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$ Pre#ious Ne%t & AORN Journal 'olume ()* Issue + * Pa"es ,(,-+./* No#ember 0.12

S3I4CH for Safety5 Perio6erati#e Hand-off 4ools Fay Johnson* 7SN* RN* CNOR* Patty !o"sdon* CNOR* Sandra Fisher* 7S* RN* CNOR SN* RN* CNOR* 8im Fournier* ADN* RN*

Abstract Full 4e%t PDF Ima"es

References

Article Outline Abstract Hand-off Communication Settin" Rollout 9%6ansion Feedbac: and Success 9%amination; Continuin" 9ducation Pro"ram S3I4CH for Safety5 Perio6erati#e Hand-off 4ools Pur6ose<=oal Ob>ecti#es ?uestions !earner 9#aluation; Continuin" 9ducation Pro"ram S3I4CH for Safety5 Perio6erati#e Hand-off 4ools Ob>ecti#es Content References 7io"ra6hy Co6yri"ht Abstract

Communication brea:do@n is the leadin" cause of re6orted sentinel e#ents in the 6erio6erati#e settin"; 7arriers to o6timal communication include noise* stress* multitas:in"* and ra6id turno#er bet@een 6rocedures; AORN has identified communication durin" 6ersonnel chan"es Aie* hand offsB as a 6oint of #ulnerability for the sur"ical 6atient; A standardiCed hand-off method 6ro#ides an o66ortunity for 6ersonnel to as: and ans@er Duestions and should be a#ailable in the 6erio6erati#e settin"; At one facility* the standardiCation of hand-off re6ortin" resulted in the de#elo6ment of ne@ hand-off tools s6ecific to the 6erio6erati#e en#ironment; A standardiCed re6ortin" method enabled health care 6ro#iders to address communication barriers and to maintain their focus on the 6atient durin" critical moments Ae"* shift chan"esB* thereby im6ro#in" 6atient safety;

8ey @ords5 communication tools* communication brea:do@n* hand-off tools* hand-off re6orts* 6atient safety* hand-off communication

Continuin" 9ducation

Communication of essential information durin" the transfer of 6atient care from one 6erio6erati#e care 6ro#ider to another is critical to 6atient safety and continuity of care; 4he leadin" cause of re6orted sentinel e#ents in the OR is communication brea:do@n;1* 0 EA sentinel e#ent is an une%6ected occurrence in#ol#in" death or serious 6hysical or 6sycholo"ical in>ury* or the ris: thereof; Serious in>ury s6ecifically includes loss of limb or function; ; ; ; Such e#ents are called FsentinelG because they si"nal the need for immediate in#esti"ation and res6onse;H2 7arriers to concise communication include noise* information o#erload* inattention* stress* multitas:in"* and time 6ressures caused by ra6id turno#er bet@een 6rocedures;, ore than 2*... sentinel e#ents analyCed from 1((+ to 0.., re#ealed that I+J of re6orted 6roblems @ere caused by 6oor communication;+ In 0..+* that 6ercenta"e increased to /.J* of @hich half of re6orted e#ents occurred durin" the hand-off communication 6eriod;+ Communication durin" 6ersonnel chan"es is a 6oint of #ulnerability durin" @hich incorrect information can be con#eyed or crucial information omitted* leadin" to medical error; Hand offs are the most common health care transaction 6rone to error;I

In 0..I* 4he Joint Commission 6ublished National Patient Safety =oal 09; 4he 6ur6ose of this safety "oal @as to "uide 6ro#iders in im6lementin" a standardiCed a66roach to hand-off communications* includin" ensurin" that they ha#e an o66ortunity to as: and res6ond to Duestions;+ In an effort to deal @ith communication failures* 4he Joint Commission re#ised and e%6anded that safety "oal in 0..) to reDuire the follo@in"5 1;Interacti#e communications allo@in" for the o66ortunity for Duestionin" bet@een the "i#er and the recei#er of 6atient information;

0;K6-to-date information re"ardin" the 6atientGs care* treatment* ser#ices* condition* and any recent or antici6ated chan"es;

2;A 6rocess for #erification of the recei#ed information* includin" the use of re6eat-bac: and read-bac:* as a66ro6riate;

,;An o66ortunity for the recei#er of the handoff information to re#ie@ rele#ant 6atient historical data* @hich may include 6re#ious care* treatment* and ser#ices;

+;Interru6tions durin" handoffs are limited to minimiCe the 6ossibility that information @ould fail to be con#eyed or @ould be for"otten;/

Health care facility mana"ement 6ersonnel should de#elo6 and im6lement a 6rocess to com6ly @ith this safety "oal;+

7ac: to Article Outline Hand-off Communication

4he terms hand-off* hando#er* si"n-o#er* and shift re6ort are synonymous; A Ehand offH may be described as the transfer of 6atient information* alon" @ith the authority and res6onsibility to care for that 6atient* from one health care 6ro#ider to another durin" the transfer of care;)* ( For e%am6le* a hand off in the OR may be from one RN circulator to another RN circulator or from one scrub 6erson to another scrub 6erson; 4he Ehand-off communication re6ort must be com6lete* concise* concrete* clear* and accurate;H,A6+B All team members in#ol#ed should ha#e the o66ortunity to as: Duestions* res6ond to Duestions* and discuss 6atient care 6ro#ided by the 6re#ious clinician and care that @ill be reDuired by the ne%t clinician; StandardiCed hand-off systems and techniDues are @idely a#ailable and include the follo@in" formats5 S7AR5 situation* bac:"round* assessment* recommendationL

I PASS the 7A4ON5 introduction* 6atient* assessment* situation* safety concerns* AtheB bac:"round* actions* timin"* o@nershi6* ne%tL

SHAR?5 situation* history* assessment* recommendations* DuestionsL

Fi#e Ps5 6atient* 6lan* 6ur6ose of 6lan* 6roblem* 6recautionL and

Fi#e Ps* second #ersion5 6atient* 6recautions* 6lan of care* 6roblems* 6ur6ose;1.* 11

Althou"h these hand-off methods hel6 to ensure clear and com6lete hand-off communication* none are s6ecific to the needs in the 6erio6erati#e en#ironment;

7ac: to Article Outline Settin"

As a result of a 0.1. safety sur#ey* members of the Sur"ical Ser#ices Partnershi6 Council at Pro#idence St 'incent edical Center* Portland* Ore"on* learned of 6erio6erati#e nursesG concerns re"ardin" inconsistencies in hand-off re6ortin"; Althou"h the S7AR method @as used for hand-off communications throu"hout the hos6ital* it did not address s6ecific and critical information that needed to be relayed durin" the intrao6erati#e hand off; 4he result @as inconsistent use of S7AR by health care 6ro#iders or 6ersonnel 6erformin" their o@n #ersion of S7AR; Critical information related to sur"ical 6atientsMsuch as totals of medications administered* instruments off the sterile field* and details about s6ecimens or countsMoften may not be communicated for #arious reasons Ae"* distractions* need for ra6id room turno#erB; Such inconsistency @as creatin" a 6atient safety issue;

In res6onse to these concerns and after re#ie@in" resources about hand-off communication for "uidance*11* 10 council members decided that a standardiCed hand-off tool desi"ned s6ecifically for the OR @as needed; Council members then identified barriers to effecti#e communication at the facility* @hich included the follo@in"5 the lac: of an established 6rocess or @ritten scri6t for hand offsL

re6orts "i#en #erbally Aie* no @ritten re6ort tem6lateB* @hich forced indi#iduals to rely on memory aloneL

6ersonnel brea:s ta:en @ithout team members 6erformin" a thorou"h hand-off re6ortL

noise distractions Ae"* music 6layin"* bac:"round con#ersations* eDui6ment noiseBL

6ersonnel @ho multitas:ed Ae"* com6letin" documentation* 6erformin" the sur"ical 6re6* 6ositionin" the 6atientB durin" the hand offL

6ersonnel feelin" 6ressured to 6erform ra6id turno#ers bet@een 6roceduresL

the incon#enient timin" of the hand off in relation to the status of the 6rocedure Ae"* a hand off occurrin" durin" the be"innin" or end of the 6rocedure or at a critical 6oint in the 6rocedure* such as durin" 6ositionin" or countin"BL and

the facilityGs recent con#ersion to electronic chartin" and the subseDuent increase in chartin" demands* @hich affected the intrao6erati#e @or:flo@;

Relyin" on memory* bein" distracted by noise and other acti#ities* and ad>ustin" to ne@ @or:flo@s all interfered @ith accurate re6ortin"; In addition* the 6recedin" items indicated that 6ersonnel at our facility @ere encounterin" se#eral barriers to o6timal communication* namely not ha#in" a standardiCed hand-off a66roach or accuracy in re6ortin"* follo@ed closely by a lac: of com6leteness and clarity durin" the information e%chan"e; =i#en the 6erio6erati#e team membersG #ariety of e%6eriences* trainin"* and bac:"rounds* council members decided that a standardiCation tool @as necessary to im6ro#e 6rocesses and ensure 6atient safety;

After careful assessment of safety concerns and the identified barriers to hand-off communication* the council decided to de#elo6 and im6lement its o@n scri6ted solution; 4his resulted in S3I4CH AFi"ure 1B* a ne@ hand-off tool for im6ro#ed communication; 4he acronym S3I4CH stands for sur"ical 6rocedure*

@et Aie* fluidsB*

instruments*

tissue Aie* s6ecimenB*

counts* and

ha#e you any DuestionsN

9ach of the S3I4CH acronym cate"ories 6ermitted additional subcate"ories* such as medications in the @et cate"ory* to allo@ 6erio6erati#e team members to adeDuately address communication s6ecific to their #arious roles and hand-off needs; Similar to other communication techniDues* S3I4CH is easy to remember because* as an acronym* it s6ells a @ord that con#eys the critical acti#ities that occur @hen 6ersonnel care for the 6atient; Knli:e other communication techniDues* ho@e#er* the S3I4CH tool is "eared to@ard the s6ecialiCed needs of the 6erio6erati#e en#ironment; 4he councilGs "oal in de#elo6in" the S3I4CH tool @as to standardiCe the hand-off re6ortin" 6rocess and to ensure that a face-to-face hand off occurred bet@een out"oin" and incomin" 6ersonnel;

'ie@ !ar"e Ima"e Do@nload to Po@erPoint Fi"ure 1

Initial use of the ne@ S3I4CH tool @as for the hand off bet@een t@o RN circulators or scrub 6erson to scrub 6erson;

odified and used @ith 6ermission from Pro#idence St 'incent

edical Center* Portland* OR;

7ac: to Article Outline Rollout

In 6re6aration for im6lementin" the S3I4CH tool* the council considered ho@ difficult chan"e can be for indi#iduals; An indi#idualGs resistance to chan"e can be attributed to factors such as habits* com6lacency* disor"aniCation* 6ercei#ed loss of 6o@er* and not understandin" the need for chan"e;12 4o alle#iate the 6otential for any resistance to chan"e* council members made sure that all 6ersonnel @ere a@are of the need for and the reasonin" behind the chan"e; 4his occurred durin" se#eral inser#ice meetin"s led by council members; In6ut recei#ed from 6erio6erati#e 6ersonnel durin" these inser#ice meetin"s "uided council members in the de#elo6ment of the S3I4CH tool and @as es6ecially hel6ful in delineatin" subcate"ories; An early 6a6er #ersion of the tool @as tested by 6erio6erati#e 6ersonnel for se#eral @ee:s* and feedbac: that council members recei#ed on the @ritten layout and content @as ta:en into consideration before rollout of the final #ersion;

4he official rollout of S3I4CH be"an @ith council members educatin" 6ersonnel about the ne@ tool; Durin" mandatory inser#ice 6ro"rams for 6ersonnel from each shift* council members re#ie@ed the reasons for chan"in" hand-off re6ortin" and 6resented the S3I4CH tool itself; Ne%t* 6erio6erati#e 6ersonnel 6artici6ated in role-6layin" e%ercises and an acti#ity of matchin" hand-off information to the correct S3I4CH cate"ory; All 6ersonnel* includin" those @ho @ere not able to attend* @ere assi"ned an electronic learnin" module that council members created to orient 6ersonnel to and further educate them about S3I4CH;

4o 6romote a@areness and aid in retention durin" the rollout* council members distributed 6a6er S3I4CH forms to each of the ORs in the facility; 4hese forms used bullet 6oints to illustrate each cate"ory of the hand-off tool; !aminated forms also @ere a#ailable at the RN circulatorsG com6uter @or: station* to be used @ith a dry-erase mar:er for @ritten hand-off re6ortin"; 4his laminated form allo@ed the RN circulator to @rite :ey notes that @ould 6re6are him or her to "i#e a hand-off re6ort efficiently and remember critical 6atient information; Another lar"e laminated S3I4CH tool @as 6laced on the @all near the scrub 6ersonOs bac: table; It 6ermitted the scrub 6ersonnel to easily read the form and to "i#e his or her hand off in a standardiCed fashion; Council members also distributed smaller #ersions of the laminated cards to team members to @ear behind their name ta"s;

4he S3I4CH tool 6ro#ided 6ersonnel a frame@or: @ith @hich to im6ro#e their hand-off s:ills and 6re#ent communication errors; For e%am6le* durin" a hand off for a 6atient @ho is under"oin" a ri"ht mastectomy @ith a sentinel node bio6sy and breast reconstruction @ith 6lacement of a tissue e%6ander* the hand-off re6ort bet@een t@o RN circulators @hen one is lea#in" for a brea: AFi"ure 0B @ould include the follo@in"5 S5 sur"eryMri"ht mastectomy* sentinel node bio6sy* reconstruction @ith tissue e%6ander 6lacementL 6atient is aller"ic to 6enicillinL 6atient @ill be transferred to the 6ostanesthesia care unit APACKB after sur"ery

35 @etM.;0+J bu6i#acaine 6lain A2. m!B* +.*... units of bacitracin diluted in 1*... m! of .;(J sodium chloride irri"ation solution* t@o 1+-Fr closed colla6sible drains o6ened on sterile field

I5 instrumentsMusin" the t@o trays of mastectomy instrumentsL tissue e%6anders a#ailable in room

45 tissueMone s6ecimen5 ri"ht breast to be sent to 6atholo"y for 6ermanent section and t@o sentinel nodes sent to 6atholo"y for touch 6re6

C5 countsM#erify count board5 0. la6arotomy s6on"es* 10 suture needles* si% :nife blades* t@o electrosur"ical unit ti6s

H5 ha#e you any DuestionsN 3hat is the status of fillin" out the im6lant cardN

An e%am6le of a scrub 6ersonGs hand off to another scrub 6erson AFi"ure 2B for the same 6atient mi"ht include the follo@in"5 S5 sur"eryMri"ht mastectomy* sentinel node bio6sy* reconstruction @ith im6lantL ha#e t@o se6arate ayo stands and bac: tablesL 6atient is aller"ic to 6enicillin

35 @etM.;0+J bu6i#acaine 6lain A2. m!B* +.*... units of bacitracin diluted in 1*... m! of .;(J sodium chloride irri"ation solution* t@o 1+-Fr closed colla6sible drains o6ened on sterile field

I5 instrumentsMusin" the t@o trays of mastectomy instrumentsL tissue e%6anders in room but not o6ened

45 tissueMthree s6ecimens5 ri"ht breast to be sent to 6atholo"y for 6ermanent section and t@o sentinel nodes sent to 6atholo"y for touch 6re6 handed off the sur"ical field to the RN circulator

C5 countsM#erify chan"e of shift count5 ei"ht la6arotomy s6on"es in s6on"e countin" ba" off the field* 10 la6arotomy s6on"es on the field* 10 sutures* si% :nife blades* t@o electrocautery unit ti6s

H5 ha#e you any DuestionsN

'ie@ !ar"e Ima"e Do@nload to Po@erPoint Fi"ure 0

4@o RN circulators 6erform a S3I4CH hand off before a shift chan"e;

'ie@ !ar"e Ima"e Do@nload to Po@erPoint Fi"ure 2

One scrub 6erson 6erforms a S3I4CH hand off @ith another scrub 6erson before a shift chan"e;

7ac: to Article Outline 9%6ansion

After im6lementation of S3I4CH* the council redesi"ned the toolGs conce6t so that it could be used for indirect 6erio6erati#e 6atient care areas throu"hout the OR; 4he char"e nurses at the OR front des: did not ha#e a standardiCed re6ortin" method* and the out"oin" char"e nurse sometimes failed to relay critical information to the oncomin" char"e nurse; 4he 6artnershi6 council member @ho initiated the S3I4CH conce6t @as also the @ee:end char"e nurse; She 6ro6osed a modification of the S3I4CH tool that @ould ma:e the front des: schedulin" char"e re6orts more efficient and effecti#e AFi"ure ,B; 7y ad>ustin" the S3I4CH cate"ories Aie* chan"in" the @ords associated @ith each letter of the acronymB* a re#ised #ersion of the tool @as de#elo6ed to address the areas of concern related to mana"in" the OR schedulin" Ae"* 6ersonnel on duty* scheduled 6roceduresB;

'ie@ !ar"e Ima"e Do@nload to Po@erPoint Fi"ure ,

Kse of the S3I4CH hand-off tool e%tended beyond the OR to front-des: 6ersonnel;

odified and 6rinted @ith 6ermission from Pro#idence St 'incent

edical Center* Portland* OR;

4he follo@in" e%am6le illustrates ho@ the modifications to the S3I4CH tool can be used by the char"e nurses at the front des:5 S5 staffin" issuesMneed one nurse for OR P, and one scrub 6erson for OR P/ because of sic: calls

35 @hat still needs to be doneMse#en rooms are runnin"* robotics room needs to be set u6* code carts need to be chec:ed

I5 itemsMinstruments and im6lants are comin" in for a s6ecial 6rocedure in OR PI

45 timeMtimes a#ailable for add-ons or emer"enciesL "a6 in schedule from 102. to 1,.. in OR P1

C5 casesMOR P1, delayed because of an emer"ency* and the sur"eon is late in OR P0.L all a66ro6riate 6ersonnel ha#e been notified

H5 ha#e you any DuestionsN

4he char"e nurses learned that each lettered item may not al@ays a66ly* but runnin" throu"h all of the cate"ories and 6ossible subcate"ories of the tool ensures that no one misses critical information; 4he char"e nurses decided to :ee6 6rocessed S3I4CH forms in a binder for future e#aluation and analysis;

One council member @as an anesthesia technician; He decided to use the OR S3I4CH tool to de#elo6 a modified #ersion for the anesthesia de6artment AFi"ure +B; Pre#iously* this de6artment did not ha#e a standardiCed method or scri6ted tool; 4he @or: areas that anesthesia technolo"ists are res6onsible for e%tend beyond the main OR* ma:in" hand-off communication more challen"in"; 3ith the S3I4CH tool* the anesthesia technolo"ists @ere able to im6ro#e communication at brea: times and shift chan"es; 4his success led to de6artmental use of S3I4CH to establish a more effecti#e trac:in" system of s6ecialty carts and their locations; Procedures that this "rou6 6erformed outside the main OR became more easily trac:ed* and less time @as s6ent locatin" lost eDui6ment in different de6artments; 9Dui6ment from radiolo"y* the catheteriCation laboratory* endosco6y* and the neonatal intensi#e

care unit sto66ed "ettin" mis6laced* @hich im6ro#ed efficiency and reduced re6lacement costs; 4he hand-off tool also made it easier for anesthesia technolo"ists to identify @hich carts need to be cleaned and restoc:ed* @hich resulted in a more efficient and effecti#e de6artment; Ha#in" eDui6ment readily a#ailable also has made it safer for the 6atients;

'ie@ !ar"e Ima"e Do@nload to Po@erPoint Fi"ure +

Anesthesia 6ersonnel also @ere able to use S3I4CH* @hich led to im6ro#ed trac:in" of carts;

odified and 6rinted @ith 6ermission from Pro#idence St 'incent

edical Center* Portland* OR;

At Pro#idence St 'incent edical Center* the anesthesia 6rofessional is ty6ically accom6anied to the PACK by the sur"eon* resident* or 6hysician assistant; 4he anesthesia 6rofessional "i#es the main hand-off re6ort to the PACK nurse; 4he RN circulator may call the PACK nurse @ith a s6ecific 6atient concern before the 6atient is transferred to the PACK or may accom6any the anesthesia 6rofessional to the PACK if he or she has s6ecific hand-off information that may not be "i#en by the anesthesia 6rofessional; 4his #ariability facilitates faster room turno#er; A standardiCed hand-off tool is bein" de#elo6ed at this time for the hand-off communication bet@een the anesthesia 6rofessional and PACK RN;

7ac: to Article Outline Feedbac: and Success

A council member shared the S3I4CH hand-off tool for the RN circulator and scrub 6erson @ith 6ersonnel from se#eral other hos6itals in the Portland area; Additionally* council members 6resented the tool at a local AORN cha6ter meetin"* on AORN ember4al: Aie* AORN listser#B* and as a 6oster 6resentation at the 0.10 AORN Con"ress in Ne@ Orleans* !ouisiana; 4he council recei#ed 6ositi#e feedbac: re"ardin" the hand-off tool; After usin" S3I4CH for one year* Sur"ical Ser#ices Partnershi6 Council members 6resented a sur#ey to measure com6liance @ith the toolGs use; Of the 22 team members Aie* 0. nurses* 10 sur"ical technolo"ists* one anesthesia technolo"istB @ho com6leted the sur#ey* (/J thou"ht that the S3I4CH hand-off tool @as #ery im6ortant for 6atient safety and )/J thou"ht it @as easy to use;

Council members ha#e listened to the comments of the sur#ey; As a result* council members added a subcate"ory to the form for dressin"s and drains; Other comments recei#ed @ere that 6ersonnel @ant to be able to "i#e their re6ort @ithout feelin" rushed or interru6ted*

the scri6t 6ro#ides a #erbal and @ritten re6ort but also allo@s time for as:in" and ans@erin" Duestions*

nurses li:e the #ersatility of ha#in" both laminated and 6a6er forms of the tool a#ailable* and

standardiCation of hand-off re6orts :ee6s the care 6ro#iderGs focus on the 6atient and increases 6atient safety;

ana"erial feedbac: e%6ressed su66ort and encoura"ement for usin" S3I4CH for e#ery 6atient e#ery time* and mana"ers ha#e reDuested audits of the 6a6er #ersion of the tool to document com6liance;

Council members successfully im6lemented the Kni#ersal ProtocolQ for time outs1, and* subseDuently* the 3orld Health Or"aniCation Sur"ical Safety Chec:list;1+ 9Dually im6ortant to mana"ers and council members ali:e* as @ell as to 6atient safety* has been the successful im6lementation of the S3I4CH hand-off tool; Hand-off re6orts are a time for health care 6ro#iders to focus on the transfer of care @ithout interru6tion* a time to 6ause* and a time to ES3I4CH for Safety;H 4he use of the S3I4CH tool at our facility has :e6t the focus of the handoff e%chan"e on the care of the 6atient and* in fact* has s6otli"hted 6atient safety @hile at the same time ensurin" concise and com6lete re6ortin"; Perio6erati#e ser#ices is a s6ecialiCed ser#ice area in @hich usin" a standardiCed* scri6ted tool has benefited all RN circulators* scrub 6ersonnel* anesthesia technolo"ists* and indirect 6atient care 6ro#iders but* most im6ortantly* the 6atients;

7ac: to Article Outline 9%amination; Continuin" 9ducation Pro"ram S3I4CH for Safety5 Perio6erati#e Hand-off 4ools Pur6ose<=oal

4o 6ro#ide :no@led"e s6ecific to im6ro#in" hand-off communications durin" 6erio6erati#e transfers of care from one health care 6ro#ider to another; Ob>ecti#es

1;Discuss the leadin" cause of re6orted sentinel e#ents;

0;Identify barriers to communication;

2;Describe hand-off communications;

,;Identify standardiCed formats used for hand offs;

+;Discuss S3I4CH tools used for 6erio6erati#e hand offs;

4he 9%amination and !earner 9#aluation are 6rinted here for your con#enience; 4o recei#e continuin" education credit* you must com6lete the 9%amination and !earner 9#aluation online at htt65<<@@@;aorn;or"<C9; ?uestions

1;4he leadin" cause of re6orted sentinel e#ents in the OR is a;assessment;

b;communication brea:do@n;

c;the 6hysical en#ironment;

d;medication mana"ement;

0;7arriers to concise communication include 1;inattention;

0;information o#erload;

2;multitas:in";

,;noise;

+;stress;

I;time 6ressures; a;1* 2* and +

b;0* ,* and I

c;0* 2* +* and I

d;1* 0* 2* ,* +* and I

2;4he most common health care transactions 6rone to error are a;billin";

b;electronic data interchan"e;

c;hand-off communication;

,;A hand off includes the transfer of 1;6atient information;

0;the authority to care for the 6atient;

2;the res6onsibility to care for the 6atient;

,;staff de6artment meetin" information; a;1 and 2

b;0 and ,

c;1* 0* and 2

d;1* 0* 2* and ,

+;StandardiCed formats for hand offs include 1;S7AR;

0;I PASS the 7A4ON;

2;SHAR?;

,;Fi#e Ps;

+;Fi#e Ps* second #ersion; a;, and +

b;1* 0* and 2

c;1* 0* 2* and ,

d;1* 0* 2* ,* and +

I;In the OR* the S3I4CH acronym stands for sur"ical 6rocedure* @hat needs to be done* instruments* time* counts* and ha#e you any Duestions; a;true

b;false

/;Accordin" to the OR S3I4CH tool* the 6lan for 6osto6erati#e 6atient dis6osition belon"s in the RRRRRRRRRRR section; a;sur"ical 6rocedure

b;@et

c;tissue

d;ha#e you any DuestionsN

);Accordin" to the OR front-des: S3I4CH tool* identifyin" "a6s in the OR schedule belon"s in the RRRRRRRRRRR section; a;staff issues

b;items

c;time

d;ha#e you any DuestionsN

(;Accordin" to the anesthesia S3I4CH tool* identifyin" items that are bro:en or out for re6air belon"s in the RRRRRRRRRRR section; a;s6ecialty carts and de6artments

b;@hite carts

c;instruments

d;hel6ful communication

1.;Of the 22 team members @ho com6leted a sur#ey after usin" the S3I4CH hand-off tool for a year* (/J thou"ht that the S3I4CH hand-off tool @as #ery im6ortant for 6atient safety; a;true

b;false

7ac: to Article Outline !earner 9#aluation; Continuin" 9ducation Pro"ram S3I4CH for Safety5 Perio6erati#e Hand-off 4ools

4his e#aluation is used to determine the e%tent to @hich this continuin" education 6ro"ram met your learnin" needs; Rate the items as described belo@; Ob>ecti#es

4o @hat e%tent @ere the follo@in" ob>ecti#es of this continuin" education 6ro"ram achie#edN 1;Discuss the leadin" cause of re6orted sentinel e#ents; !o@ 1; 0; 2; ,; +; Hi"h

0;Identify barriers to communication; !o@ 1; 0; 2; ,; +; Hi"h

2;Describe hand-off communications; !o@ 1; 0; 2; ,; +; Hi"h

,;Identify standardiCed formats used for hand offs; !o@ 1; 0; 2; ,; +; Hi"h

+;Discuss S3I4CH tools used for 6erio6erati#e hand offs; !o@ 1; 0; 2; ,; +; Hi"h

Content

I;4o @hat e%tent did this article increase your :no@led"e of the sub>ect matterN !o@ 1; 0; 2; ,; +; Hi"h

/;4o @hat e%tent @ere your indi#idual ob>ecti#es metN !o@ 1; 0; 2; ,; +; Hi"h

);3ill you be able to use the information from this article in your @or: settin"N 1; Ses 0; No

(;3ill you chan"e your 6ractice as a result of readin" this articleN AIf yes* ans@er Duestion P(A; If no* ans@er Duestion P(7;B

(A;Ho@ @ill you chan"e your 6racticeN ASelect all that a66lyB 1;I @ill 6ro#ide education to my team re"ardin" @hy chan"e is needed;

0;I @ill @or: @ith mana"ement to chan"e<im6lement a 6olicy and 6rocedure;

2;I @ill 6lan an informational meetin" @ith 6hysicians to see: their in6ut and acce6tance of the need for chan"e;

,;I @ill im6lement chan"e and e#aluate the effect of the chan"e at re"ular inter#als until the chan"e is incor6orated as best 6ractice;

+;Other5 RRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRR

(7;If you @ill not chan"e your 6ractice as a result of readin" this article* @hyN ASelect all that a66lyB 1;4he content of the article is not rele#ant to my 6ractice;

0;I do not ha#e enou"h time to teach others about the 6ur6ose of the needed chan"e;

2;I do not ha#e mana"ement su66ort to ma:e a chan"e;

,;Other5 RRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRR

1.;Our accreditin" body reDuires that @e #erify the time you needed to com6lete the 0;2 continuin" education contact hour A12)-minuteB 6ro"ram5 RRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRR

7ac: to Article Outline References Na"6al 8* 'ats A* !amb 7* et al; Information transfer and communication in sur"ery5 a systematic re#ie@; Ann Sur"; 0.1.L0+0A0B500+T02( 'ie@ In ArticleCrossRef 4ane#a S* =rote =* 9asty A* Plattner 7; Decodin" the 6erio6erati#e 6rocess brea:do@ns5 a theoretical model and im6lications for system desi"n; Int J ed Inform; 0.1.L/(A1B51,T2. 'ie@ In ArticleAbstractFull 4e%t Full-4e%t PDF AI(2 87B CrossRef Sentinel e#ent; 4he Joint Commission; htt65<<@@@;>ointcommission;or"<sentinelRe#ent;as6%; Accessed Au"ust (* 0.12; 'ie@ In Article Hos6ital and Health Ser#ice Performance Di#ision; Promotin" 9ffecti#e Communication Amon" Healthcare Professionals to Im6ro#e Patient Safety and ?uality of Care; elbourne* Australia5 'ictoria =o#ernment De6artment of HealthL 0.1.L1T10 'ie@ In Article 4he Joint Commission; Im6ro#in" handoff communications5 meetin" National Patient Safety =oal 09; Joint Pers6ect Patient Safety; 0..ILI5(T1+ 'ie@ In Article 'an Dam S; A 6rocess 6rone to error and needin" im6ro#ement; Forum; 0../L0+A1B51,T1+ 'ie@ In Article 0..) Hos6ital Patient Safety =oals5 Im6lementation e%6ectations for handoffs; 4he Joint Commission; htt65<<@@@;>ointcommission;or"<NR<rdonlyres<)07/1/D)-71IA-,,,0-AD..C921))C0F..A<.<.)RHAPRNPS=sR aster;6df; Accessed October 0* 0.12;

'ie@ In Article Friesen A* 3hite S'* 7yers JF; Handoffs5 im6lications for nurses; In5 Patient Safety and ?uality5 An 9#idence-7ased Handboo: for Nurses; Roc:#ille* D5 A"ency for Healthcare Research and ?ualityL 0..)L6; 1T1/ 'ie@ In Article Hand-off communications; Healthcare Ins6irations; htt65<<@@@;healthcareins6irations;com<hciRhand-offRcommunications;html; Accessed Au"ust (* 0.12; 'ie@ In Article Sandlin D; Im6ro#in" 6atient safety by im6lementin" a standardiCed and consistent a66roach to hand-off communications; J Perianesth Nurs; 0../L00A,B50)(T0(0 'ie@ In ArticleFull 4e%t Full-4e%t PDF A//I 87B CrossRef Patient Hand Off Communication 4ool 8it; AORN* Inc; htt65<<@@@;aorn;or"<ClinicalRPractice<4ool8its<PatientRHandROffR4oolR8it<PatientRHandROffR4 oolR8it;as6%; Accessed Au"ust 2.* 0.12; 'ie@ In Article 4ransitions of care A4OCB 6ortal; 4he Joint Commission; htt65<<@@@;>ointcommission;or"<toc;as6%; Accessed Au"ust (* 0.12; 'ie@ In Article Simms 9; 4he com6onents of chan"e5 creati#ity and inno#ation* critical thin:in" and 6lanned chan"e; In5 Roussel !* S@ansbur" R editor; ana"ement and !eadershi6 Administration for Nurse Administrators; ,th ed;; Sudbury* A5 Jones and 7artlett PublishersL 0..IL6; ++T). 'ie@ In Article 4he Kni#ersal Protocol; 4he Joint Commission; htt65<<@@@;>ointcommission;or"<standardsRinformation<u6;as6%; Accessed Au"ust (* 0.12; 'ie@ In Article Sur"ical Safety Chec:list; 4he 3orld Health Or"aniCation; htt65<<@@@;@ho;int<6atientsafety<safesur"ery<toolsRresources<SSS!RChec:listRfinalJun.);6df; Accessed Au"ust (* 0.12; 'ie@ In Article

Fay Johnson* 7SN* RN* CNOR* is a clinical le#el , 6erio6erati#e nurse in the OR at Pro#idence St 'incent edical Center* Portland* OR; s Johnson has no declared affiliation that could be 6ercei#ed as 6osin" a 6otential conflict of interest in the 6ublication of this article;

Patty !o"sdon* SN* RN* CNOR* is a 6erio6erati#e nurse in the OR at 3a:e ed Health and Hos6itals* Ralei"h* North Carolina; s !o"sdon has no declared affiliation that could be 6ercei#ed as 6osin" a 6otential conflict of interest in the 6ublication of this article;

8im Fournier* ADN* RN* CNOR* is a clinical le#el , 6erio6erati#e nurse in the OR at Pro#idence St 'incent edical Center* Portland* OR; s Fournier has no declared affiliation that could be 6ercei#ed as 6osin" a 6otential conflict of interest in the 6ublication of this article;

Sandra Fisher* 7S* RN* CNOR* is a clinical ladder le#el , 6erio6erati#e nurse in the OR at Pro#idence St 'incent edical Center* Portland* OR; s Fisher has no declared affiliation that could be 6ercei#ed as 6osin" a 6otential conflict of interest in the 6ublication of this article;

9ditorGs note5 4he Kni#ersal Protocol for Pre#entin" 3ron" Site* 3ron" Procedure* 3ron" Person Sur"ery is a trademar: of 4he Joint Commission* Oa:broo: 4errace* I!;

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U 0.12 AORN* Inc; Published by 9lse#ier Inc; All ri"hts reser#ed; $ Pre#ious Ne%t & AORN Journal 'olume ()* Issue + * Pa"es ,(,-+./* No#ember 0.12

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