Implementation of a standardized checklist for Operating Theatre handover

By TSANG Siu King, Cindy, RN, BSc (NursStud), FHKAN (Perioperative) OT, Senior Nursing Officer

Purpose

This study was performed to improve the current operating theatre shift handover system in Hong Kong Sanatorium and Hospital. A checklist was developed for the operating theatre

staff for handover of clinical and managerial information for the night shift. After the feasibility of the checklist was tested and the outcome was evaluated, a new checklist handover system was introduced. Staff satisfaction may be improved with the new checklist handover system.

Background

Standardized handoff communication is a process in which information is communicated in a consistent manner from one health care provider to another1. When improving handovers, the aim is to reduce the risk of miscommunication, misunderstanding, and /or the omission of critical information2.

In current practice at HKSH, Operating Theatre (OT) staff handover between shifts consist of both verbal and written information.

Occasionally, vital information was found missing, particularly when they were busy handling with an emergency operation. When the face to face handover was not completed or was done poorly, the quality of the surgery preparation may be impacted.

Methods

A new handover checklist was created to facilitate the handover system. This new checklist included standard works and important first case information. The checklist can be used even when the face to face handover was not available.

A pre-intervention questionnaire was distributed to OT night shift in-charge nurses to measure different components to handover and overall satisfaction with the process (n=29).

After implementation of the new handover system, those nurses who participated in the pre-intervention survey were invited to join the post intervention survey. The same instrument tool was distributed to the participants (n=29). Both response rates were 100%. Data from both surveys were compared.

Results

Four aspects including the standard handover practice, accuracy, efficiency, staff satisfaction were analyzed from the results of the pre-intervention and Post intervention surveys.

The new handover system was more standardized, efficient and accurate. Only 3% nurses did the handover in their own method and needed to note down different items for handover in the new checklist handover system instead of over 75% in the current handover practice.

Following the items listed in the checklist, the information and routine works founded in-completed were all decreased 40% in average. Further, none of the nurses received information only when they had time to do face to face handover.

Overall there were about 90% nurses satisfied with the new checklist handover system. Comparing with the old handover system, the satisfaction rate was increased 72%.

Discussion

Using a structured checklist may help to standardize the handover system. The checklist allowed for more efficient documentation of routine work. Further, handover information can be obtained even face to face handover was not available. The checklist was available to view, retrieve and verify the information. It can be used as a guide to complete the routine works and help to guide the newly in-charge nurses.

About 90% nurses were satisfied with the new handover system. The new checklist system seems useful and can be adopted by the operating theatre staff.

According to the changes of the routine works in operating theatre, it was important to encourage the user to give comments to enrich, review and update the content of the handover checklist.

Periodic audit may be also needed to carry out to assess whether staff are continuing to use the checklists accurately.