hand-off communication: a requisite for perioperative ... by the recipient reduces error and ......

With the increasingly specializednature of surgical care, patientsundergoing surgery are at a

greater risk of experiencing iatrogenic er-rors, especially if inadequate hand-off re-ports occur. The traditional patient reportfrom nurse to nurse now needs to be asophisticated, precise, comprehensivecompendium of patient information thatfocuses on patient safety. Communica-tion during a hand off (ie, a transitionfrom one care provider to another careprovider) should not be an abrupt,meaningless summary concluding onecaregiver’s responsibility, but rather acoordinated effort among professionalsinvolved in the changeover of patientcare. Hand-off communication must beaccurate, clear, and specific and providethe opportunity for all parties involvedto ask questions or voice concerns.1 Thisarticle proposes an easy-to-remember,standardized format for hand-off com-munication between care providerswith the goal of improving patient safe-ty throughout the perioperative process.

POTENTIAL FOR ADVERSE EVENTSAccording to Brennan et al,2 adverse

events occur more often for surgical pa-tients than for patients in any otherclinical specialty. Schimpff3 explainedthat disproportionately greater harmresults from surgical errors. The surgi-

cal patient is more vulnerable to hand-off errors than patients in other clinicalspecialties because of the prodigiousnumber of checkpoints and transitionsthat occur throughout the preoperative,intraoperative, and postoperative phasesof care. Transitions between these phas-es are considered high-risk time frames.

At each phase of the complex jour-ney through a facility’s perioperativedepartment, each team of caregivershas specific responsibilities and objec-tives that are as different as they aresimilar. With such specialized care, ef-fective communication between mem-bers of the perioperative team is ofparamount importance.

Numerous factors and environmentaldistractors occur during the perioperativeprocess that increase the potential for er-rors. Care provided in all phases of the pe-rioperative process is driven by the need• for rapid turnover,• for increased volume and efficiency,• to improve physician satisfaction, and• to accelerate throughput for the sur-

gical patient.

1.6

indicates that continuing education contacthours are available for this activity. Earn the con-tact hours by reading this article and taking theexamination on pages 771–772 and then com-pleting the answer sheet and learner evaluationon pages 773–774.

You also may access this article online athttp://www.aornjournal.org.

© AORN, Inc, 2008 NOVEMBER 2008, VOL 88, NO 5 • AORN JOURNAL • 763

Hand-Off Communication:A Requisite for

Perioperative Patient SafetyELAINE J. AMATO-VEALEY, PHD, RN; MARIANNE P. BARBA, MS, RN; RYAN J. VEALEY, BS

TRANSITIONS FROM ONE CARE PROVIDER toanother put patients at increased risk of injuriesand errors. A standardized approach to hand-offcommunication helps minimize these risks.

ONE RECOGNIZED APPROACH to addressing thisconcern is the SBAR (ie, situation, background, as-sessment, recommendation) communication tech-nique. Reference cards with the SBAR communica-tion approach can be used by all staff members dur-ing hand offs in the preoperative, intraoperative, andpostoperative phases of surgical patient care. AORN J88 (November 2008) 763-770. © AORN, Inc, 2008.

ABSTRACT

NOVEMBER 2008, VOL 88, NO 5 Amato-Vealey — Barba — Vealey

764 • AORN JOURNAL

This hurried environment often is the back-drop for communication errors and mistakesthat could have fatal implications.

Ineffective communication is the most fre-quently cited root-cause category of sentinelevents.2 Effective communication, which istimely, accurate, complete, unambiguous, andunderstood by the recipient reduces error andresults in improved patient safety.1,4 In an ef-fort to prevent sentinel events from occurring,the Joint Commission publishes the NationalPatient Safety Goals annually.5 National Pa-tient Safety Goal 02.05.01 states that healthcare organizations are required to implement astandardized approach to hand-off communi-cations, which must include an opportunity toask and respond to questions.5

THE SBAR COMMUNICATION TECHNIQUEThe SBAR (ie, situation, background, as-

sessment, recommendation) communicationtechnique provides a standardized frameworkfor communication between members of thehealth care team about a patient’s condition.4

The SBAR technique is an easy-to-remember,concrete mechanism useful for framing a con-versation, especially a critical one that requiresa clinician’s immediate attention and action. Itprovides a focused way to set expectations forwhat will be communicated and how it will becommunicated between members of the team,which is essential for developing teamworkand fostering a culture of patient safety.

The SBAR communication technique con-sists of four components.

• Situation—What is going on with thepatient? Identify yourself and the patient.State the problem.

• Background—What is the background onthis patient? Review the chart before speak-ing up if the situation allows the time.Anticipate questions the other care pro-vider may have.

• Assessment—Provide your observationsand evaluations of the patient’s currentstate.

• Recommendation—Make an informedsuggestion based on sound informationfor the continued care of the patient.6(p187)

Operationalizing the SBAR technique duringthe perioperative period can help minimizepatient safety risks.

OPERATIONALIZING SBARErrors can occur when a procedure is

scheduled, when care providers are obtainingthe patient’s history and performing the pre-operative physical examination, during theinformed consent process, and when a careprovider is documenting care provided at anypoint in the surgical process. The SBAR tech-nique helps prevent errors by providing astandardized approach for perioperative staffmembers to use as a patient• is prepared for the OR;• undergoes an operative or other invasive

procedure; and

• phase I recovery (ie, the immediate post-operative period during which the pa-tient regains physiological homeostasisand receives appropriate nursing inter-ventions as needed) to

• phase II recovery (ie, the period of timeduring which the patient becomes morealert and functional and prepares forself-care, care by family members, orcare in an extended care environment).7

HAND-OFF COMMUNICATION BETWEEN THE SURGEON’SSCHEDULING OFFICE AND THE HEALTH CARE FACILITY SCHED-ULING DEPARTMENT. The surgical verificationprocess begins at the time the surgical proce-dure is scheduled, originating from the sur-geon’s office and moving to the health care fa-cility’s surgical scheduling office.8 Potentially,this interaction can be the first break in thecommunication process. An error that occurshere can go undetected and has the likelihoodto result in patient harm. Unfortunately, mis-communications at this point may not bepicked up until the day of the surgery andmay cause a delay in the OR or, more signifi-cantly, result in wrong site surgery. One solu-tion to prevent such last-minute errors wouldbe to call both the surgeon’s office and the pa-tient on the day before the surgery to verifythe correct date, time, and procedure.

are fully knowledgeable of the process and thecorrect surgical procedure.

HAND-OFF COMMUNICATION BETWEEN THE PREOPERATIVE

AREA AND THE INTRAOPERATIVE AREA. Hand-off commu-nication improves patient outcomes when allparticipants take active part in the process.10 Inthe past, the hand-off communication betweenthe preoperative and intraoperative areassometimes was a short, terse statement or noreport at all. Implementation of a standardizedguide during hand-off communication can in-crease efficiency and patient safety and reduceunnecessary redundancy while encouragingbuilt-in redundancy of vital facts. Table 1 out-lines the SBAR elements of the optimal preop-erative to intraoperative hand-off communica-tion. This transition of care summarizes criticalpatient information such as• verifying the correct patient and surgical

procedure,• reviewing required documents,• discussing patient safety concerns,• assessing preoperative vital signs and pain

level,• identifying cultural implications and the

need for family presence, and• verifying that all components of the surgi-

cal process have been followed correctly.This hand-off communication serves as abaseline for future clinical transfers and en-sures that patients are safe, secure, and com-fortable as they are brought to the OR suite.All subsequent actions are based on thishand-off communication.

Another component of the Universal Proto-col is the surgical time out.11,12 Before startingany operative or invasive procedure, a final“time out” verification should be conducted toconfirm the correct patient, procedure, and site.This time out should include ensuring that allrelevant documentation, related information,and necessary equipment are available. Al-though the surgical time out is initiated by adesignated member of the surgical team, all im-mediate members of the surgical team mustparticipate in the time out, during which allother activities are suspended as much as possi-ble without compromising patient safety. Theprocedure is not started until all questions andconcerns have been addressed satisfactorily.

Amato-Vealey — Barba — Vealey NOVEMBER 2008, VOL 88, NO 5

AORN JOURNAL • 765

HAND-OFF COMMUNICATION BETWEEN THE HEALTH CARE

FACILITY’S SCHEDULING DEPARTMENT AND THE PREOPERATIVE

AREA. One of the first responsibilities of thepreoperative nurse is to obtain the surgeryschedule. The preoperative nurse then en-sures that the scheduled procedure is consis-tent with the patient’s understanding of theprocedure as well as the informed consent,and that both are consistent with the patient’sdiagnosis. The nurse also ensures that all re-quired documents are in place, including thehistory and physical examination (H&P),blood work results, and any other diagnostictest results required for surgery. The nurse en-sures that the surgeon has performed an H&Pupdate before surgery.

The Joint Commission’s Universal ProtocolTM

has become a guiding principle for all periop-erative team members and should be appliedto or adapted for all operative and other inva-sive procedures.9 The Universal Protocol isnow included in the overall 2009 Hospital Na-tional Patient Safety Goals document.5 Thesurgical verification process must include thefollowing essential elements:• active communication among all members

of the surgical team;• involvement of the patient or a legally des-

ignated representative in the process; and• a requirement for site marking that focuses

on surgical procedures involving laterality(ie, right/left distinction), multiple struc-tures (eg, fingers, toes), or multiple levels(eg, spine).9

Verification of the correct person, correct site,and correct procedure occurs at the followingtimes including . . . any time the responsibil-ity for care of the patient is transferred to an-other member of the procedural care team,(including the anesthesia providers) at thetime of, and during, the procedure.9

The patient’s family members may be dis-tractors in the surgical verification process be-cause of the stress they are experiencing fromtheir loved one’s impending surgery. The preop-erative nurse should endeavor to involve thepatient’s family members in the verificationprocess at every opportunity to ensure that they



HAND-OFF COMMUNICATION BETWEEN THE INTRAOPERA-TIVE AREA AND PHASE I PACU. In the past, the pa-tient’s response to the surgical experience mayhave been noted in a routine report with littleemphasis on specific surgical events. Hand-offcommunication during this transition of careoften occurs when nursing staff members areperforming several tasks simultaneously. Staffmembers should set aside time for hand-offcommunication, allowing opportunities to askquestions or to ask for clarifications. Table 2outlines the SBAR elements of the intraopera-

tive to PACU transition, highlighting ORevents that have occurred. Being as specific aspossible is critical. Informing the PACU nurseabout the patient’s past medical history alsomay be vitally important.

Components of this transition should in-clude presenting information on how the pa-tient tolerated the procedure and whether theprocedure went as planned. The circulatingnurse should inform the PACU nurse whetherthe patient is hemodynamically stable (eg,heart rate and rhythm) and whether the patient

TABLE 2Elements of the Intraoperative toPostanesthesia Care Unit (PACU)

Hand-Off CommunicationSituationName of patient and date of birthName of operative or invasive procedure

performed including modifiers and site

BackgroundType of anesthesia administered and name

of anesthesia care providerIntraoperative medications administered

including dose and timeIV fluids administeredEstimated blood lossPertinent information related to the surgical

site such as dressings, tubes, drains, orpacking

Any significant OR events

AssessmentHemodynamic stabilityAirway and oxygenation statusThermal status (eg, presence of hypother-

mia or hyperthermia)Urine outputPresence or absence of surgical complicationsLevel of painMethod of pain management

RecommendationsEnsure that immediate postoperative orders

have been completedDischarge from the PACU when stableAllow opportunity for intraoperative andPACU staff members to ask questions or

voice concerns

TABLE 1Elements of the

Preoperative to IntraoperativeHand-Off Communication

SituationName of patient and date of birthName of operative or invasive procedure to

be performed including modifiers and sitePertinent documents are present and

consistent

BackgroundElements of patient history pertinent to

surgeryMedical clearancePatient allergies and NPO statusPatient’s vital signs and pain levelMedication profile and medications taken

todaySpecific laboratory resultsCode status of patient

AssessmentPatient’s current level of understanding of

the surgerySpecial patient needs or precautionsPertinent aspects of the patient’s emotional

and spiritual statusPertinent cultural implicationsAnesthesia requests

RecommendationsState whether the patient has been seen pre-

operatively by the surgeon and anesthesiacare provider

Determine whether the patient is ready forsurgery

Allow an opportunity for preoperative andintraoperative staff members to ask ques-tions or voice concerns



experienced any intraoperative complications.The circulating nurse should inform the PACUnurse of any medications he or she gave intra-operatively including the dose(s), time(s), andtherapeutic responses. The circulating nursealso should report the patient’s current com-fort level to the PACU nurse.

HAND-OFF COMMUNICATION BETWEEN PHASE I PACU TO

THE PHASE II RECOVERY AREA. At the completion ofphase I recovery, patients may be admitted to ahospital room or proceed to phase II recoveryfor discharge. These transitions of care are sim-ilar, but are differentiated by emphasis placedeither on continuing hospitalization or dis-charge. Table 3 outlines the SBAR elements ofthe PACU to inpatient unit hand-off communi-cation, which should mirror that of the intra-operative to PACU transition. Specific empha-sis is placed on medication reconciliation.Medications administered in the PACU mustbe added to the medication reconciliation formand the patient response noted, as well as thetime that the last dose was administered. Vitalsigns and pain level also are emphasized dur-ing this transition of care. As the patient’s levelof consciousness returns, assessment parame-ters are reestablished as a baseline for hand-offcommunication to the next caregiver. Patientswho are fully recovered and are preparing toleave the health care facility require educationfor discharge as well as the completed medica-tion reconciliation form.

CASE STUDYMrs L is a 66-year-old woman who present-

ed to her physician’s office with a three-monthhistory of vaginal bleeding. After a lengthy dis-cussion and physical examination, the physi-cian recommended and the patient consentedto undergoing an abdominal hysterectomy.Mrs L met with the physician’s surgical coordi-nator to have her surgery scheduled. The officewas busy with telephones ringing, several pa-tients signing in to be seen, and a product rep-resentative asking to see the surgeon. The sur-gical coordinator asked, “What date is good foryou?” Mrs L identified a preferred date for sur-gery and the surgical coordinator suggested a9 AM start time and then informed Mrs L thatshe would call her later to confirm all the infor-

mation. Although this never occurred, Mrs Lassumed that it meant her surgery date andtime were approved.

Mrs L presented to the ambulatory surgicalcenter (ASC) for an abdominal hysterectomyat 9 AM on the suggested date. On arrival, the

TABLE 3Elements of the PostanesthesiaCare Unit (PACU) to Inpatient

Unit Hand-Off Communication*SituationName of patient and date of birthName of operative or invasive procedure

performed including modifiers and site

BackgroundType of anesthesia administered and name

of anesthesia care providerMedications administered in the OR and

PACU including dose and timeIV fluids administered in the OR and PACUEstimated blood lossPertinent information related to the surgical

site such as dressings, tubes, drains, orpacking

Any significant OR eventsAny significant PACU events

AssessmentHemodynamic stabilityAirway and oxygenation statusThermal status (eg, presence of hypothermia

or hyperthermia)Urine outputPresence or absence of surgical complicationsLevel of painMethod of pain management

RecommendationsEnsure that PACU physician orders have

been completedEnsure that the surgeon’s plan of care has

been implementedIdentify patient’s and family members’

educational needsProvide discharge instructionsDischarge after two hours or when stableAllow an opportunity for PACU and inpa-

tient unit staff members to ask questionsor voice concerns

* This SBAR hand-off communication outlinealso is applicable for phase I PACU to phase IIrecovery hand-off communications.



ASC secretary asked Mrs L to verify her name,date of birth, and surgical procedure. The sec-retary noted that the surgical schedule listedMrs L as being scheduled for a “vaginal” hys-terectomy. The secretary immediately notifiedthe OR manager of the discrepancy in proce-dure type. The OR manager then notified theassigned circulating nurse. The nurse and as-signed scrub person worked cooperatively torepick a case cart for the corrected procedure,repositioned the OR bed, and reset up theOR for an abdominal rather than a vaginalhysterectomy.

This error resulted in a surgical delay, whichfrustrated the surgeon. Although the patient un-derstood the error and delay, she became veryanxious. Mrs L’s family also was very anxiousand required reassurance that the correct sur-gery was going to take place.

Using the SBAR communication technique,the preoperative nurse gave the followinghand-off report to the circulating nurse.

• Situation—This is Mrs L, date of birth9/21/42, a 66-year-old patient of Dr H.She has been preoperatively prepared foran abdominal hysterectomy. All documen-tation, laboratory reports, and signedinformed consent are present in the record.Mrs L’s history and physical examinationare on the chart and have been updated.

• Background—For the past three months,Mrs L has experienced postmenopausalbleeding. Furthermore, she has a medicalhistory of atrial fibrillation that is con-trolled with diltiazem and warfarin andhas chronic obstructive pulmonary disease(COPD) that is well controlled with anipratropium/albuterol inhaler. As instruct-ed by her surgeon, Mrs L has not taken thewarfarin for the past five days. She hasno known allergies and has been NPOsince 10 PM last night.

• Assessment—Mrs L experienced a sche-duling error today, so she is extremely ner-vous. To verify again, she is scheduled toundergo an abdominal hysterectomy.

• Recommendations—Mrs L has been seen pre-operatively by her surgeon and her anesthesiacare provider. Do you have any questions?

The surgical procedure proceeded withoutincident and the anesthesia care provider andthe circulating nurse transported Mrs L to thePACU. The following hand-off report, whichdid not follow the SBAR technique, took placebetween the circulating nurse, anesthesia careprovider, and PACU nurse:

Mrs L—abdominal hysterectomy. Receivedgeneral. Is on her fourth bag of lactatedRinger’s (LR) solution. Minimal blood loss.Dressing is dry. Catheter placed in the OR.Was given ondansetron and morphine in theOR before coming out.

By comparison, the following exchangewould have complied with the Joint Commis-sion’s National Patient Safety Goal on hand-offcommunication. The circulating nurse andanesthesia care provider could have used theSBAR communication technique and coopera-tively reported the following information tothe assigned PACU nurse:

• Situation—This is Mrs L, date of birth9/21/42, a 66-year-old patient of Dr H. Shejust underwent an abdominal hysterectomy.

• Background—Mrs L has experienced post-menopausal bleeding for the past threemonths. Mrs L has no known allergies, butshe has a medical history of atrial fibrillationthat is controlled with diltiazem and war-farin. Mrs L also has COPD that is wellcontrolled with an ipratropium/albuterolinhaler. Mrs L received general anesthesiawith endotracheal intubation and has re-ceived 3,000 mL IV LR solution duringsurgery. This is her fourth bag of LR. Mrs Lhad approximately 200 mL of blood loss, andher abdominal dressing is dry and intact.

• Assessment—Mrs L’s tympanic tempera-ture is 37° C. An indwelling urinarycatheter was placed in the OR, whichdrained 300 mL of clear urine duringsurgery, and the bag was emptied beforetransfer. She was given morphine 4 mgat 10:15 AM and ondansetron 4 mg at10:30 AM. Mrs L’s vital signs when leav-ing the OR were 96/64, 78, 16, pulseoximetry 99% on 3 L of oxygen. She is



hemodynamically stable although she con-tinues in atrial fibrillation. No complica-tions occurred.

• Recommendations—Maintain the patienton 3 L of oxygen by face mask because ofher history of COPD. Discharge her to thepatient care unit when stable. Does anyonehave any questions?

As illustrated by the above example, theSBAR communication technique provides muchmore context into which clinical data related tosurgery is communicated. Too often, criticalpieces of the patient’s past medical history areomitted from the hand-off report given by thecirculating nurse and anesthesia care provider tothe PACU nurse because these details are notdeemed “pertinent.” Such omissions can, in fact,be detrimental and even catastrophic for the pa-tient. The extra few minutes required to providehand-off communication in a standardized waycan prevent miscommunications from occur-ring, which could ultimately result in an unnec-essary adverse event.

EFFECTIVE HAND-OFF COMMUNICATIONSEffective and standardized communication

between care providers at hand-off pointsduring the perioperative process will helpthem facilitate safety and anticipate and limitcomplications. Communication that is timely,accurate, complete, unambiguous, and under-stood by the recipient reduces error and re-sults in improved patient safety.

The SBAR mnemonic outlines caregiverconversations to summarize critical patient in-formation. With this format, communicationoccurs effectively with information beingtransmitted in the same format and order,every time. Operationalizing hand-off commu-nication throughout the perioperative processcan be challenging; however, for each transi-tion phase, the SBAR technique not only con-tains unique information pertinent to thatphase of care but also provides built-in redun-dancy of vital facts so that essential informa-tion is not lost in the process.

It is possible that certain errors cannot beavoided during the surgical experience, but acommunication error is not one of them. It is rec-

ommended that reference cards be created simi-lar to the tables presented in this article. Thesereference cards can be attached to employeeidentification badges for quick and easy refer-ence to facilitate safe patient care and encourageadequate hand-off communication.

Editor’s note: The Universal Protocol for Prevent-ing Wrong Site, Wrong Procedure, Wrong PersonSurgery is a trademark of the Joint Commission,Oakbrook Terrace, IL.

REFERENCES1. 2007 National Patient Safety Goals. The Joint Com-mission. http://www.jointcommission.org/NR/rdonlyres/8912113B-72C6-409F-82A9-77F187424C34/0/07_bhc_npsgs.pdf. Accessed September 25, 2008.2. Brennan TA, Leape LL, Laird NM, et al. Incidenceof adverse events and negligence in hospitalized pa-tients: results of the Harvard Medical Practice StudyI. 1991. Qual Saf Health Care. 2004;13(2):145-151.3. Schimpff SC. Improving operating room andperioperative safety: background and specific rec-ommendations. Surg Innov. 2007;14(2):127-135.4. Effective teamwork as a care strategy: SBAR andother tools for improving communication betweencaregivers. Institute for Healthcare Improvement.http://www.ihi.org/IHI/Programs/AudioAndWebPrograms/Effective+Teamwork+as+a+Care+Strategy+SBAR+and+Other+Tools+for+Improving+Communication+Between+Careg.htm?TabId=2. AccessedSeptember 25, 2008.5. 2009 National Patient Safety Goals. The JointCommission. http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals. Ac-cessed September 2, 2008.6. Powell SM, Hill RK. My copilot is a nurse—usingcrew resource management in the OR. AORN J. 2006;83(1):178-202.7. AORN guidance statement: postoperative patientcare in the ambulatory surgery setting. PerioperativeStandards and Recommended Practices. Denver, CO:AORN, Inc; 2008:219-225.8. Groah L. Hand offs—a link to improving patientsafety [Patient Safety First]. AORN J. 2006;83(1):227-230.9. Universal protocol for preventing wrong site,wrong procedure, wrong person surgery. The JointCommission. http://www.jointcommission.org/NR/rdonlyres/AEA17A06-BB67-4C4E-B0FC-DD195FE6BF2A/0/UP_HAP_20080616.pdf. Ac-cessed September 2, 2008.10. Catalano K. JCAHO’S National Patient SafetyGoals 2006. J Perianesth Nurs. 2006;21(1):6-11.11. Universal Protocol UP.01.03.01. The Joint Com-mission. http://www.jointcommission.org/NR/rdonlyres/F71BC4E9-FEB6-495C-99D8-DB9F0850E75B


/0/09_NPSG_General_Presentation.ppt#312,51,UniversalProtocol. Accessed September 18, 2008.12. Accreditation Program. Hospital NationalPatient Safety Goals UP.01.03.01. The Joint Commis-sion. http://www.jointcommission.org/NR/rdonlyres/31666E86-E7F4-423E-9BE8-F05BD1CB0AA8/0/HAP_NPSG.pdf. Accessed September 18, 2008.

RESOURCESBeyea SC. The National Patient Safety Goals:

a focus for action [Patient Safety First]. AORN J.2006;84(3):485-488.

Carr DD. Case managers optimize patient safetyby facilitating effective care transitions. Prof CaseManage. 2007;12(2):70-82.

Catalano K, Fickenscher K. Complying with the2008 National Patient Safety Goals. AORN J. 2008;87(3):547-556.

Crum Gregory BS. Standardizing hand-offprocesses. AORN J. 2006;84(6):1059-1061.

Knapp C. American Hospital Association-McKessonquest for quality prize. Bronson Methodist Hospital:journey to excellence in quality and safety. Joint CommJ Qual Patient Saf. 2006;32(10):556-563.

Mikos K. Monitoring handoffs for standardiza-tion. Nurs Manage. 2007;38(12):16-20.

Nemeth CP, O’Connor M, Nunnally M, KlockPA, Cook RI. Distributing cognition: how hand-offcommunication actually works. Department ofAnesthesia and Critical Care, University of Chicago,IL. http://ctlab.protectedsite.net/documents/ASA2005%20Handoffs%20POSTER.pdf. Accessed Sep-tember 2, 2008.

Patterson ES, Roth EM, Woods DD, Chow R,Gomes JO. Handoff strategies in settings with highconsequences for failure: lessons for health care op-erations. Int J Qual Health Care. 2004;16(2):125-132.

Sandlin D. Improving patient safety by imple-menting a standardized and consistent approachto hand-off communication. J Perianesth Nurs. 2007;22(4):289-292.


Elaine J. Amato-Vealey, PhD, RN, is a nursemanager at Women & Infants’ Hospital, Prov-idence, RI. Dr Amato-Vealey has no declared af-filiation that could be perceived as a potential con-flict of interest in publishing this article.

Marianne P. Barba, MS, RN, is a facultymember at the University of MassachusettsDartmouth College of Nursing, North Dart-mouth. Ms Barba has no declared affiliationthat could be perceived as a potential conflict ofinterest in publishing this article.

Ryan J.Vealey, BS, is a medical student III atthe University of Vermont College of Medi-cine, Burlington. Mr Vealey has no declared affil-iation that could be perceived as a potential con-flict of interest in publishing this article.

Taking a French maritime pine bark extract mayreduce symptoms of dysmenorrhea, a condition

that causes extremely painful menstruation, ac-cording to a June 18, 2008, news release fromNatural Health Science, Inc, Hoboken, New Jersey.Research showed that women taking the extracthad less painful menstrual periods and took fewernonsteroidal anti-inflammatory drugs (NSAIDs)than women taking placebo.

The double-blind study, conducted in Japan, in-cluded 116 women ages 18 to 48 years. The womenkept a diary throughout the six-cycle study to notepain levels and NSAID usage. For the first two cycles,the women did not receive any treatment; for thesecond two cycles, they were randomly assigned to

receive either pine bark extract or placebo; and forthe final two cycles, they discontinued treatment.

Analysis showed the number of painful days de-creased from an average of 2.1 days prior to treat-ment to 1.3 days with pine bark treatment. Whentreatment was discontinued, pain did not immedi-ately return and NSAID usage did not increase.

Dysmenorrhea is believed to be caused by elevat-ed levels of inflammation. The pine bark extract wasstudied for alleviating symptoms of menstrual painbecause of its natural anti-inflammatory properties.

New study: pine bark significantly reduces menstrual pain[news release]. Hoboken, NJ: Natural Health Science, Inc;June 18, 2008.

Pine Bark Extract May Reduce Menstrual Pain

Examination 1.6

NOVEMBER 2008, VOL 88, NO 5 • AORN JOURNAL • 771© AORN, Inc, 2008

1. A hand-off report1. is communication that takes place

during a patient’s transition from onecare provider to another.

2. is a comprehensive compendium ofpatient information.

3. must be accurate and specific.4. should provide an opportunity for all

parties involved to ask questions andvoice concerns.

5. should focus on the patient’s safety.a. 1 and 3b. 2, 4, and 5c. 2, 3, 4, and 5d. 1, 2, 3, 4, and 5

2. National Patient Safety Goal 02.05.01states that health care facilities musta. conduct preprocedure verification.b. communicate a complete list of the pa-

tient’s medications when the patient istransferred to another setting.

c. implement a standardized approach tohand-off communications that includesan opportunity to ask and respond toquestions.

d. use at least two patient identifiers when

providing care, treatment, and services.

3. The SBAR technique1. is a concrete mechanism for framing a

conversation.2. provides a focused way to determine

what information will be communicated.3. can be used to develop teamwork and

foster a culture of patient safety.a. 1b. 2c. 2 and 3d. 1, 2, and 3

4. The component of the SBAR communica-tion technique during which the relievingcare provider supplies the receiving clini-cian with observations and evaluations ofthe patient’s current state is thea. situation.b. background.c. assessment.d. recommendation.

5. One element that is unique to the preop-erative to intraoperative hand-off report iscommunicating

PURPOSE/GOALTo educate perioperative nurses about how to operationalize the SBAR (ie, situation, back-ground, assessment, recommendation) technique for hand-off communication during periopera-tive transitions.

BEHAVIORAL OBJECTIVESAfter reading and studying the article on perioperative hand-off communication, nurses will be able to

1. define hand-off communication,

2. explain how National Patient Safety Goal 02.05.01 addresses hand-off communication,

3. describe the SBAR communication technique, and

4. explain how to use the SBAR technique in hand-off communication during perioperativetransitions.

QUESTIONS

Hand-Off Communication:A Requisite for Perioperative Patient Safety

ExaminationNOVEMBER 2008, VOL 88, NO 5


a. whether the patient has been seen pre-operatively by the surgeon and anesthe-sia care provider.

b. the name of the operative or inva-sive procedure performed includingmodifiers and site.

c. the patient’s hemodynamic stability andthermal status.

d. what IV fluids have been administered.

6. The intraoperative to postanesthesia careunit (PACU) hand-off communicationshould include

1. the type of anesthesia administered.2. the estimated blood loss.3. any significant OR events.4. pertinent information related to the

surgical site.a. 1b. 2 and 4c. 1, 2, and 3d. 1, 2, 3, and 4

7. Specific surgical events do not have tobe relayed during the intraoperative tophase I PACU hand-off communicationbecause nursing staff members are per-forming several tasks simultaneouslyduring this transition time.a. trueb. false

8. One element that is unique to the PACUto inpatient unit hand-off report is com-municating thea. need to provide discharge instructions.b. patient’s airway and oxygenation status.c. presence or absence of surgical

complications.d. type of anesthesia administered.

9. During the PACU to inpatient unit hand-off communication, specific emphasis isplaced on medication reconciliation.a. trueb. false

10. Elements that are common to all perioper-ative hand-off communications (eg, pre-operative to intraoperative, intraoperativeto PACU, PACU to inpatient unit) include

1. the patient’s name and date of birth.2. the name of the operative or invasive

procedure.3. any significant OR events.4. the patient’s level of understanding of

the surgery.5. the opportunity for staff members to

ask questions or state concerns.a. 1 and 3b. 1, 2, and 5c. 2, 3, 4, and 5d. 1, 2, 3, 4, and 5

The behavioral objectives and exam-ination for this program were preparedby Rebecca Holm, RN, MSN, CNOR,clinical editor, with consultation fromSusan Bakewell, RN, MS, BC, direc-tor, Center for Perioperative Educa-tion. Ms Holm and Ms Bakewell haveno declared affiliations that could beperceived as potential conflicts of inter-est in publishing this article.

This program meets criteria for CNOR and CRNFA recertification, as well asother continuing education requirements.

AORN is accredited as a provider of continuing nursing education by theAmerican Nurses Credentialing Center’s Commission on Accreditation.

AORN recognizes these activities as continuing education for registerednurses. This recognition does not imply that AORN or The AmericanNurses Credentialing Center approves or endorses products mentionedin the activity.

AORN is provider-approved by the California Board of Registered Nursing,Provider Number CEP 13019. Check with your state board of nursing foracceptance of this activity for relicensure.

© AORN, Inc, 2008

AORN (ID) #____________________________________________

Name__________________________________________________

Address________________________________________________

City ___________________________________________________ State __________ Zip __________

Phone number __________________________________________

RN license #____________________________________________ State __________

Fee enclosed ___________________________________________

or bill the credit card indicated ■■ MC ■■ Visa ■■ American Express ■■ Discover

Card # ___________________________________ Expiration date _____________________

Signature _______________________________________________________________ (for credit card authorization)

Fee: Members $8Nonmembers $16

Program offered November 2008

The deadline for this program is November 30, 2011

A score of 70% correct on the examination is required for credit.

Participants receive feedback on incorrect answers.

Each applicant who successfully completes this program will receive a certificate of completion.

NOVEMBER 2008, VOL 88, NO 5 • AORN JOURNAL • 773

Please fill out the application and answer formon this page and the evaluation form on the back

of this page. Tear the page out of the Journal or makephoto copies and mail with appropriate fee to:

AORN Customer Servicec/o AORN Journal Continuing Education

2170 S Parker Rd, Suite 300Denver, CO 80231-5711

or fax with credit card information to (303) 750-3212.

Additionally, please verify by signature that you have reviewed the objectives and read the

article, or you will not receive credit.

Signature ______________________________________

1. Record your AORN member identification number inthe appropriate section below. (See your membercard.)

2. Completely darken the spaces that indicate your an-swers to examination questions 1 through 10. Use blueor black ink only.

3. Our accrediting body requires that we verify the timeyou needed to complete this 1.6 continuing educationcontact hour (96-minute) program. ______

4. Enclose fee if information is mailed.

Hand-Off Communication: A Requisite for Perioperative Patient Safety

Answer Sheet 1.6

Event #08058Session #5039

This evaluation is used to determine theextent to which this continuing education

program met your learning needs. Rate theseitems on a scale of 1 to 5.

PURPOSE/GOALTo educate perioperative nurses about how tooperationalize the SBAR (ie, situation, back-ground, assessment, recommendation) tech-nique for hand-off communication during perioperative transitions.

OBJECTIVESTo what extent were the following objectives ofthis continuing education program achieved?1. Define hand-off communication.2. Explain how National Patient Safety Goal

02.05.01 addresses hand-off communication.3. Describe the SBAR communication tech-

nique.4. Explain how to use the SBAR technique in

hand-off communication during perioper-ative transitions.

CONTENTTo what extent5. did this article increase your know ledge

of the subject matter?6. was the content clear and organized?7. did this article facilitate learning?8. were your individual objectives met?9. did the objectives relate to the overall

purpose/goal?

TEST QUESTIONS/ANSWERSTo what extent10. were they reflective of the content?11. were they easy to understand?12. did they address important points?

LEARNER INPUT13. Will you be able to use the information

from this article in your work setting?1. yes2. no

14. I learned of this article via1. the AORN Journal I receive as an AORN

member.2. an AORN Journal I obtained elsewhere.

3. the AORN Journal web site.15. What factor most affects whether you take

an AORN Journal continuing educationexamination?1. need for continuing education contact

hours2. price3. subject matter relevant to current

position4. number of continuing education contact

hours offered

What other topics would you like to see ad-dressed in a future continuing education arti-cle? Would you be interested or do you knowsomeone who would be interested in writingan article on this topic?Topic(s): ________________________________________________________________________________________________________________________________________________________________Author names and addresses: ___________________________________________________________________________________________________

Hand-Off Communication: A Requisite for Perioperative Patient Safety

Learner Evaluation

© AORN, Inc, 2008774 • AORN JOURNAL • NOVEMBER 2008, VOL 88, NO 5

1.6

hand-off communication: a requisite for perioperative ... by the recipient reduces error and ......

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