Patient Status Evaluation (Transfer of Care) for Certified Perioperative Nurse (CNOR)
Included In This Lesson
Outline
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
Transcript
References
- Rothrock, J. (2019). Alexander’s Care of the Patient in Surgery (16th ed.). Elsevier Health Sciences.
- Association of perioperative Registered Nurses (AORN): Guideline Essentials (website), 2022, https://www.aorn.org/guidelines-resources/guidelines-for-perioperative-practice/guideline-essentials
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