Patient transitioning from unit to unit marks a critical time for both nurses and those receiving care. According to research, breakdowns in communication between nursing staff members are most likely to occur during this period.1 To improve communication, nurses must have standard tools encompassing universal phraseology that are easy to apply in the practice setting.2 OSF St. Anthony Medical Center (SAMC) in Rockford, Ill., re-cently developed a hand-off tool that accomplishes this need. The tool's structural view is defined by the data elements which include Identifica-tion, the Situation, Background information, Assessment of the situation, and Recommendations (ISBAR).

Hand-off analysis

The development of SAMC's hand-off tool was a detailed process. To determine what current technology worked best, the perioperative clinical nurse specialist (CNS) and an OR staff nurse investigated several hand-off reporting tools used by other institutions, along with information published by the Association of peri-Operative Registered Nurses.3 A research team was formed that consisted of three surgical services managers, the perioperative CNS, three staff nurses, and a nursing supervisor. A patient representative was also included to develop standard hand-off tools across the SAMC patient care continuum.

As part of the design process, team members sought staff input about the information that needed to be included on the tool. After reviewing the information, the committee members agreed that one hand-off tool would not meet every unit's needs. Three specific tools were developed: a hand-off tool when transporting the patient from the ambulatory surgery unit (ASU) to the OR, one when transporting the patient directly back to ASU from the OR, and the third for transporting the patient from the OR to PACU (see Key elements of the post procedural OR to PACU hand-off tool).

Successful results

The hand-off tool is an effective method to augment verbal communication. It works as an essential re-minder to perioperative nurses of the importance of disseminating pertinent patient care information.

Key elements of the post proced-ural OR to PACU hand-off tool

The ISBAR hand-off tool is an effective method to augment verbal communication. The tool is not a part of the patient's medical record, but acts as an essential reminder of pertinent information that needs to be disseminated. Listed below are the key elements included in the tool when transporting the patient from OR to PACU.

I = Identification

Date and time

Reporting RN

Procedure surgeon

Anesthesia provider

RN accepting report

S = Situation

Procedure

Type of anesthesia

B = Background

Medical history and allergies

Isolation

Medications given

Critical lab results

A = Assessment

Vital signs/oxygen saturation

Ventilator settings

I.V. fluids

Neuro/vascular

Hemodynamic (CVP/PA line/Arterial line)

Estimated blood loss

Blood glucose level

Sutures/dressing/packing

Drains/nasogastric tube/chest tube

Code status

Family available

R = Recommendation

New orders

Other

References