Enhanced Safety in Intraoperative Anesthesia Handoffs by Standardizing Communication with the Application of the Patient Checklist Tool

Abstract

Background/Significance Poor communication sequences have been reported as the leading cause of patient safety errors (Barbeito, Agarwala, & Lorinc, 2018). Due to the recurrence of patient sentinel events, The Joint Commission (TJC) has made effective handoff communication a national patient safety goal (Jullia et al., 2017). Unstandardized intraoperative anesthesia handoffs not only increase the likelihood of patient harm, but they are also associated with increased morbidity and mortality (Mattei, Ordookhanian, & Kaloostian, 2018). There is a plethora of evidence-based literature supporting that standardization of communication during the intraoperative anesthesia handoff results in effective communication, enhanced patient safety, and improved patient outcomes (Jones et al., 2018; Keebler et al., 2016). In addition to this, the literature also supports enhanced provider satisfaction and perception of communication during the intraoperative handoff when utilizing a checklist tool (Foster & Manser, 2012). Unfortunately, despite the considerable amount of evidence-based research, the intraoperative anesthesia handoff continues to be informal and unstructured. Purpose The purpose of this scholarly project was to assess the perception of certified registered nurse anesthetists (CRNAs) towards improved communication when adopting the PATIENT checklist tool. Methods The PATIENT protocol, created by Dr. Suzanne M. Wright (2013) provides a systematic approach in reporting accurate patient information during the intraoperative anesthesia handoff. This doctor of nursing practice (DNP) quality improvement project consisted of gathering qualitative and quantitative data through a pre- and post-assessment survey following an educational intervention at a hospital in the Phoenix, Arizona area. Results The results of the survey revealed that a majority of CRNAs (n=12) do not use a standardized communication process during the anesthesia handoff. The results also demonstrated a majority (n=13) of them perceived that standardizing the handoff would be beneficial as well as they would likely adopt a checklist as part of their workflow (n=13). The DNP project results reflect that CRNAs perceive (n=16) that applying a checklist tool to the intraoperative anesthesia handoff would be beneficial, and that the tool is adequate in length, comprehensive, and would enhance patient safety. Discussion This DNP quality improvement project was intended to utilize evidence and raise awareness into local practice for the benefit of improving consistency of evidence-based care. This was done by informing CRNAs about the implications behind poor communication towards patient outcomes and how standardization of communication can remediate this problem. This DNP quality improvement project promoted organizational collaboration within this local practice and enhanced a culture of safety amongst anesthesia providers.