Authors

  1. Forsythe, Lydia RN, CNOR, PhD
  2. Persaud, Debra RN-BC, MS
  3. Swanson, Margaret RN-BC, MSN
  4. Stierman, Cynthia RN

Article Content

Patient transitioning from unit to unit marks a critical time for both nurses and those receiving care. According to research, breakdowns in communication between nursing staff members are most likely to occur during this period.1 To improve communication, nurses must have standard tools encompassing universal phraseology that are easy to apply in the practice setting.2 OSF St. Anthony Medical Center (SAMC) in Rockford, Ill., re-cently developed a hand-off tool that accomplishes this need. The tool's structural view is defined by the data elements which include Identifica-tion, the Situation, Background information, Assessment of the situation, and Recommendations (ISBAR).

 

Hand-off analysis

The development of SAMC's hand-off tool was a detailed process. To determine what current technology worked best, the perioperative clinical nurse specialist (CNS) and an OR staff nurse investigated several hand-off reporting tools used by other institutions, along with information published by the Association of peri-Operative Registered Nurses.3 A research team was formed that consisted of three surgical services managers, the perioperative CNS, three staff nurses, and a nursing supervisor. A patient representative was also included to develop standard hand-off tools across the SAMC patient care continuum.

 

As part of the design process, team members sought staff input about the information that needed to be included on the tool. After reviewing the information, the committee members agreed that one hand-off tool would not meet every unit's needs. Three specific tools were developed: a hand-off tool when transporting the patient from the ambulatory surgery unit (ASU) to the OR, one when transporting the patient directly back to ASU from the OR, and the third for transporting the patient from the OR to PACU (see Key elements of the post procedural OR to PACU hand-off tool).

 

Successful results

The hand-off tool is an effective method to augment verbal communication. It works as an essential re-minder to perioperative nurses of the importance of disseminating pertinent patient care information.

 

Key elements of the post proced-ural OR to PACU hand-off tool

The ISBAR hand-off tool is an effective method to augment verbal communication. The tool is not a part of the patient's medical record, but acts as an essential reminder of pertinent information that needs to be disseminated. Listed below are the key elements included in the tool when transporting the patient from OR to PACU.

 

I = Identification

 

Date and time

 

Reporting RN

 

Procedure surgeon

 

Anesthesia provider

 

RN accepting report

 

S = Situation

 

Procedure

 

Type of anesthesia

 

B = Background

 

Medical history and allergies

 

Isolation

 

Medications given

 

Critical lab results

 

A = Assessment

 

Vital signs/oxygen saturation

 

Ventilator settings

 

I.V. fluids

 

Neuro/vascular

 

Hemodynamic (CVP/PA line/Arterial line)

 

Estimated blood loss

 

Blood glucose level

 

Sutures/dressing/packing

 

Drains/nasogastric tube/chest tube

 

Code status

 

Family available

 

R = Recommendation

 

New orders

 

Other

 

References

 

1. Behara R, Wears RL, Perry SJ, et al. A conceptual framework for studying safety transitions in emergency care. Advances in Patient Safety: From Research to Implementation. Available at: http://www.ahrq.gov/downloads/pub/advances/vol2/Behara.pdf. Accessed January 3, 2008. [Context Link]

 

2. United States Government Accountability Office. VA patient safety program: A cultural perspective at four medical facilities. GAO-05-83: Report to the Secretary of Veterans Affairs. Available at: http://www.gao.gov/new.items/d0583.pdf. Accessed January 3, 2008. [Context Link]

 

3. AORN (2007). Hand-off toolkit to improve transitions in care within the perioperative environment. Available at http://www.aorn.org. Accessed January 10, 2008. [Context Link]