Transfer of Accountability between PACU and 16CC: Developing a standardized approach K. Macqueen, RN, BN, CNCC(C), PANC(C); K. Mansfield, RN, BScN, MN, CGN; N. Rudyk, RN, BScN, MN St Michael’s Hospital, Toronto, Ontario, Canada
BACKGROUND
PROCESS (CONTINUED)
CHALLENGES
• The RNAO’s Best Practice Guidelines on Care Transitions states that discussion and documentation should be standardized and streamlined to ensure clear and accurate transfer of information (RNAO 2014). • Accreditation Canada’s Standards for Perioperative Services (2015) includes the need for documentation tools and communication strategies that allow for standardized transfer of information during care transitions. This is defined as any time a client experiences a change in team member, location, admission, handover, transfer and discharge. • There is currently no standardized handover tool between PACU and the surgical floors. Report is given via telephone. • The goal was to develop a standardized tool that if piloted successfully may eventually be able to be used between PACU and all surgical units. • A literature review conducted found information related to transfer of accountability (ToA) from OR to PACU, shift to shift, ICU to floor, ICU to ICU and hospital to hospital, but no information regarding ToA from PACU to floor.
• Tool went through 2 revisions before final roll out. • Roll out began in February
• There had been difficulties giving report due to break coverage, RN workload and assignment, the hope is that with this tool any nurse on 16CC can receive report on a patient, therefore improving patient flow and timely discharge from PACU. • Before roll out there were inconsistencies and discrepancies when giving report due to lack of standardized tool. Certain information was not being communicated or was communicated but not documented. • Initial resistance to using tool but frequent prompting and reminders ensured compliance
Fig. 1: one initial draft of tool
Fig. 2: final version of tool
CONCLUSION AND NEXT STEPS
FINDINGS
REFERENCES
• The CNO’s practice standards on documentation state that nurses should be minimizing duplication of information in the health record (CNO 2008). • Feedback from PACU nursing staff was that this tool required frequent “double charting”. Agree that standardized tool is useful but feel there could be a more efficient way. • Post surveys are still to be completed by both units.
• College of Nurses of Ontario, (2008). Practice Standards: Documentation. Retrieved from: http://www.cno.org/globalassets/docs/prac/41001_documentati on.pdf • Registered Nurses’ Association of Ontario, (2014). Clinical Best Practice Guidelines: Care Transitions. Retrieved from: http://rnao.ca/sites/rnao-ca/files/Care_Transitions_BPG.pdf • Accreditation Canada, (2015). Standards: Perioperative Services and Invasive Procedures. Retrieved from: http://callaway/web-assets/resources/accreditation/standardsperiopertive-services-invasive-procedures.pdf
Some feedback from PACU nurses:
OBJECTIVES • To describe steps undertaken by PACU and 16CC to develop and pilot a standardized tool for ToA. • To describe findings and next steps.
Fig. 3: previous process of giving report
PACU RN signs patient flow sheet once patient meets discharge criteria
Telephone report given to receiving RN on 16CC
Patient discharged to 16CC
“Feel like it is more time consuming.”
PROCESS • Process involved collaboration between PACU, 16CC and the hospital’s ToA subcommitee. • Education sessions were provided by 16CC Clinical Nurse Educator and PACU CLM to staff on both units prior to roll out regarding the need for standardized ToA • A template was designed, and necessary revisions made before rolling out. Staff were asked for feedback on what should be included and what was not required.
Fig. 4: process of giving report with new tool PACU RN completes and signs tool attached to front of patient chart when ready for discharge
Receiving RN on 16CC completes and signs same tool whilst receiving telephone report from PACU
Information not covered in tool can then be discussed over the telephone before patient leaves PACU
• Everyone in agreement that standardized tool is necessary, however there could be a more efficient tool developed. • Post surveys to get RN feedback. • Complete an audit of PACU delays related to giving report to examine whether this has decreased since roll out. • Complete an audit of event trackers related to handover to examine if there has been an improvement • Plan is to possibly pilot another model similar to those used between ED and TNICU, or the IPASS model used by other units.
“Oh no, MORE paperwork!”
“A lot of double charting.”