Standardizing Communication During Patient Transfers
In July 2012, the Trihealth organization converted to an electronic medical record (EMR) system. Transitioning from the standard paper charting in the Post Anesthesia Care Unit (PACU) has created many challenges and changes, especially in our flow of patient information. The handoff communication process is the verbal and/or written exchange of pertinent information regarding the responsibility and authority of activities during a patient’s transfer of care (Catalano, 2009).
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Get Help Now!The 2006 National patient safety goals of the Joint Commission on Accreditation of Healthcare Organization (JACHO) requires organizations involved with patient care to standardize the handoff communication between healthcare professionals. This requirement was instituted after JACHO reviewed a decade’s worth of data reporting that “breakdowns in communication” were associated in two-thirds of all types of sentinel events (Croteau, 2005).
Unfortunately, in 2012 “The Joint Commission reported that poor communication remains the leading cause of sentinel events and that more than one third of all patient handoffs are defective” (Jukkala, James, Autrey, Azuero, & Miltner, 2012, p. 240).
Prior to EMR, during the handoff process, the PACU nurses relied on informal hand written paper forms and were efficient in navigating through a paper chart to find necessary information. Now in a “paperless system” the post-operative handoffs have become merely a verbal process. Patient care handoffs postoperatively are cognitively intense, dynamic, complex, and filled with a myriad of critical information, which typically lasts 5 minutes.
Slivers of information presented in a handoff by the operating room (OR) team include name, age, allergies, anesthesia, analgesia, antibiotics, presser agents, positioning, blood loss, volume expanders, IV fluid intake, endotracheal tube size, type of dressing, complications,
The organizational SP must be congruent with the SR process in developing values, vision, mission, goals, objectives and strategies for a standardized handoff. The fundamental purpose of strategic planning (SP) is to align the organizational performance between its set mission, vision, and values (Harrison, 2010). Sare & Ogilvie (2010) stress “being clear about the “why we are here” launches the process of determining the objectives and goals that we want to achieve”
Once team members define the goals in a SR, the strategic “how-to” objectives are established (Sare & Ogilvie, 2010). These strategic objectives are utilized to identify the larger picture of the mission, assisting to accomplish goals (Sare & Ogilvie, 2010). The ultimate goal is to continuously find ways to improve patient safety. The primary objective of standardization is to provide accurate information about a patient’s care, treatment, services, condition or changes
It is crucial for handoffs to be accurate and pertinent during the exchange of patient information to ensure safe patient care, especially with the increasing complexity for patients in acute care institutions (Staggers, Clark, Blaz, & Kapsandoy, 2011). Designing a standardized individualized patient handoff tool relevant to the content in the peri-operative area will enhance and improve high quality patient care and safety.
Strategic Review Team Members
The primary stakeholders included as team members in developing a standardized tool would include at least one representative from each of the three departmental disciplines involved. This would include a clinician from the PACU, anesthesia and the OR. This collaboration is necessary because anesthetists and recovery nurses often have different expectations concerning content and timing of information transfer (Manser, Foster, Flin, & Patey, 2012). Sare & Ogilvie (2010) affirm, “In the SR, it is crucial to have the right people asking the right questions” (p 122). Working collab
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