Improving Post Anesthesia Care Unit Handoff by Enforcing a Standardized Checklist

Post anesthesia care unit (PACU) handoff involves effective communication and attention to improve patient outcome after a surgical procedure. In the Operating Room (OR), nurses and anesthesiologists have a consistent communication practice that prevents medical errors and other adverse events. A continuous patient care should be observed during preoperative, perioperative and postoperative surgical stages. Patient transfer from the operating room to the PACU unit requires a handoff checklist to reduce the risk of adverse events. The checklist ensures nurses recall information discussed during handover. In this review, three articles will be used to support the need for a standardized checklist to be used by nurses during patient transfer from the OR to PACU unit.

According to Tabaac, Arenas, Fastovets, & Patil, (2014), they studied how undivided attention improves patient outcome during the post anesthesia care. In this study, three stages namely preoperative, perioperative and postoperative were assessed concerning undivided attention presented by nurses. The researchers also focused on standards of patient care in the three stages. From the study, it was clear that cases of undivided attention during patient handover to post anesthesia care unit were significantly associated with medical errors and adverse events in the post anesthesia care. Another study by Heck, Huges, & Konia, (2017) also evaluated nurses adherence to a standard handoff checklist. Improved handoff checklists have been designed but adherence to the tools is a great problem with nurses. According to Heck, Huges, & Konia, (2017), the current educational approach for handoffs doesnt provide a full assurance that there will be total adherence to standardized handoff techniques. From the study, they also found that introduction of written or electronic handoff checklists would ensure compliance with the handoff techniques. Another finding from the study was that frequent administration of refresher courses was essential in improving nurses adherence to standardized handoff techniques. Poor patient handover process may jeopardize patient safety and therefore having a succinct handoff checklist is an important implementation (Potestio, Mottla, Kelly, Degroot, 2015). According to their study, Potestio, Mottla, Kelly, Degroot, (2015), found that implementation of a succinct checklist improved post anesthesia care unit. In their improved checklist, they focused on exchange of information and easy transition of patient during practice. Having a succinct checklist provides fewer items that one is able to remember and the major items included patient status, procedure and medication. A succinct checklist has the potential to increase the amount of information exchanged during patient handover (Potestio, Mottla, Kelly, Degroot, 2015).

From the above literature, they have not provided what it means by a standardized handoff checklist. According to Tabaac, Arenas, Fastovets, & Patil, (2014), they claimed that divided attention contributed to medical errors that are observed in the patient transition from OR to PACU. The study provided a clinical implication that with or without a handover checklist, undivided attention plays a significant role in determining patient safety. A comparative study had also brought in another clinical problem whereby adherence to the standardized handoff checklist is often observed. From the literature, it is then clear that having a handoff checklist is not enough and additional interventions such as continuous medical education and patient handover simulations are necessary (Heck, Huges, & Konia, 2017). The third study proposed that having a brief checklist improved the exchange of information during the handover process. A succinct checklist provides the necessary information and therefore easier to practice as compared to other forms of checklists (Potestio, Mottla, Kelly, Degroot, 2015). PACU handoffs also require organization and therefore a simple and easy to follow checklist has a higher potential for adherence.

Concerning the findings provided by the literature, therefore, enforcing a standardized checklist requires several tools that will ensure staff satisfaction during application and delivering patient safety. To avoid conflict of interest that promotes divided attention during PACU handover process, the standardized checklist should provide the essential information easy to follow-up and understand as proposed by Potestio, Mottla, Kelly, Degroot, (2015). The problem concerning lack of adherence to the checklist as studied by Heck, Huges, & Konia, (2017) has an impact on standard PACU handoff checklist. A brief checklist, therefore, will improve the potential of adherence. Another clinical implication concerning standardized patient handoff checklist is improving information exchange. During the practice, time is a factor to consider during the patient transition from OR to PACU. For efficient exchange of information, therefore, a checklist should take the minimum time possible to improve adherence. After comparing the time taken when using a checklist and without a checklist during patient handover, Potestio, Mottla, Kelly, Degroot, (2015) found that nurses preferred working without a checklist to save on time. A standardized checklist to improve PACU handoff should have tools that will promote adherence and easy to understand and follow during application.

Concerning integration of the literature findings to the scope of practice, it is essential to use a standardized checklist when transferring postoperative patients from the OR to a PACU unit. The application of a checklist has the potential to reduce medical errors and to improve patient safety. Additionally, it reduces the risk of adverse events experienced by postoperative patients. In conclusion, to improve on PACU handoff through a standardized checklist should reduce the degree of divided attention and improve on the potential of adherence during application. Education interventions and regular simulations hold a potential in improving patient care in the post anesthesia care unit.

References

Heck, M. C., Huges, P., & Konia, M. (January 01, 2017). An Evaluation of CA-1 Residents'

Adherence to a Standardized Handoff Checklist. The Journal of Education in Perioperative Medicine : Jepm, 19, 1.)

Potestio, C., Mottla, J., Kelly, E., & DeGroot, K., (2015). Improving Post Anesthesia Care Unit

(PACU) Handoff by Implementing a Succinct Checklist. (2017). Apsf.org. Retrieved 12 September 2017, from https://www.apsf.org/newsletters/html/2015/June/04_PACU.htm

Tabaac, B., Arenas, A., Fastovets, G., & Patil, V. (July 01, 2014). Undivided attention improves

postoperative anesthesia handover recall. Advances in Medical Education and Practice, 215.