attention the PACU nurses gave to the handoff report. The Iowa Model, which is the theoretical
framework used for this study, encourages healthcare providers to identify “triggers” that come
from questioning current practice (Melnyk & Fineout-Overholt, 2011). This was the impetus for
the practice change at AGMC. Although there were no outcome studies at AGMC that
suggested adverse events were associated with poor communication, there were enough
knowledge-focused triggers that caused an increase in awareness of the importance of good
handoff communication within the anesthesia and PACU departments. In the Anesthesia Practice
Safety Foundation (APSF) Newsletter published in 2012, it states: there is a need for studies to
investigate and identify best practices in postoperative patient handoffs. The Chair of the
Department of Anesthesia approached me and suggested that there was a need to change the way
the anesthesia department relayed information to the PACU. He had received enough complaints
regarding poor communication from the CRNAs, PACU RNs, and anesthesiologists. Most of the
dissatisfaction was related to the omission of information, specifically the timing and doses of
medications. Anesthesiologists were reluctant to give pain medication orders without adequate
information and PACU nurses had to step away from the bedside to look at the chart, and at
times, this was when the patient’s physiologic status was most demanding.
In response, the Department of Anesthesia Chair, and the Nurse Manager of the PACU
met several times and developed a more comprehensive handoff form that included spaces to fill
in time and dose of opioids and anti-emetics that were given in the operating room. It was also
felt that making the handoff form a document that would stay in the chart, would help to
formalize the process. Comorbidities were also added to the handoff form. This standardized
handoff form was developed in order to help reduce the risk of missed information and
hopefully, improve satisfaction among postoperative providers.