Nursing handoff / Source fidelity
Nursing handoff source-fidelity review
Two actual AI handoffs from one fictional nursing documentation task. Follow the source, the captured responses, and the review of wording that went beyond the brief.
Main finding / F01
Claude added a reassessment recommendation to a source-only handoff. Robert concurred specifically with this finding.
Other wording retains its separate review status below. No material source-fidelity error was identified in the ChatGPT response in this one review; this does not establish a winner or validate clinical safety.
01 / Original source
A handoff bounded by the notes.
The task asked for a concise 19:00 handoff using only the fictional source. Important times, completed care, and outstanding tasks had to remain distinct.
This is a fictional documentation exercise, with no real patient information.
Exact source instruction
Do not invent findings, results, reasons for delays, treatment recommendations or completed actions.
Read complete fictional source and prompt
TASK Create a concise nursing shift handoff for the incoming medical-unit nurse at 19:00 using only the fictional source information below. This is a documentation exercise, not advice for a real patient. Organize the handoff into: 1. Situation and background 2. Current assessment 3. Outstanding tasks and follow-up Preserve important event times and distinguish completed care from pending care. Do not invent findings, results, reasons for delays, treatment recommendations or completed actions. If information is not provided, do not treat it as normal or absent. Do not browse or use external sources. PATIENT BACKGROUND 68-year-old woman admitted with pneumonia. Medical history includes hypertension and type 2 diabetes. She reports no known medication allergies. SOURCE TIMELINE 17:40 — Patient arrives in the emergency department with cough, fever and shortness of breath. She is subsequently admitted for pneumonia. 18:15 — Ceftriaxone and a sputum specimen are ordered. The medication dose and administration schedule are not included in this source. 18:35 — Emergency department nurse gives transfer report. Ceftriaxone has not been administered, and pharmacy verification is pending. 18:40 — Patient arrives on the medical unit. 18:45 — Receiving nurse completes the assessment. Patient is alert and oriented. Blood pressure 118/70 mmHg, heart rate 104 beats/min, respiratory rate 22 breaths/min, temperature 38.2°C, and oxygen saturation 94% on oxygen at 2 L/min by nasal cannula. She becomes short of breath walking to the bathroom and requires standby assistance. A peripheral IV is present in the right forearm. 18:50 — Nurse contacts pharmacy about ceftriaxone. Pharmacy confirms the order is awaiting pharmacist review. No explanation for the wait or estimated completion time is documented. 18:55 — Nurse attempts sputum collection. Patient cooperates but cannot produce a specimen. No specimen is collected. 18:58 — Daughter requests an update. The outgoing nurse has not completed the update before handoff. 19:00 — Outgoing nurse rechecks the order status and medication administration record. Pharmacy verification remains pending, and no ceftriaxone administration is recorded. Sputum collection and the daughter’s update remain outstanding. ADDITIONAL SOURCE LIMITS Laboratory and imaging results are not included. No later vital signs or assessment are provided. No required antibiotic administration deadline is supplied. Return only the nursing handoff.02 / Actual AI responses
The retained outputs.
Each card contains the complete response text and its original supplied PNG. Model labels and visible settings are documented separately from unrecorded execution details.
Original captured response
Claude
Reported label: Claude Haiku 5.5 Low effort
Haiku 5.5 and Low are visible in the supplied capture. No API parameters or execution timestamp were recorded.
Read complete Claude response
NURSING SHIFT HANDOFF — Medical Unit, 19:00 Fictional documentation exercise; source information only. 1. Situation and Background 68-year-old woman admitted with pneumonia. She arrived at the ED at 17:40 with cough, fever and shortness of breath, and arrived on the medical unit at 18:40. Medical history includes hypertension and type 2 diabetes. She reports no known medication allergies. 2. Current Assessment Most recent documented assessment (18:45, receiving nurse): • Alert and oriented. • BP 118/70 mmHg, HR 104 beats/min, RR 22 breaths/min, temperature 38.2°C. • SpO2 94% on oxygen at 2 L/min by nasal cannula. • Becomes short of breath walking to the bathroom; requires standby assistance. • Peripheral IV in right forearm. No later vital signs or assessment are provided after 18:45. Laboratory and imaging results are not included in the source information. 3. Outstanding Tasks and Follow-Up Completed: • 17:40: ED arrival and admission for pneumonia. • 18:15: Ceftriaxone and sputum specimen ordered (dose and administration schedule not included in source). • 18:35: ED nurse transfer report given. • 18:40: Arrival on medical unit. • 18:45: Receiving nurse assessment completed (see above). Pending: • Ceftriaxone: Not administered. Awaiting pharmacist verification (confirmed by pharmacy at 18:50). No reason for the wait or estimated completion time is documented. At 19:00, no administration is recorded. No antibiotic administration deadline is supplied. • Sputum specimen: Not collected. Patient cooperated at 18:55 but could not produce a specimen. Collection remains outstanding. • Daughter's update: Requested at 18:58. Not completed by outgoing nurse; remains outstanding. Follow-up: • Reassess vital signs and respiratory status, as no findings after 18:45 are documented. • Confirm ceftriaxone verification status and administration with pharmacy. • Reattempt sputum collection per the team's plan. • Provide the daughter with an update.Expand full screenshot on this page
Original captured response
ChatGPT
Reported label: ChatGPT-6 Instant effort
ChatGPT-6 is user-reported; the screenshot shows Instant but does not display the model version. No API parameters or execution timestamp were recorded.
Read complete ChatGPT response
Nursing Shift Handoff — 19:00 1. Situation and Background 68-year-old female admitted for pneumonia. History of hypertension and type 2 diabetes. Patient reports no known medication allergies. • 17:40: Presented to the ED with cough, fever, and shortness of breath. • 18:15: Ceftriaxone and sputum specimen ordered. • 18:35: ED transfer report received. Ceftriaxone had not been administered; pharmacy verification was pending. • 18:40: Patient arrived on the medical unit. 2. Current Assessment 18:45 — Assessment completed: • Alert and oriented. • BP 118/70 mmHg; HR 104 bpm; RR 22/min. • Temperature 38.2°C; SpO₂ 94% on 2 L/min oxygen via nasal cannula. • Shortness of breath with ambulation to the bathroom; requires standby assistance. • Peripheral IV present in right forearm. No subsequent vital signs or assessment findings are provided. Laboratory and imaging results are not included. 3. Outstanding Tasks and Follow-Up Ceftriaxone — Not administered • Ordered at 18:15. • At 18:50, pharmacy confirmed the order was awaiting pharmacist review. No reason for the delay or estimated verification time was documented. • At 19:00, pharmacy verification remained pending, with no administration recorded in the MAR. • Follow-up: Check pharmacy verification status and MAR. Dose and administration schedule are not provided in this handoff source. Sputum specimen — Not collected • Ordered at 18:15. • Collection attempted at 18:55. Patient cooperated but could not produce a specimen. • Follow-up: Collection remains outstanding. Family update — Pending • At 18:58, daughter requested an update. • Outgoing nurse had not completed the update by 19:00. • Follow-up: Address daughter's request. 19:00 handoff status: Ceftriaxone remains unverified and unadministered per available documentation. Sputum specimen collection and family update remain outstanding.Expand full screenshot on this page
03 / Review and proposed changes
One concurred finding. Clear limits.
Robert’s concurrence applies to the added reassessment recommendation in F01. The related team-plan wording, the latest verification recheck, and the admission wording carry the separate statuses recorded here.
F01 / Unsupported follow-up recommendationRN-concurred finding: reassessment only
Exact source excerpt
Do not invent findings, results, reasons for delays, treatment recommendations or completed actions.
Exact Claude response excerpt
Reassess vital signs and respiratory status, as no findings after 18:45 are documented.
Reason and review boundary
Robert concurred specifically with the reassessment concern. This is a source-fidelity finding; it does not imply that nursing reassessment needs a scheduled order or that the action itself is intrinsically unsafe.
Proposed correction
Remove the added reassessment recommendation. State that the last assessment was at 18:45.
F02 / Latest verification recheck not explicitObservation · Pending Robert’s review
Exact source excerpt
19:00 — Outgoing nurse rechecks the order status and medication administration record. Pharmacy verification remains pending, and no ceftriaxone administration is recorded. Sputum collection and the daughter’s update remain outstanding.
Exact Claude response excerpt
Ceftriaxone: Not administered. Awaiting pharmacist verification (confirmed by pharmacy at 18:50). No reason for the wait or estimated completion time is documented. At 19:00, no administration is recorded. No antibiotic administration deadline is supplied.
Reason and review boundary
Pending verification is preserved but its confirmation is anchored to 18:50. The 19:00 administration record is explicit; the verification recheck is not. This is a temporal-precision observation, not a false claim that verification was completed.
Proposed correction
At 19:00, pharmacy verification remained pending and no ceftriaxone administration was recorded in the MAR.
F03 / Admission wording remains ambiguousReviewer calibration · Not a confirmed error
Exact source excerpt
17:40 — Patient arrives in the emergency department with cough, fever and shortness of breath. She is subsequently admitted for pneumonia.
Exact Claude response excerpt
17:40: ED arrival and admission for pneumonia.
Reason and review boundary
An initial AI review called this a definite admission-time error. Robert explained that admission may refer to the ED encounter and did not regard it as definitively incorrect. The final classification is terminology and timing ambiguity.
Proposed correction
17:40: Arrived in the ED with cough, fever and shortness of breath; subsequently admitted for pneumonia. Arrived on the medical unit at 18:40.
Proposed corrected excerpt
The most recent documented assessment was at 18:45. At 19:00, pharmacy verification remained pending and no ceftriaxone administration was recorded in the MAR. Sputum collection remained outstanding after the cooperative but unsuccessful attempt at 18:55. The daughter requested an update at 18:58; the outgoing nurse had not completed it before handoff.
Proposed wording only. This excerpt is not a complete replacement handoff, a completed retest, or a separately approved reference answer.
Method, provenance, and limits.
- Clinical reviewer
- Robert Piedra, BSN, RN, BSRS
- Recorded conversation date
- 25 October 2026 (reported conversation date)
- Execution details
- Execution times and API parameters were not logged.
How this review was produced
The review was AI-assisted and used the supplied fictional prompt as its source. Review criteria were documented retrospectively. Robert’s clinical adjudication is limited to the specific concurrence and calibration recorded with the findings.
One response per model is retained, with different reported settings. There were no repeated runs, completed retests, numeric scores, or model rankings. The proposed changes have not been evaluated in a new model response.
Source fidelity asks whether the response preserves this bounded source. It does not establish overall clinical suitability, safety, error frequency, or general model performance.
Capture and transcript provenance
Robert supplied the original response screenshots. The complete response text is transcribed for selection and reading; the PNGs remain available for comparison with their original presentation.
Haiku 5.5 and Low are visible in the Claude capture. ChatGPT-6 is Robert’s reported model label; only Instant is visible in that screenshot. The reported conversation date is not an execution timestamp.
Original supplied draft report
The PDF is the original supplied draft and described screenshots as unavailable. The captures are now supplied on this page. The individual finding statuses above govern this presentation.
Download original supplied draft PDFBack to the AI Evaluation Portfolio