Improving handover in recovery

Abstract

Background: An anaesthetist’s responsibility for patient safety continues into the recovery area where the patient remains at risk of surgical and anaesthetic complications. The multidisciplinary team is of vital importance, with recovery nurses taking a leading role in patient care. A clear handover between professionals should ensure continuity, quality, and safety of patient care.1 The Royal College of Anaesthetists provides guidance about this handover.2 Studies have shown that the use of checklists in anaesthesia can decrease human error, and improve teamwork and quality of care.3 In this project, we aimed to evaluate the quality of handovers in the recovery area at Inverclyde Royal Hospital and identify how these may be improved. Methods: An online questionnaire was sent to all theatre staff via Microsoft Forms with questions about the quality of the current handover process. Using this information, a ‘Recovery handover checklist’ was created and presented at the anaesthetic departmental meeting. We then trialled using a distraction-free ‘pause’ and the checklist, displayed in every recovery bay, to structure handovers over a 4-month period. A second online questionnaire was sent to all theatre staff with questions about the impact of this change. The length of handover was timed before and after the change. Results: The initial questionnaire received 20 respondents, including recovery nurses, anaesthetists, anaesthetic nurses, and theatre nurses. Some 65% of respondents thought current handover was not adequate. Fifty-five percent thought not all relevant information was handed over. Eighty-five percent thought there were distractions during handover. The follow-up questionnaire received 38 respondents, again from the full multidisciplinary team. Some 71% of respondents thought the ‘pause’ for handover had been useful and 76% would be keen to continue this. Eighty-two percent thought that there were fewer distractions during handover. However, 73% of recovery nurses thought that staff are only sometimes pausing before handover. There was no increase in average time taken for handover after the changes. Conclusion: Most of the multidisciplinary team at our hospital have found the introduction of a distraction-free ‘pause’ and checklist for handover in recovery useful. This new handover process has not increased the length of time taken for handover. Further work should include promotion of the checklist so that it is used more consistently in our department. 1.Arora V, Johnson J. Jt Comm J Qual Patient Saf 2006; 32: 646–552.Royal College of Anaesthetists. Novice Guide 2019. https://www.rcoa.ac.uk/documents/novice-guide/typical-day-novice (accessed 20/03/23)3.Saxena S, Krombach JW, Nahrwold DA, Pirracchio R. Anaesth Crit Care Pain Med 2020; 39: 65–73