Date of Award
Projects: SPU Access Only
Doctor of Nursing Practice (DNP)
Background and Significance
Effective postoperative handoff communication is essential to patient safety, continuity of care, and preventing adverse events during the transition period (Nagpal et al., 2013). The accuracy and precision of the information transfer ensure a safe handoff of care. Postoperative handoffs are common, and failures in communication may increase morbidity and mortality. For example, a 43% increase in in-hospital mortality and a 27% increase in significant morbidity were associated with intraoperative handoffs in cardiac surgery (Hudson et al., 2015).
Problem and Purpose Statement
The lack of a standardized process and tools for patient handoffs during the transfer of surgical patients from the OR to the PACU in the agent hospital led to the conduct of the project. The current OR nurses’ note is handwritten without any structure, and it is not user-friendly but provides a brief description of the surgery. The PACU nurses rely on the brief notes written by OR nurses to tailor the patient’s information to the patient care and document in the electronic health record (EHR). This project was to implement a standardized handoff tool to eliminate potential communication-related information omission and errors and improve patient safety and continuity of care. The project aimed to: (1) develop a structured and feasible handoff tool for the OR and PACU nurses, and (2) examine nurses’ perception of the handoff process.
The project was conducted in three phases: A pre-implementation phase, an implementation phase, and a post-implementation phase. The intervention for a standardized perioperative nurse handoff was to use the mnemonic phrase to create a one-page standardized written form. The participants used Microsoft forms to complete the demographic information, Handoff Evaluation Scale (HES), and three open-ended questions anonymously. The evaluation questionnaire focused on the quality of handoff information, communication methods, and perception of teamwork. The HES contains 11 questions which are ranked on a five-point Likert scale. The data analysis was performed using the IBM Statistical Package for the Social Sciences (SPSS), version 28, adopting a significance level of p < .05. Paired t-tests were used to evaluate the various aspect of the handoff process and nurses’ perceptions of the process.
The project was successfully implemented in an agent hospital. The project sample comprised a convenience sample of 43 RNs (86% of the total RNs) working in the two units. The majority of them (32/43, 74%) participated in the posttest survey. Of these 32 RNs, 26 pre/posttest surveys were successfully matched and paired. The outcomes measured displayed a significant improvement in the quality of the handoff information conveyance, interaction and support, and efficiency. After utilizing the new structured handoff communication tool, the mean scores of the nurses’ perception of team communication in both departments have been significantly increased.
Guided by the PDSA cycle, establishing the key stakeholders helped optimize changes in a quick fashion, which resulted in staff enthusiasm (Nelson et al., 2013). The process of designing the new handoff tool was optimized by the involvement of staff nurses in the units. Both OR and PACU nurses have provided positive and constructive feedback to modify the tool, so the project brought positive outcomes. As a result, staff nurses are highly motivated for further improvement. When recognizing this QI project can increase patient safety and nursing satisfaction, the administration is likely to buy-in and keep this change as a standard practice protocol. In addition, the handoff tool is cost neutral as it only requires the use of a copy machine and paper. Each leader and the team members always consider choosing a cost-effective tool that will work best in a given situation. The department administration indicated their interest in mandating the use of the new handoff communication tool and subsequently throughout the facility to improve handoff communication. The plan to disseminate this project includes sharing the data analysis findings with the surgery departments on another campus.
Implications for Practice
The positive impacts of this project can facilitate a positive outcome, which is the prevention of communication errors. This project highlighted the value of utilizing a handoff communication tool to ensure the continuity of care and improve patient outcomes. The use of the new standardized handoff tool should be implemented systemically to improve healthcare communication and create a safer patient care environment. A standard handoff tool is certainly an effective educational method for new RN fellows to improve communication competence and critical thinking under similar circumstances at the clinical site (Noh & Kim, 2021). Therefore, the standard handoff tool can not only provide handoff items, but also reduce clinical training stress, and enhance clinical competence in the new RN fellows. The tool can facilitate increased confidence in presenting situations to other healthcare providers and can expedite the orientation process.
Nagpal, K., Abboudi, M., Manchanda, C., Vats, A., Sevdalis, N., Bicknell, C., Vincent, C., & Moorthy, K. (2013). Improving postoperative handover: A prospective observational study. The American Journal of Surgery, 206(4), 494–501. https://doi.org/10.1016/j.amjsurg.2013.03.005
Hunter, H., Tara, C., Wesley, C., Juliane, B., Susan, H., Paula, S., Sara, E., Kevin, L., Ji Yun, K., & Renaldo, B. (2017). Assessing sbar during intraoperative handoff. Perioperative Care and Operating Room Management, 6, 7–10. Retrieved July 6, 2022, from https://doi.org/10.1016/j.pcorm.2016.12.004
Noh, G., & Kim, M. (2021). Effectiveness of assertiveness training, sbar, and combined sbar and assertiveness training for nursing students undergoing clinical training: A quasi-experimental study. Nurse Education Today, 103, 104958. Retrieved July 24, 2022, from https://doi.org/10.1016/j.nedt.2021.104958
Shen, Yan, "Improving Safety and Efficiency of Postoperative Patient Handoff" (2023). Doctor of Nursing Practice (DNP) Scholarly Projects. 62.