Operating Room Nurse to Post Anesthesia Care Unit Nurse Handoff: Implementation of a Written SBAR Intervention

The lack of standardized handoff from the operating room (OR) nurse to the post anesthesia care unit (PACU) nurse may result in the miscommunication or omission of patient information, which increases the risk of patient safety events. The goal of this EBP project was to standardize OR to PACU nurse handoff in order to reduce risks to patient safety. A literature review revealed guidelines for handoff which included implementing a standardized protocol and using a mnemonic phrase. The Iowa Model of Evidence-Based Practice and Lewin’s Model of Change guided the EBP project. Handoff quality was evaluated by OR and PACU nurses using a Handoff Evaluation form for two weeks. After two weeks, education was conducted on the importance of standardized handoff and OR nurses began using the standardized SBAR Handoff form while PACU nurses continued with the Handoff Evaluation form until project completion. At intervals of two and six weeks, perioperative nurses completed the Safety Attitudes Questionnaire (SAQ) as a pretest and posttest for perceptions of safety. Cronbach’s alpha, independent t and paired t tests were completed on the SAQ. SBAR Handoff and Handoff Evaluation forms were paired based on patient information. Handoff Evaluation and SBAR Handoff forms were analyzed with frequencies, mean score, and independent t tests. Handoff Evaluation forms were also analyzed with a paired t test and analysis of variance for the three data collection points. Patient safety was measured via an audit of MIDAS risk reports prior to and at the end of data collection. OR and PACU SAQ scores revealed one significant item between the pretest and posttest, which was the Support item (t(11) = 2.60, p = 0.025). Means of the handoff items on the PACU Handoff Evaluation form increased from phase one (M = 8.14, SD = 3.2) to phase two (M = 8.31, SD = 3.4) and then ultimately decreased to phase three (M = 7.57, SD = 3.25). Means of the handoff items on the OR SBAR Handoff form decreased from phase two (M = 12.38, SD = 3.69) to phase three (M = 11.5, SD = 3.48). This was supported by independent t and paired t testing. The Handoff Evaluation from ANOVA did not support any significant change in handoff items among the three phases and frequencies showed no significant changes in reported items (F(66,68) = 0.207, p = 0.814). MIDAS risk reports did not change and no reports were filed during the time of the audit. The literature recommends perioperative nurses should use a mnemonic phrase and implement a standardized protocol to aid nurse memory during handoff; however, these recommendations were not beneficial in standardizing perioperative nurse handoff in this EBP project