SDS Accreditation Update
More info is best when handing off patients
Ask the receiver to confirm information
When reviewing your handoff communication process, don’t just focus on the handoff between clinical areas such as the operating room and the post-anesthesia care unit (PACU).
Ensuring good communications about the patient’s needs starts with your pre-op call, say experts interviewed by Same-Day Surgery.
"Communication starts at the time we receive the booking from the physician’s office," explains Betty Bozutto, RN, MBA, CASC, executive director of Naugatuck Valley Surgical Center in Waterbury, CT.
"A copy of the booking sheet is given to anesthesia staff members so they have the medical information, and a copy is given to nursing or materials management if special equipment or other arrangements are needed," she says.
Although her facility is accredited by the Accreditation Association for Ambulatory Health Care (AAAHC) and does not have a specific standard or requirement related to handoff communications to which it must comply, Bozutto points out that good communications between staff members is essential for ensuring patient safety.
"During the pre-admission call made by an RN the day before surgery, we take a significant medical history," she says. "Any abnormal or significant issues are discussed throughout the day with the medical director, while the patient is still on the phone."
At the end of the day, the nurses share the information with pre-op nurses, managers, anesthesia staff, and medical directors.
"Any significant information, such as the patient’s MRSA [methicillin-resistant Staphylococcus aureus] history, will be verbally communicated to the nurse who will first provide care the next day," Bozutto explains.
At the University of New Mexico Hospital in Albuquerque, communication between the operating room and PACU is done by both the OR nurse and the anesthesiologist, according to Christina Flynn, RN, charge nurse.
When Flynn arrives in PACU with the patient, she helps put on monitors if necessary. "While the PACU nurse assesses the patient, I take the PACU sheet and write everything I know about the patient on it," she says.
"Then I give the PACU nurse a rundown on what I’ve written as well as any information that doesn’t normally appear on the record, such as whether or not the family is in the waiting room," Flynn explains.
After she gives her report, the anesthesia provider gives his or her report to the PACU nurse verbally, Flynn notes.
"Because both the RN and the anesthesia provider give all of the information with which they are most familiar, there is some redundancy," she admits.
The redundant information isn’t a problem, she says. "It is better to repeat information than to miss sharing something," she explains.
The type of information shared during handoff communications differs according to the patient, the type of procedure, and intraoperative events, points out Yelena Barclay, RN, surgical staff nurse at Morton Plant Mease Hospital in Clearwater, FL.
"For every patient, we give the patient’s name; type and location of procedure; type and location of tubes, drains, or catheters; medications; brief information on any complications or difficulties during surgery; and contact information for the patient’s family," she says.
Patient-specific information is crucial
In addition to this information, the nurse also gives the receiving staff member patient-specific information, she adds.
Examples include HIV status, history of hepatitis, language restrictions, visual or sensory restrictions, preoperative pain level, psychological status of patient, and any special requests the patient may have made, she explains.
"Our anesthesiologist or CRNA [certified registered nurse anesthetists] will give the information related to type of anesthesia, post-intubation status, fluids given, medications, and brief intraoperative status," Barclay says.
Make sure the information you have given is understood by asking the receiving staff member if all of the information is clear, she suggests.
The staff member who is handing off the patient lets the receiving staff member know where he or she will be the rest of the day in case there are questions that do arise, Barclay adds.
Continuous staff education is an important part of standardizing your handoff communication, Barclay notes.
Establishing a policy is a good first step, but the only way to make sure the policy is followed consistently is by letting staff members know why communication during the handoff is important and reminding them of the importance, she says.
Remember, too, that the information you pass along to others is only as good as the information you collect, Flynn points out.
"If this was your family member, wouldn’t you want everything known about them communicated to caregivers?" she asks.
Flynn says she gets funny looks when she asks about food allergies, "but many foods are related to iodine and latex and might indicate an allergy to those items.
"If I ask about allergies and pass the information along to others, I might prevent a problem later in the surgical process," Flynn adds.
Sources
For more information about handoff communications, contact:
- Yelena Barclay, RN, Staff Nurse, Morton Plant Mease Hospital, 300 Pinellas St., Clearwater, FL 33756. E-mail: [email protected].
- Betty Bozutto, RN, MB, CASC, Executive Director, Naugatuck Valley Surgical Center, 160 Robbins St., Waterbury, CT 06708. Phone: (203) 755-6663. E-mail: [email protected].
- Christina Flynn, RN, Charge Nurse, University of New Mexico Hospital, 2211 Lomas Blvd. N.E., Albuquerque, NM 87106. E-mail: [email protected].
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