SWITCH for Safety: Perioperative Hand-Off Tools FAY JOHNSON, BSN, RN, CNOR; PATTY LOGSDON, MSN, RN, CNOR; KIM FOURNIER, ADN, RN, CNOR; SANDRA FISHER, BS, RN, CNOR 2.3

CONTINUING EDUCATION SWITCH for Safety: Perioperative Hand-off Tools FAY JOHNSON, BSN, RN, CNOR; PATTY LOGSDON, MSN, RN, CNOR; KIM FOURNIER, ADN, RN, CNOR; SANDRA FISHER, BS, RN, CNOR 2.3

www.aorn.org/CE

Continuing Education Contact Hours Approvals indicates that continuing education (CE) contact hours are This program meets criteria for CNOR and CRNFA available for this activity. Earn the CE contact hours by recertification, as well as other CE requirements. reading this article, reviewing the purpose/goal and objectives, AORN is provider-approved by the California Board of and completing the online Examination and Learner Evalua- Registered Nursing, Provider Number CEP 13019. Check tion at http://www.aorn.org/CE. A score of 70% correct on the with your state board of nursing for acceptance of this activity examination is required for credit. Participants receive feed- for relicensure. back on incorrect answers. Each applicant who successfully completes this program can immediately print a certificate of completion. Conflict of Interest Disclosures Event: #13532 Ms Johnson, Ms Logsdon, Ms Fournier, and Ms Fisher Session: #0001 have no declared affiliations that could be perceived as Fee: Members $13.80, Nonmembers $27.60 posing potential conflicts of interest in the publication of this article. The CE contact hours for this article expire November 30, The behavioral objectives for this program were created 2016. Pricing is subject to change. by Rebecca Holm, MSN, RN, CNOR, clinical editor, with consultation from Susan Bakewell, MS, RN-BC, director, Purpose/Goal Perioperative Education. Ms Holm and Ms Bakewell have To provide knowledge specific to improving hand-off com- no declared affiliations that could be perceived as posing munications during perioperative transfers of care from one potential conflicts of interest in the publication of this health care provider to another. article. Objectives 1. Discuss the leading cause of reported sentinel events. Sponsorship or Commercial Support 2. Identify barriers to communication. No sponsorship or commercial support was received for this 3. Describe hand-off communications. article. 4. Identify standardized formats used for hand offs. 5. Discuss SWITCH tools used for perioperative hand offs. Disclaimer Accreditation AORN recognizes these activities as CE for RNs. This rec- AORN is accredited as a provider of continuing nursing ognition does not imply that AORN or the American Nurses education by the American Nurses Credentialing Center’s Credentialing Center approves or endorses products mentioned Commission on Accreditation. in the activity.

http://dx.doi.org/10.1016/j.aorn.2013.08.016 494 j AORN Journal November 2013 Vol 98 No 5 Ó AORN, Inc, 2013 SWITCH for Safety: Perioperative Hand-off Tools FAY JOHNSON, BSN, RN, CNOR; PATTY LOGSDON, MSN, RN, CNOR; KIM FOURNIER, ADN, RN, CNOR; SANDRA FISHER, BS, RN, CNOR 2.3

www.aorn.org/CE

ABSTRACT

Communication breakdown is the leading cause of reported sentinel events in the perioperative setting. Barriers to optimal communication include noise, stress, multitasking, and rapid turnover between procedures. AORN has identiﬁed communication during personnel changes (ie, hand offs) as a point of vulnerability for the surgical patient. A standardized hand-off method provides an opportunity for personnel to ask and answer questions and should be available in the perioperative setting. At one facility, the standardization of hand-off reporting resulted in the development of new hand-off tools speciﬁc to the perioperative environment. A standardized reporting method enabled health care providers to address communication barriers and to maintain their focus on the patient during critical moments (eg, shift changes), thereby improving patient safety. AORN J 98 (November 2013) 495-504. Ó AORN, Inc, 2013. http://dx.doi.org/10.1016/j.aorn.2013.08.016

Key words: communication tools, communication breakdown, hand-off tools, hand- off reports, patient safety, hand-off communication.

ommunication of essential information analyzed from 1995 to 2004 revealed that 65% of during the transfer of patient care from reported problems were caused by poor communi- C one perioperative care provider to another cation.5 In 2005, that percentage increased to 70%, is critical to patient safety and continuity of care. of which half of reported events occurred during The leading cause of reported sentinel events in the the hand-off communication period.5 Communi- OR is communication breakdown.1,2 “A sentinel cation during personnel changes is a point of event is an unexpected occurrence involving death vulnerability during which incorrect information or serious physical or psychological injury, or the can be conveyed or crucial information omitted, risk thereof. Serious injury speciﬁcally includes leading to medical error. Hand offs are the most loss of limb or function. . . . Such events are called common health care transaction prone to error.6 ‘sentinel’ because they signal the need for imme- In 2006, The Joint Commission published diate investigation and response.”3 Barriers to National Patient Safety Goal 2E. The purpose of concise communication include noise, information this safety goal was to guide providers in imple- overload, inattention, stress, multitasking, and menting a standardized approach to hand-off time pressures caused by rapid turnover between communications, including ensuring that they have procedures.4 More than 3,000 sentinel events an opportunity to ask and respond to questions.5 http://dx.doi.org/10.1016/j.aorn.2013.08.016 Ó AORN, Inc, 2013 November 2013 Vol 98 No 5 AORN Journal j 495 November 2013 Vol 98 No 5 JOHNSON ET AL

In an effort to deal with communication failures, n I PASS the BATON: introduction, patient, The Joint Commission revised and expanded that assessment, situation, safety concerns, (the) safety goal in 2008 to require the following: background, actions, timing, ownership, next; n 1. Interactive communications allowing for the SHARQ: situation, history, assessment, recom- opportunity for questioning between the giver mendations, questions; n and the receiver of patient information. Five Ps: patient, plan, purpose of plan, problem, 2. Up-to-date information regarding the patient’s precaution; and n care, treatment, services, condition, and any Five Ps, second version: patient, precautions, 10,11 recent or anticipated changes. plan of care, problems, purpose. 3. A process for verification of the received in- Although these hand-off methods help to ensure formation, including the use of repeat-back and clear and complete hand-off communication, none read-back, as appropriate. are specific to the needs in the perioperative 4. An opportunity for the receiver of the handoff environment. information to review relevant patient histor- ical data, which may include previous care, treatment, and services. SETTING 5. Interruptions during handoffs are limited to As a result of a 2010 safety survey, members minimize the possibility that information would of the Surgical Services Partnership Council at fail to be conveyed or would be forgotten.7 Providence St Vincent Medical Center, Portland, Oregon, learned of perioperative nurses’ concerns Health care facility management personnel should regarding inconsistencies in hand-off reporting. develop and implement a process to comply with Although the SBAR method was used for hand-off 5 this safety goal. communications throughout the hospital, it did not address specific and critical information that HAND-OFF COMMUNICATION needed to be relayed during the intraoperative hand The terms hand-off, handover, sign-over, and shift off. The result was inconsistent use of SBAR by report are synonymous. A “hand off” may be de- health care providers or personnel performing their scribed as the transfer of patient information, along own version of SBAR. Critical information related with the authority and responsibility to care for that to surgical patientsdsuch as totals of medications patient, from one health care provider to another administered, instruments off the sterile field, and during the transfer of care.8,9 For example, a hand details about specimens or countsdoften may not off in the OR may be from one RN circulator to be communicated for various reasons (eg, distrac- another RN circulator or from one scrub person to tions, need for rapid room turnover). Such incon- another scrub person. The “hand-off communica- sistency was creating a patient safety issue. tion report must be complete, concise, concrete, In response to these concerns and after review- clear, and accurate.”4(p5) All team members in- ing resources about hand-off communication for volved should have the opportunity to ask ques- guidance,11,12 council members decided that tions, respond to questions, and discuss patient care a standardized hand-off tool designed specifically provided by the previous clinician and care that for the OR was needed. Council members then will be required by the next clinician. Standardized identified barriers to effective communication at hand-off systems and techniques are widely avail- the facility, which included the following: able and include the following formats: n SBAR: situation, background, assessment, n the lack of an established process or written recommendation; script for hand offs;

496 j AORN Journal PERIOPERATIVE HAND-OFF TOOLS www.aornjournal.org n reports given verbally (ie, no written report n instruments, template), which forced individuals to rely on n tissue (ie, specimen), memory alone; n counts, and n personnel breaks taken without team members n have you any questions? performing a thorough hand-off report; Each of the SWITCH acronym categories permitted n noise distractions (eg, music playing, back- additional subcategories, such as medications in the ground conversations, equipment noise); wet category, to allow perioperative team members n personnel who multitasked (eg, completing to adequately address communication specific to documentation, performing the surgical prep, their various roles and hand-off needs. Similar to positioning the patient) during the hand off; other communication techniques, SWITCH is easy n personnel feeling pressured to perform rapid to remember because, as an acronym, it spells turnovers between procedures; a word that conveys the critical activities that occur n the inconvenient timing of the hand off in re- when personnel care for the patient. Unlike other lation to the status of the procedure (eg, a hand communication techniques, however, the SWITCH off occurring during the beginning or end of the tool is geared toward the specialized needs of the procedure or at a critical point in the procedure, perioperative environment. The council’s goal in such as during positioning or counting); and developing the SWITCH tool was to standardize n the facility’s recent conversion to electronic the hand-off reporting process and to ensure that charting and the subsequent increase in charting a face-to-face hand off occurred between outgoing demands, which affected the intraoperative and incoming personnel. workflow. ROLLOUT Relying on memory, being distracted by noise In preparation for implementing the SWITCH tool, and other activities, and adjusting to new work- the council considered how difficult change can flows all interfered with accurate reporting. In be for individuals. An individual’s resistance to addition, the preceding items indicated that per- change can be attributed to factors such as habits, sonnel at our facility were encountering several complacency, disorganization, perceived loss of barriers to optimal communication, namely not power, and not understanding the need for change.13 having a standardized hand-off approach or accu- To alleviate the potential for any resistance to racy in reporting, followed closely by a lack of change, council members made sure that all completeness and clarity during the information personnel were aware of the need for and the exchange. Given the perioperative team members’ reasoning behind the change. This occurred during variety of experiences, training, and backgrounds, several inservice meetings led by council members. council members decided that a standardization Input received from perioperative personnel during tool was necessary to improve processes and ensure these inservice meetings guided council members in patient safety. the development of the SWITCH tool and was es- After careful assessment of safety concerns and pecially helpful in delineating subcategories. An the identified barriers to hand-off communication, early paper version of the tool was tested by peri- the council decided to develop and implement its operative personnel for several weeks, and feedback own scripted solution. This resulted in SWITCH that council members received on the written layout (Figure 1), a new hand-off tool for improved and content was taken into consideration before communication. The acronym SWITCH stands for rollout of the final version. n surgical procedure, The official rollout of SWITCH began with n wet (ie, fluids), council members educating personnel about the

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SWITCH for OR Hand Off

S Surgical procedure □ Diagnosis □ Stage of procedure (ie, beginning, middle, end) □ Specific patient concerns (eg, allergies, implants, health status) □ Imaging needed (eg, x-ray) □ Incision type/dressings needed □ Plan for postoperative patient disposition □ Procedure to follow W Wet (ie, fluids) □ Medications on the sterile field (ie, type, amount) □ Irrigation (ie, type, amount) □ Blood loss and blood products available □ Urine out □ Drains I Instruments □ Need to reprocess instruments for to-follow cases □ Instruments on hold □ Implants needed T Tissue (ie, specimen) □ Specimen (ie, name, source of specimen) □ Grafts (ie, type, source of graft, location of graft [eg, specimen refrigerator, dry storage cabinet]) □ Type of laboratory procedure (eg, frozen, touch prep) C Counts □ Sponges, needles, sharps, and instruments □ Items off the sterile field or in body cavities H Have you any questions? □ Status of charting?

Figure 1. Initial use of the new SWITCH tool was for the hand off between two RN circulators or scrub person to scrub person. Modiﬁed and used with permission from Providence St Vincent Medical Center, Portland, OR. new tool. During mandatory inservice programs for that council members created to orient personnel to personnel from each shift, council members re- and further educate them about SWITCH. viewed the reasons for changing hand-off reporting To promote awareness and aid in retention and presented the SWITCH tool itself. Next, peri- during the rollout, council members distributed operative personnel participated in role-playing paper SWITCH forms to each of the ORs in the exercises and an activity of matching hand-off facility. These forms used bullet points to illustrate information to the correct SWITCH category. All each category of the hand-off tool. Laminated personnel, including those who were not able to forms also were available at the RN circulators’ attend, were assigned an electronic learning module computer work station, to be used with a dry-erase

498 j AORN Journal PERIOPERATIVE HAND-OFF TOOLS www.aornjournal.org marker for written hand-off reporting. This lam- placement; patient is allergic to penicillin; inated form allowed the RN circulator to write key patient will be transferred to the postanesthesia notes that would prepare him or her to give a hand- care unit (PACU) after surgery off report efficiently and remember critical patient n W: wetd0.25% bupivacaine plain (30 mL), information. Another large laminated SWITCH 50,000 units of bacitracin diluted in 1,000 mL tool was placed on the wall near the scrub person’s of 0.9% sodium chloride irrigation solution, two back table. It permitted the scrub personnel to easily 15-Fr closed collapsible drains opened on sterile read the form and to give his or her hand off in a field standardized fashion. Council members also dis- n I: instrumentsdusing the two trays of mastec- tributed smaller versions of the laminated cards to tomy instruments; tissue expanders available team members to wear behind their name tags. in room The SWITCH tool provided personnel a frame- n T: tissuedone specimen: right breast to be sent work with which to improve their hand-off skills to pathology for permanent section and two and prevent communication errors. For example, sentinel nodes sent to pathology for touch prep during a hand off for a patient who is undergoing n C: countsdverify count board: 20 laparotomy a right mastectomy with a sentinel node biopsy and sponges, 12 suture needles, six knife blades, two breast reconstruction with placement of a tissue electrosurgical unit tips expander, the hand-off report between two RN n H: have you any questions? What is the status of circulators when one is leaving for a break filling out the implant card? (Figure 2) would include the following: An example of a scrub person’s hand off to another n S: surgerydright mastectomy, sentinel node scrub person (Figure 3) for the same patient might biopsy, reconstruction with tissue expander include the following:

Figure 2. Two RN circulators perform a SWITCH hand off before a shift change.

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Figure 3. One scrub person performs a SWITCH hand off with another scrub person before a shift change. n S: surgerydright mastectomy, sentinel node 12 sutures, six knife blades, two electrocautery biopsy, reconstruction with implant; have two unit tips separate Mayo stands and back tables; patient is n H: have you any questions? allergic to penicillin n W: wetd0.25% bupivacaine plain (30 mL), EXPANSION 50,000 units of bacitracin diluted in 1,000 mL After implementation of SWITCH, the council of 0.9% sodium chloride irrigation solution, two redesigned the tool’s concept so that it could be 15-Fr closed collapsible drains opened on sterile used for indirect perioperative patient care areas field throughout the OR. The charge nurses at the OR n I: instrumentsdusing the two trays of mastec- front desk did not have a standardized reporting tomy instruments; tissue expanders in room but method, and the outgoing charge nurse sometimes not opened failed to relay critical information to the oncoming n T: tissuedthree specimens: right breast to be charge nurse. The partnership council member who sent to pathology for permanent section and initiated the SWITCH concept was also the week- two sentinel nodes sent to pathology for touch end charge nurse. She proposed a modification of prep handed off the surgical field to the the SWITCH tool that would make the front desk RN circulator scheduling charge reports more efficient and ef- n C: countsdverify change of shift count: eight fective (Figure 4). By adjusting the SWITCH cat- laparotomy sponges in sponge counting bag egories (ie, changing the words associated with off the field, 12 laparotomy sponges on the field, each letter of the acronym), a revised version of the

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SWITCH for Front-Desk Hand Off

S Staff issues □ Any personnel working overtime; any “on call” (ie, resource) working □ Any sick calls W What still needs to be done □ Rooms running □ Rooms to be set up □ Quality checks (eg, code carts, sterilizers) I Items □ Out for repair □ On loan outside of the department □ Expected for return T Time □ Available for procedures □ Gaps in schedule C Cases □ Add-ons—who has been notified? □ Cancellations—who has been notified? H Have you any questions? □ Other

Figure 4. Use of the SWITCH hand-off tool extended beyond the OR to front-desk personnel. Modified and printed with permission from Providence St Vincent Medical Center, Portland, OR. tool was developed to address the areas of concern n C: casesdOR #14 delayed because of an related to managing the OR scheduling (eg, per- emergency, and the surgeon is late in OR #20; sonnel on duty, scheduled procedures). all appropriate personnel have been notified The following example illustrates how the n H: have you any questions? modifications to the SWITCH tool can be used by The charge nurses learned that each lettered item the charge nurses at the front desk: may not always apply, but running through all of n S: staffing issuesdneed one nurse for OR #4 the categories and possible subcategories of the tool and one scrub person for OR #7 because of sick ensures that no one misses critical information. The calls charge nurses decided to keep processed SWITCH n W: what still needs to be donedseven rooms forms in a binder for future evaluation and analysis. are running, robotics room needs to be set up, One council member was an anesthesia techni- code carts need to be checked cian. He decided to use the OR SWITCH tool to n I: itemsdinstruments and implants are coming develop a modified version for the anesthesia de- in for a special procedure in OR #6 partment (Figure 5). Previously, this department n T: timedtimes available for add-ons or emergen- did not have a standardized method or scripted tool. cies; gap in schedule from 1230 to 1400 in OR #1 The work areas that anesthesia technologists are

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Figure 5. Anesthesia personnel also were able to use SWITCH, which led to improved tracking of carts. Modiﬁed and printed with permission from Providence St Vincent Medical Center, Portland, OR. responsible for extend beyond the main OR, mak- times and shift changes. This success led to de- ing hand-off communication more challenging. partmental use of SWITCH to establish a more With the SWITCH tool, the anesthesia technologists effective tracking system of specialty carts and their were able to improve communication at break locations. Procedures that this group performed

502 j AORN Journal PERIOPERATIVE HAND-OFF TOOLS www.aornjournal.org outside the main OR became more easily tracked, the survey, 97% thought that the SWITCH hand-off and less time was spent locating lost equipment tool was very important for patient safety and 87% in different departments. Equipment from radi- thought it was easy to use. Council members have ology, the catheterization laboratory, endoscopy, and listened to the comments of the survey. As a result, the neonatal intensive care unit stopped getting mis- council members added a subcategory to the form placed, which improved efficiency and reduced for dressings and drains. Other comments received replacement costs. The hand-off tool also made it were that easier for anesthesia technologists to identify which n personnel want to be able to give their report carts need to be cleaned and restocked, which resulted without feeling rushed or interrupted, in a more efficient and effective department. Having n the script provides a verbal and written report equipment readily available also has made it safer for but also allows time for asking and answering the patients. questions, At Providence St Vincent Medical Center, the n nurses like the versatility of having both lami- anesthesia professional is typically accompanied to nated and paper forms of the tool available, and the PACU by the surgeon, resident, or physician n standardization of hand-off reports keeps the assistant. The anesthesia professional gives the care provider’s focus on the patient and in- main hand-off report to the PACU nurse. The RN creases patient safety. circulator may call the PACU nurse with a specific patient concern before the patient is transferred to Managerial feedback expressed support and en- the PACU or may accompany the anesthesia pro- couragement for using SWITCH for every patient fessional to the PACU if he or she has specific every time, and managers have requested audits hand-off information that may not be given by the of the paper version of the tool to document anesthesia professional. This variability facilitates compliance. faster room turnover. A standardized hand-off tool Council members successfully implemented the 14 is being developed at this time for the hand-off Universal ProtocolTM for time outs and, subse- communication between the anesthesia profes- quently, the World Health Organization Surgical 15 sional and PACU RN. Safety Checklist. Equally important to managers and council members alike, as well as to patient FEEDBACK AND SUCCESS safety, has been the successful implementation of A council member shared the SWITCH hand-off the SWITCH hand-off tool. Hand-off reports are tool for the RN circulator and scrub person with a time for health care providers to focus on the personnel from several other hospitals in the Port- transfer of care without interruption, a time to land area. Additionally, council members presented pause, and a time to “SWITCH for Safety.” The use the tool at a local AORN chapter meeting, on of the SWITCH tool at our facility has kept the AORN MemberTalk (ie, AORN listserv), and as focus of the hand-off exchange on the care of the a poster presentation at the 2012 AORN Congress patient and, in fact, has spotlighted patient safety in New Orleans, Louisiana. The council received while at the same time ensuring concise and positive feedback regarding the hand-off tool. After complete reporting. Perioperative services is using SWITCH for one year, Surgical Services a specialized service area in which using a stan- Partnership Council members presented a survey to dardized, scripted tool has benefited all RN circu- measure compliance with the tool’s use. Of the 33 lators, scrub personnel, anesthesia technologists, team members (ie, 20 nurses, 12 surgical technol- and indirect patient care providers but, most im- ogists, one anesthesia technologist) who completed portantly, the patients.

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Editor’s note: The Universal Protocol for Pre- Roussel L, Swansburg R, eds. Management and Lead- ership Administration for Nurse Administrators. 4th ed. venting Wrong Site, Wrong Procedure, Wrong Sudbury, MA: Jones and Bartlett Publishers; 2006:55-80. Person Surgery is a trademark of The Joint 14. The Universal Protocol. The Joint Commission. http:// Commission, Oakbrook Terrace, IL. www.jointcommission.org/standards_information/up .aspx. Accessed August 9, 2013. 15. Surgical Safety Checklist. The World Health Organiza- References tion. http://www.who.int/patientsafety/safesurgery/tools 1. Nagpal K, Vats A, Lamb B, et al. Information transfer _resources/SSSL_Checklist_finalJun08.pdf. Accessed and communication in surgery: a systematic review. Ann August 9, 2013. Surg. 2010;252(2):225-239. 2. Taneva S, Grote G, Easty A, Plattner B. Decoding the perioperative process breakdowns: a theoretical model and implications for system design. Int J Med Inform. 2010;79(1):14-30. Fay Johnson, BSN, RN, CNOR, is a clinical 3. Sentinel event. The Joint Commission. http://www.joint level 4 perioperative nurse in the OR at commission.org/sentinel_event.aspx. Accessed August 9, 2013. Providence St Vincent Medical Center, Portland, 4. Hospital and Health Service Performance Division. OR. Ms Johnson has no declared affiliation Promoting Effective Communication Among Healthcare Professionals to Improve Patient Safety and Quality of that could be perceived as posing a potential Care. Melbourne, Australia: Victoria Government De- conflict of interest in the publication of this partment of Health; 2010:1-12. 5. The Joint Commission. Improving handoff communica- article. tions: meeting National Patient Safety Goal 2E. Joint Patty Logsdon, MSN, RN, CNOR, is a peri- Perspect Patient Safety. 2006;6:9-15. 6. Van Dam S. A process prone to error and needing im- operative nurse in the OR at WakeMed Health provement. Forum. 2007;25(1):14-15. and Hospitals, Raleigh, North Carolina. Ms 7. 2008 Hospital Patient Safety Goals: Implementation expectations for handoffs. The Joint Commission. http:// Logsdon has no declared affiliation that could be www.jointcommission.org/NR/rdonlyres/82B717D8- perceived as posing a potential conflict of in- B16A-4442-AD00-CE3188C2F00A/0/08_HAP_NPSGs_ Master.pdf. Accessed October 2, 2013. terest in the publication of this article. 8. Friesen MA, White SV, Byers JF. Handoffs: implications for nurses. In: Patient Safety and Quality: An Evidence- Kim Fournier, ADN, RN, CNOR, is a clinical Based Handbook for Nurses. Rockville, MD: Agency for level 4 perioperative nurse in the OR at Healthcare Research and Quality; 2008:1-17. Providence St Vincent Medical Center, Portland, 9. Hand-off communications. Healthcare Inspirations. http://www.healthcareinspirations.com/hci_hand-off_ OR. Ms Fournier has no declared affiliation that communications.html. Accessed August 9, 2013. could be perceived as posing a potential conflict 10. Sandlin D. Improving patient safety by implementing a standardized and consistent approach to hand-off of interest in the publication of this article. communications. J Perianesth Nurs. 2007;22(4):289-292. 11. Patient Hand Off Communication Tool Kit. AORN, Inc. Sandra Fisher, BS, RN, CNOR, is a clinical http://www.aorn.org/Clinical_Practice/ToolKits/Patient ladder level 4 perioperative nurse in the OR at _Hand_Off_Tool_Kit/Patient_Hand_Off_Tool_Kit.aspx. Providence St Vincent Medical Center, Portland, Accessed August 30, 2013. 12. Transitions of care (TOC) portal. The Joint Commission. OR. Ms Fisher has no declared affiliation that http://www.jointcommission.org/toc.aspx. Accessed could be perceived as posing a potential conflict August 9, 2013. 13. Simms E. The components of change: creativity and of interest in the publication of this article. innovation, critical thinking and planned change. In:

504 j AORN Journal EXAMINATION CONTINUING EDUCATION PROGRAM 2.3

SWITCH for Safety: Perioperative www.aorn.org/CE Hand-off Tools

PURPOSE/GOAL

To provide knowledge speciﬁc to improving hand-off communications during perioperative transfers of care from one health care provider to another.

OBJECTIVES

1. Discuss the leading cause of reported sentinel events. 2. Identify barriers to communication. 3. Describe hand-off communications. 4. Identify standardized formats used for hand offs. 5. Discuss SWITCH tools used for perioperative hand offs.

The Examination and Learner Evaluation are printed here for your conven- ience. To receive continuing education credit, you must complete the Exami- nation and Learner Evaluation online at http://www.aorn.org/CE.

QUESTIONS 3. The most common health care transactions prone to error are 1. The leading cause of reported sentinel events in a. billing. the OR is b. electronic data interchange. a. assessment. c. hand-off communication. b. communication breakdown. c. the physical environment. 4. A hand off includes the transfer of d. medication management. 1. patient information. 2. the authority to care for the patient. 2. Barriers to concise communication include 3. the responsibility to care for the patient. 1. inattention. 4. staff department meeting information. 2. information overload. a. 1 and 3 b. 2 and 4 3. multitasking. c. 1, 2, and 3 d. 1, 2, 3, and 4 4. noise. 5. stress. 5. Standardized formats for hand offs include 6. time pressures. 1. SBAR. a. 1, 3, and 5 b. 2, 4, and 6 2. I PASS the BATON. c. 2, 3, 5, and 6 d. 1, 2, 3, 4, 5, and 6 3. SHARQ.

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4. Five Ps. 8. According to the OR front-desk SWITCH tool, 5. Five Ps, second version. identifying gaps in the OR schedule belongs in a. 4 and 5 b. 1, 2, and 3 the ______section. c. 1, 2, 3, and 4 d. 1, 2, 3, 4, and 5 a. staff issues b. items c. time d. have you any questions? 6. In the OR, the SWITCH acronym stands for 9. According to the anesthesia SWITCH tool, iden- surgical procedure, what needs to be done, tifying items that are broken or out for repair instruments, time, counts, and have you any belongs in the ______section. questions. a. specialty carts and departments a. true b. false b. white carts c. instruments 7. According to the OR SWITCH tool, the plan for d. helpful communication postoperative patient disposition belongs in the ______section. 10. Of the 33 team members who completed a survey a. surgical procedure after using the SWITCH hand-off tool for a year, b. wet 97% thought that the SWITCH hand-off tool was c. tissue very important for patient safety. d. have you any questions? a. true b. false

506 j AORN Journal LEARNER EVALUATION CONTINUING EDUCATION PROGRAM 2.3

SWITCH for Safety: Perioperative www.aorn.org/CE Hand-off Tools

his evaluation is used to determine the extent 9. Will you change your practice as a result of reading to which this continuing education program this article? (If yes, answer question #9A. If no, T met your learning needs. Rate the items as answer question #9B.) described below. 9A. How will you change your practice? (Select all that apply) 1. I will provide education to my team regarding OBJECTIVES why change is needed. To what extent were the following objectives of this 2. I will work with management to change/ continuing education program achieved? implement a policy and procedure. 1. Discuss the leading cause of reported sentinel events. 3. I will plan an informational meeting with Low 1. 2. 3. 4. 5. High physicians to seek their input and acceptance 2. Identify barriers to communication. of the need for change. Low 1. 2. 3. 4. 5. High 4. I will implement change and evaluate the 3. Describe hand-off communications. effect of the change at regular intervals until Low 1. 2. 3. 4. 5. High the change is incorporated as best practice. 4. Identify standardized formats used for hand offs. 5. Other: ______Low 1. 2. 3. 4. 5. High 9B. If you will not change your practice as a result of 5. Discuss SWITCH tools used for perioperative hand reading this article, why? (Select all that apply) offs. Low 1. 2. 3. 4. 5. High 1. The content of the article is not relevant to my practice. 2. I do not have enough time to teach others CONTENT about the purpose of the needed change. 6. To what extent did this article increase your 3. I do not have management support to make knowledge of the subject matter? a change. Low 1. 2. 3. 4. 5. High 4. Other: ______7. To what extent were your individual objectives met? 10. Our accrediting body requires that we verify Low 1. 2. 3. 4. 5. High the time you needed to complete the 2.3 con- 8. Will you be able to use the information from this tinuing education contact hour (138-minute) article in your work setting? 1. Yes 2. No program: ______

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