add vancomycin and page the attending about removing the port.

4. If fever persists but she remains stable: do not broaden antibiotics overnight; the day team will reassess at [48] hours.

5. If she develops new cough or hypoxia: chest radiograph if not yet read, and consider antifungal coverage only after discussion with oncology.

What this part is doingThe contingency section is the longest because handoffs most often fail on the event nobody planned for.
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S: Synthesis by Receiver

The receiver reads back the illness severity, the next antibiotic time and the first two contingencies, and asks any questions before the sender leaves. Tonight's receiver confirmed: "Watcher; cefepime due at [02:25]; if she drops her pressure, bolus, vancomycin, rapid response; if the cultures turn gram-positive, add vancomycin."

What this part is doingThe read-back is quoted, because a synthesis that is only described cannot show what the receiver actually understood.
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Why This Format

I-PASS was tested across nine pediatric hospitals, where its introduction was followed by a 23 percent fall in medical errors and a 30 percent fall in preventable adverse events, without longer handoffs (Starmer et al., 2014). The receiver's synthesis is the part most often skipped, and it is the only part that proves the handoff was heard.

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References

Freifeld, A. G., Bow, E. J., Sepkowitz, K. A., Boeckh, M. J., Ito, J. I., Mullen, C. A., Raad, I. I., Rolston, K. V., Young, J.-A. H., & Wingard, J. R. (2011). Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 52(4), e56-e93. https://doi.org/10.1093/cid/cir073

Klastersky, J., Paesmans, M., Rubenstein, E. B., Boyer, M., Elting, L., Feld, R., Gallagher, J., Herrstedt, J., Rapoport, B., Rolston, K., & Talcott, J. (2000). The Multinational Association for Supportive Care in Cancer risk index: A multinational scoring system for identifying low-risk febrile neutropenic cancer patients. Journal of Clinical Oncology, 18(16), 3038-3051. https://doi.org/10.1200/JCO.2000.18.16.3038

Starmer, A. J., Spector, N. D., Srivastava, R., West, D. C., Rosenbluth, G., Allen, A. D., Noble, E. L., Tse, L. L., Dalal, A. K., Keohane, C. A., Lipsitz, S. R., Rothschild, J. M., Wien, M. F., Yoon, C. S., Zigmont, K. R., Wilson, K. M., O'Toole, J. K., Solan, L. G., Aylor, M., . . . Landrigan, C. P. (2014). Changes in medical errors after implementation of a handoff program. New England Journal of Medicine, 371(19), 1803-1812. https://doi.org/10.1056/NEJMsa1405556

NU651 Unit 4 instructions, in plain terms

The Unit 4 assignment asks you to write a handoff for a patient you are signing out to the night clinician, using a structured format such as I-PASS or SBAR. You state the illness severity, summarize the patient briefly, list the tasks for the next shift, anticipate what could go wrong and how to respond, and describe how the receiver will confirm understanding. The note should be short enough to read aloud in about ninety seconds. Most prompts expect the contingency plan to be the most detailed part, because unplanned events are where handoffs fail. Evidence supporting the handoff format and the clinical plan is usually required.

How the NU 651 Unit 4 example is put together

The example follows the five I-PASS letters in order. Illness severity comes first with a reason. The patient summary keeps to three sentences: diagnosis and chemotherapy day, fever and neutrophil count with the MASCC score, and the time cultures were drawn and cefepime given. The action list has four numbered tasks with times. The contingency section is the longest and writes each line as a condition followed by a response, with the IDSA guideline cited for when to add vancomycin. The synthesis section quotes the receiver's read-back. A final paragraph explains why the format is used, citing the multicenter study behind it. Every time in the note is exact, so the receiver can plan the night around it.

Where the points sit in the NU651 Unit 4 rubric

The Unit 4 rubric gives points for use of the structured format, accuracy of the clinical content, the contingency plan, conciseness and evidence. Format earns full credit when every element is present and in order. Clinical accuracy is judged on details such as antibiotic timing and the meaning of the risk score. The contingency plan is weighted heavily; each line should name a trigger and an action specific enough to follow at night. Conciseness counts because a handoff that takes five minutes will not be used. Evidence is expected for the handoff model and for key decisions, such as when vancomycin is added in neutropenic fever.

NU651 Unit 4 help: mistakes that cost points

The most common mistake is making the summary long and the contingency plan short, which reverses what the night clinician needs. Another is writing vague contingencies such as call if worse. Students often forget the time of the next antibiotic dose. Some label a neutropenic patient with fever as stable, which invites less attention than she needs. The receiver's synthesis is frequently omitted. Others add vancomycin by reflex rather than for a stated indication. Finally, read the handoff aloud before submitting; if it takes longer than two minutes, cut the history, not the plan. Also name the time the receiver should next see the patient, even if nothing goes wrong.

Get an NU651 Unit 4 example written to your instructions

Handoff tools vary, so the NU651 Unit 4 sample follows whichever the section names, a structure such as I-PASS, a shorter one like SBAR, or one the hospital built itself; a patient scenario and the rubric complete the inputs. Written within 24-48h, with nothing owed for a first order, it carries a severity call, timed actions and contingencies written as condition and response. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.

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NU651 Unit 4 questions, answered

What did the I-PASS study actually show?

In a multicenter study of pediatric residents published in 2014, introducing the I-PASS handoff bundle was associated with a 23 percent reduction in medical errors and a 30 percent reduction in preventable adverse events, without lengthening spoken handoffs. The bundle included training and a written tool, so the sample describes the framework rather than claiming a note alone produces those results.

Can the handoff be written about someone I cared for?

A student's own handoff assignments may draw on rotation patients after de-identification; this sample relies on an invented one. Actual sign-outs given at a site, clinical hours and what a preceptor writes in an evaluation stay with the student who earned them. The model shows the structure and the contingency writing, which transfer to any patient.

Where can I find a free NU651 Unit 4 sample paper?

The full NU651 Unit 4 I-PASS handoff is on this page, with severity, a three-sentence summary, the action list, five contingencies and the receiver's read-back. For a different patient or handoff format, the desk can write you a free version.

Is a febrile neutropenic patient stable or a watcher in NU651 Unit 4?

The sample labels her a watcher: stable at handoff, but with an infection that has no source yet and could turn into septic shock within hours. The label tells the night clinician to check on her rather than wait for a call.

When is vancomycin added in the NU651 Unit 4 handoff?

Only for a stated reason: hypotension, a blood culture growing gram-positive cocci or signs of a port infection. The IDSA guideline reserves vancomycin for indications like these rather than adding it to every neutropenic fever.