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Post by katevaughn on Dec 31, 2016 11:51:07 GMT -5
We are always trying to find ways to improve patient safety with the hope to improve patient outcomes. One hot topic that is often being discussed is the standardization of patient handoff via the implementation of a checklist. This article does a nice job of highlighting the benefits along with the limitations of a checklist. It will be interesting to see what everyone thinks. Enjoy! Here is the link to the article. 1. Do you think the implementation of a checklist could potentially improve patient outcomes, why or why not? 2. Do you think it would be beneficial to have a checklist for handoff in the OR too (not just the PACU) and even take it a step further and have all providers involved in the case to come into the OR for handoff each time a new provider takes over a case?
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Post by AugustineEmmanuel on Jan 1, 2017 10:34:52 GMT -5
Good article about patient safety checklists. 1. I do think that having standardized checklists can be beneficial to improve communication between CRNAs and PACU nurses. From my practice, I've noticed that different PACU nurses focus on different areas of the report (example some only want to know about anti-emetics and pain and others want a well rounded report) depending on their goals. Having such variability during report would have a negative impact on patient care and could potentially result in a harm and excessive callbacks to providers. 2. Having an OR handoff with all providers involved is not realistic and would be a hassle. In our specific case where we practice in an ACT setting, it would be almost impossible to get all providers in the room to do a handoff due to logistical reasons.
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Post by mscotth2 on Jan 3, 2017 6:54:18 GMT -5
Ah, the patient checklist. Every since Dr. Pronovost published the central line insertion checklist and the resultant decrease in infections, there has been a lot of excitement about them. 1. We have 2 hand-off checklists in pediatrics. One for the PICU and one for the NICU. They contain a lot of redundant information that is also in EPIC. I think it is challenging to have a supplemental document that adds worthwhile information and successfully streamlines the handoff process without repetition. When patients go to the PACU, the PACU nurses have a report sheet and the anesthesia provider works their way down answering the items. Again, some of it is redundant. So, can they improve patient outcomes? Sure---if they contain the correct information. 2. Would it be helpful to have a checklist for handoff in the OR? Well, sure, especially with the number of learners we have here. However, if they don't recognize something as important or pertinent, it doesn't mean they will pass it on just because they have a piece of paper----I say this first hand because of a sentinel event I was involved in last year that occurred due to missing the importance of actions that were taken by the learner prior to handoff.
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Post by jhadley on Jan 3, 2017 12:03:22 GMT -5
1. In Weinberg and JHOC the nurses are already utilizing a handoff sheet. I do believe this does improves handoff because it prompts the PACU RN to ask questions regarding things I may inadvertently miss during handoff. In JHOC, the nurses have taken the extra step of looking through EPIC prior to the patient coming from the OR and they have the patient PMH and meds administered in the OR already written down prior to the patient arriving to PACU. One practice I have noticed happens frequently in the PACU, I give report to one RN and then even before I am signing out of EPIC another RN comes to take over and there is another handoff. As the article cited, multiple handoffs are one potential source where errors can occur. 2. I do think that a handoff sheet in the OR would be helpful. Since I have started working a resource shift every week, I have noticed there is a wide variability in the information given during handoff for breaks, etc. I do not think getting all the providers in the room during handoff is logistically feasible.
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Post by faraclarke on Jan 5, 2017 17:19:55 GMT -5
1. I do believe that a checklist may improve patient outcomes, but I am curious to see data after implementation as to how effective this is and if the outcomes are statistically significant. I think this would be more beneficial in cases where there are multiple changes in providers. Some providers prefer less information and may tune out information so there is no guarantee that a checklist will significantly improve outcomes. There also has to be a change in culture where the focus at the moment is hand-off and not what task the provider has to do next.
2. I think it could be beneficial to have a checklist in the OR, but not necessarily. It may be more beneficial to newer providers, but in my practice I have not seen a dire indication for it. In fact, I think it will be time-consuming and tedious. It is not realistic to have all providers in the room when a change in provider occurs. I think it is reasonable to ask the provider handing off necessary questions, and then send a page to the attending to discuss the case if there are any significant concerns or if the case has been complicated.
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Post by BrittneyKeating on Jan 16, 2017 13:50:34 GMT -5
1. I do think that the implementation of a checklist could improve patient outcomes, as this has been shown with the use of checklists for the insertion of central venous access and other procedural encounters throughout health systems. Unfortunately, the use of checklists are not always successful, and I feel this has to do mostly with the environment and culture in which these checklists are being utilized. As the article states, and as Jessica and Fara have mentioned in their posts, important components to improving patient safety include limiting the number of handoffs, and creating a culture that focuses on handoff as transfer of pertinent patient information, rather than the distraction of tasks that need to be done. According to this article, Hopkins carried out a study attempting to improve PACU/ICU handoff with the use of a surgery and anesthesia checklist, as well as changing the culture of handoff such that transfer of information begins only once the receiving nurse has connected the patient to the monitor, followed by an introduction of each team member. www.anesthesiologynews.com/Policy-Management/Article/02-16/OR-to-PACU-Handoff-Protocol-Succeeds-in-Reducing-Errors/35148/ses=ogst2. I think many anesthesia providers already have a mental checklist that they utilize when giving handoff to another provider. With the electronic medical record, access to pertinent patient information is just clicks away. However, in the instances when online charting systems are down or when the online record is incomplete, I think it is pertinent to have a checklist that can be referred to during handoff and for the oncoming provider to reference.
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Post by emedina1 on Jan 16, 2017 17:07:49 GMT -5
I believe that an effective handoff is very important for the continuity of care of the post op patients.
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Post by Belinda Gardner on Jan 20, 2017 16:14:54 GMT -5
1. I do think that a consistent handoff tool could certainly improve communication and patient outcomes especially in a large teaching institution like ours. On a daily basis we struggle with all the reasons the article sites for handoff downfalls from multiple handoffs and production pressure to differing communication/ handoff styles. Just like anything else, it may take a bit of getting used to but I can't imagine it would increase handoff time all that much and probably be worth it related to the potential reduction in loss of pertinent information during handoff report.
Epic has already made report easier with patient information already readily available between a couple of flow sheets and with the implementation of the new Epic handoff tool coming I imagine that data will probably be auto populated and be pretty easy to follow.
2.I find most attendings like to stop by the room and discuss the case/plan when room staff has changed as they are able even though this is not a consistent or formal process. I think that having both tams available for hand off would be more challenging for the attendings but would certainly improve communication of case information.
Thank you for this timely article!
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Post by Faresha Sims on Jan 23, 2017 17:13:16 GMT -5
1. I think a checklist could improve patient outcomes and make for a better handoff. A standardized handoff will hopefully eliminate any relevant information from being missed during handoff.
2. I don't think it is practical or ideal to have every provider in the room during handoff. I actually think this could lead to more confusion and inefficiency.
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Post by Ben Waldbaum on Jan 30, 2017 10:05:03 GMT -5
Interesting article, but limited in its analysis, size, and endpoints. Evidence has clearly shown the benefit of checklists in specific scenarios but can those results be applied more broadly? Another question is, why aren't checklists more widely utilized. In other words, what are the barriers to adoption? Some obvious barriers I would think are production pressure and the perceived slow down a checklist would cause, culture challenges such as "our current system is working well" and there is no clear evidence that there would be a benefit in this exact scenario
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Post by benwaldbaum on Jan 30, 2017 11:38:30 GMT -5
Sorry, my previous post was posted prematurely.
Interesting article, but limited in its analysis, size, and endpoints. Evidence has clearly shown the benefit of checklists in specific scenarios but can those results be applied more broadly? Another question is, why aren't checklists more widely utilized. In other words, what are the barriers to adoption? Some obvious barriers I would think are production pressure and the perceived slow down a checklist would cause, culture challenges such as "our current system is working well" and there is no clear evidence that there would be a benefit in this exact scenario
From this article it is impossible to infer if a patient check list can improve patient outcomes. First, it was not one of their endpoints. Second, they had over 20 CRNAs participate, as well as many PACU RNs, and a sample size under 60. This means that when this was done providers were doing it most likely for their first or second time and both the CRNA and PACU RN were likely hypervigilant, creating a significant bias that they did not control. It would have been much more meaningful if the study collected data pre-intervention, 1 month post-intervention once providers got the hang of it with random sampling of PACU RNs, and to repeat at 6 months. Lastly, in order to have Power for patient outcomes, the size of the study would have to be increased by many orders of magnitude.
Whether or not it is beneficial to have a checklist for intraoperative handoff cannot be concluded from this article as detailed above. But you can ask the question in reverse, is there any harm of having a checklist? Probably not. So it may be an interesting addition, but with any change, it is smart to track its utility in a scientific manner with specific endpoints to see if the change is actually beneficial.
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kty67
New Member
Posts: 22
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Post by kty67 on Feb 7, 2017 10:13:10 GMT -5
1. I don't thick anesthesia check list will improve report outcome. During verbal report we communicate with nurses and also listen what other OR providers are saying in PACU. if everybody will be giving papers, it will be more confusing who gave what paper. PACU RNs already have a report check list that they fill out during different providers report. 2. Using EPIC eliminates necessity for additional forms. If after anesthesia report, nurse still have any questions, she/he can always open a summary page and see what happened during procedure.
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