Adverse events occur more frequently in surgery than in any other department or specialty. The reasons are numerous, but a primary source — and perhaps the most preventable — frequently involves a breakdown in communication among clinical staff. Incorrect patient data, mislabeling, and missing patient information on forms and in EHRs all contribute to communications mishaps and errors in care. But there’s good news: An effective, thorough patient “handoff” communication plan can prevent many errors and ensure patient safety across the continuum of care.
Creating a baseline program
Within a surgery center, there are at least two handoff communications that should take place during the course of a surgical case; however, there may be more depending on the set-up, the flow of your center, and the complexity of the procedure or the physical status of the patient. The first handoff that typically occurs is between the pre-op RN and the OR circulator. This is important because the pre-op nurse will convey any important information — allergies, medical history, current medications, issues with the verification process — to the OR circulator. The patient should also be involved in this handoff. They can use the opportunity to be a part of their care, rather than sitting on the sidelines. Typically, the second handoff is from the circulator to the PACU RN once surgery is completed. It’s important to the patient’s wellbeing for the PACU nurse to be informed of the surgical outcome, blood loss, complications, and any other information that could have an impact on their recovery. There may be a holding area where a patient goes between pre-op and the OR, or there may be different stages of PACU that the patient moves through as they recover — each of these transfers of care would require an additional handoff from one staff member to another. If the patient is anesthetized, there should also be a handoff from the anesthesia provider to the PACU nurse. All handoff communication is important and can impact a patient’s surgical outcome.
Customizing to the ASC
While there are different types of handoff communication used within surgery centers, many facilities opt to use a hand-written form that follows patients from one area to the next. A section for questions and answers should be included when forms are used for handoff communication. Other facilities use only verbal handoffs. Regardless of which form of communication is chosen, the selected method should be standard and consistent within a center. Just as ASC staff know to never start a surgical case without first doing a time-out, a patient should never be transferred to another area of care or to another staff member without a proper handoff. A handoff, just like a time-out, should be documented as to who was involved in the communications and when it took place. Each center also should decide which pieces of information are most pertinent to providing the safest experience for the patient. There are many different handoff techniques. The following are examples of popular mnemonic handoff methods: I-SBAR (Introduction, Situation, Background, Assessment, Recommendation), PACE (Patient/Problem, Assessment/Action, Continuing treatments/Changes, Evaluation), 5Ps (Patient, Plan, Purpose, Problem, Precautions).
AORN recommendations
The Association of perioperative Registered Nurses (AORN) developed a Perioperative Patient Handoff Toolkit that lists recommendations for standardizing the handoff process. The following are the three most important: 1. Leadership should make handoff a priority by implementing a handoff program within the facility. 2. Use a system, checklist, template or mnemonic devices to update information, document recent changes in condition or circumstances, and note any anticipated changes or aspects of care that need to be monitored. 3. Teach and practice communication using clear, common language previously established among care providers during handoffs. There can be barriers to achieving a standard handoff method within a center. For example, resistance to change among staff members, language barriers, background noise/interruptions or lack of privacy can cause problems. These issues must be addressed as soon as they arise. It is important to encourage face-to-face handoffs, to allow adequate time, and to use both written and verbal methods if information is getting “lost” from one area to another. Utilize tools and references, such as AORN’s Perioperative Patient Handoff Toolkit, if you need help developing or improving your current method of handoff.
For more information about handoff methods, please contact Amiee Mingus at amingus@regentsh.com.
