Patient Status Evaluation (Transfer of Care)

Guidelines:

• The perioperative nurse evaluates patient status to facilitate transfer of care
  • PACU
  • ICU
  • home
• Evaluation is an ongoing process throughout perioperative patient care
• The perioperative nurse should utilize standardized handoff communication and reports
  • Patient safety
  • Team communication
  • Essential, up-to-date, and specific information
  • Reduces errors/omissions

Considerations:

• TJC, AORN, and WHO recommend postoperative handoffs be formalized
• Transfer-of-care processes (handoffs):
  • Nursing shift changes
  • Temporary relief or coverage
  • Nursing and physician handoffs from one department to another
  • Various other transfers of information in inpatient settings and interhospital transfers

Nurse’s role:

• The perioperative nurse evaluates patient status to facilitate transfer of care
• Communicates patient status
• Documents all nursing interventions
• Follows organization’s policies and procedures for transfer of care criteria
• Documents transfer of care

Pitfalls:

• Standardized handoff communication must include an opportunity to ask and respond to questions
• There is no single recommended handoff tool or script
• Checklists are not sufficient for hand-off communication, but can facilitate handoff communication and improved reliability of OR and PACU handoffs

Examples:

• Intraoperative Hand-off Communication between scrub persons using SBAR
  • S: Name of patient, procedure, pertinent info about procedure (stage)
  • B: history (allergies), surgical team names/roles, special items being used, blood loss, meds/fluids on backtable, specifics about equipment issues, special needs, setup
  • A: Status of specimen, counts, time remaining, complications, problems with anesthesia
  • R: note any special requests for closing/dressings/drains, prepare to introduce relief, allow opportunity for questions before breaking scrub Clamps under the drapes, not discussed in handoff

Linchpins (Key Points):

• The perioperative RN’s evaluation of patient status prior to transfer of care should:
  • Utilize of a standardized handoff tool
  • Focus on patient safety
  • Facilitate transfer of care
  • Be documented per policy