Intra-Op Handoff Communication

[sugarik13]

I am 6 months into my first job as a new grad OR nurse. My CNS has me doing research on how to improve handoffs during surgery...scrub to scrub, rn to rn at breaks and end of shift, NOT OR to PACU. I have many articles from aorn and TJC's recommendations (SBAR, IPASStheBATON, etc.), so I am not asking you to do my research for me. I was wondering if anyone had a tool or checklist that works for them they could share. Advice for how to improve communication to reduce errors. I know a tool is only as good as the people who decide to use it, but at my hospital it is very inconsistent. I would love to help implement a short, useful (thorough) handoff report template. We already have a "sign-in" and "sign-out" time out form we read from that has a checklist that is supposed to be used, which is rare. I have thought about something small, like the tab from a surgical gown which everyone always has in their pockets for notes as a potential tool, but that would require the manufacturers to get involved...and cost money. Hang it on the wall? White board? What works for you?

As a new rn I know any suggestions would surely help my own practice too.

Thanks!

[Rose_Queen, BSN, MSN, RN]

We use a half sheet form that is not part of the permanent record. It has:

-surgeon and procedure

-location of lines (swan, central line, arterial line, balloon pump, etc.)

-location of drains

-if patient has a pacer/ICD and if it has a magnet on it or is an older one that needed to be turned off

-drips the patient is on

-what blood products have been given

-antibiotics/meds on the field

-post op plan (such as if the patient is early extubation -hearts who are off the vent within 1 hour of arrival to ICU- or patient is planned to follow surgery with a cath lab procedure)

On a white board for all in the room to see:

-name

-allergies

-blood bank number

-sponge and needle count (allows scrub to check whenever they want, not just when counts are required)

I work in cardiothoracic, so we have a much more involved report than other specialties. I also find it very helpful to have something visible instead of just scribbling my own notes that I may not even be able to read later. Our sheet is green, so it stands out compared to all of the other paperwork we deal with.