Checklist for ensuring information flow when a home care client/patient transfers from one social and health care service to another
The checklist for ensuring the flow of information when a home care client/patient transfers from one social and health care service to another is intended for use during the transition phases of elderly clients/patients. It can be used as a model for planning the content of information flow during the transition phases of other client and patient groups and for planning the information flow process during transition phases in wellbeing services counties and ensuring the security of information flow.
Information is transferred from one organisation to another, from one professional to another, and from a professional to a patient/client/relative and vice versa, from a client/patient/relative to a professional. Data protection issues are taken into account in the transfer of information.
Social and healthcare professionals take into account the information on the checklist during the transition phase of the client/patient. This ensures that the transfer of personal data is as reliable and secure as possible.
You can download and print the document here (pdf).
| Information to be taken into account during the transition phase | Examples of the content and tools for ensuring the flow of information |
| Client identification | wristband, identity card |
| Service needs assessment/service and care plan/client plan made with the client, patient and/or relative | advance decision, possible power of attorney, actions related to informal care |
| Information related to health status | ISBAR structured reporting tool isbar-communication-tool.pdf |
| Functional capacity | RAI Information on the RAI system – THL Indicators Toimia database |
| Up-to-date medication information | Medication plan (from the treatment plan) Up-to-date medication information and medication list (List of medicines – Fimea.fi – Fimea) The link provides a checklist for updating medication information. |
| Informing the patient/client/relative/home care provider | Home care instructions, nursing summary, epacrises, follow-up care plan, medication information and necessary prescriptions, necessary certificates (travel allowance, medical supply distribution/loan certificate) Home care: who will visit the home, their title, which organisation they represent, when and what they will do |
| Information about relatives and loved ones/guardian information | contact details and ability/opportunity to participate in the client’s life |
| Assistive devices, communication and medical equipment in use | puhelin, verensokerimittari, turvaranneke ja etädigi-palvelulaite |
| Home safety | EVAC, fire and rescue, necessary modifications |
| Practical everyday matters | food, cleaning, pets, etc. and their carer |
| Financial situation | need for financial support, customer invoices, customer payments, medicines, rent |
| Other matters to consider (self-monitoring and organisation) | – resources (staff, budget, information systems, equipment, etc.) – remote and digital services – dangerous situation reports, procedure for notifications of concern and reports of irregularities – collection of client feedback and utilisation of information – recording – data security and protection |
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This document has been prepared in collaboration with the “Safety of Home Care Services” development line and the Client and Patient Safety Strategy Action Programme’s Strategy Priority 1 group. In addition, the tool has been circulated for comments within the network of Finnish Centre for Client and Patient Safety and approved by the Centre for Client and Patient Safety Expert Council on 27 November 2023.
Further information: Finnish Centre for Client and Patient Safety
(noharm(a)ovph.fi ).
Published on 2 January 2024. Revised on 10 November 2025. Publisher: Finnish Centre for Client and Patient Safety.
The need to update the tool is reviewed annually.