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Development of a checklist to aid handovers in an Obstetric Post- Anesthesia Care Unit
Abstract Number: T-52
Abstract Type: Original Research
Handing over patient care in the post anesthesia care unit (PACU) is an integral part of anesthesia practice. Handover practices have been shown to be haphazard and suboptimal (1) and concerns have been raised regarding potential patient harm (2). Inter-anesthesia handovers of obstetric patients in an obstetric ward have been assessed with inadequacies identified (3). There are no studies regarding handover between anesthesia providers and PACU nurses after obstetric anesthesia –chiefly after cesarean delivery. Evidence supports the implementation of standardized checklists to warrant accurate information delivery to PACU nurses (4). We decided to evaluate and improve our obstetric PACU handovers through a quality improvement (QI) process.
We commenced with a questionnaire-based survey of 20 Obstetric PACU nurses. The questionnaire explored their satisfaction using a standard 7-point satisfaction scale and asked for items commonly omitted by anesthesia providers during handovers. Five handovers were observed with respect to structure and content. A Comprehensive search of electronic data-base (PubMed) using keywords:cesarean delivery/section-handover-PACU-post anesthesia care-recovery-checklist-obstetric anesthesia was undertaken to identify improving handovers strategies, relevant inclusion items and methods of designing validated PACU handover checklists. Five handovers were then observed and screened with the draft checklist. To arrive at a consensus on the relevant checklist items, we used modified Delphi approach. 7 local expert Obstetric anesthetists were given a -yes/no- questionnaire of items deemed relevant to be included in the checklist over two rounds. These items were derived from the literature review and the nurse questionnaire.
The nurse survey revealed 45 % slight dissatisfaction with handovers. The commonly missed items listed by nurses were: neuraxial morphine dose and timing, total and type of intravenous fluids, uterotonic drugs and patient allergies. The PACU nurses strongly supported a standardized process for handing over patient care. The observed handovers were highly variable in content and organization. Literature search did not reveal any prior studies in Obstetric anesthesia PACU. No additional items were identified on observing handovers using the draft checklist. Data obtained from all sources facilitated the development of a standardized checklist unique for Obstetric PACU (table 1). We observed handovers using this checklist and found it easily usable.
Nurse satisfaction survey and observed handovers suggested improvements could be made with potential benefits for patient safety. We are now evaluating handovers in our Obstetric PACU using this tool. Our handover tool may be of value to other obstetric centers.
1-Ann Surg 2011; 253:831-837.
2-Ugeskr Laeger 2011; 173:1412–1416.
3-Anaesthesia 2015, 70(Suppl. 3), 11–101
4-Int J Qual Health Care 2013; 25: 176-181.