CONTINUING EDUCATION

SWITCH for Safety: PerioperativeHand-off ToolsFAY JOHNSON, BSN, RN, CNOR; PATTY LOGSDON, MSN, RN, CNOR;

KIM FOURNIER, ADN, RN, CNOR; SANDRA FISHER, BS, RN, CNOR 2.3www.aorn.org/CE

Continuing Education Contact Hoursindicates that continuing education (CE) contact hours are

available for this activity. Earn the CE contact hours by

reading this article, reviewing the purpose/goal and objectives,

and completing the online Examination and Learner Evalua-

tion at http://www.aorn.org/CE. A score of 70% correct on the

examination is required for credit. Participants receive feed-

back on incorrect answers. Each applicant who successfully

completes this program can immediately print a certificate of

completion.

Event: #13532

Session: #0001

Fee: Members $13.80, Nonmembers $27.60

The CE contact hours for this article expire November 30,

2016. Pricing is subject to change.

Purpose/GoalTo provide knowledge specific to improving hand-off com-

munications during perioperative transfers of care from one

health care provider to another.

Objectives

1. Discuss the leading cause of reported sentinel events.

2. Identify barriers to communication.

3. Describe hand-off communications.

4. Identify standardized formats used for hand offs.

5. Discuss SWITCH tools used for perioperative hand offs.

AccreditationAORN is accredited as a provider of continuing nursing

education by the American Nurses Credentialing Center’s

Commission on Accreditation.

494 j AORN Journal � November 2013 Vol 98 No 5

ApprovalsThis program meets criteria for CNOR and CRNFA

recertification, as well as other CE requirements.

AORN is provider-approved by the California Board of

Registered Nursing, Provider Number CEP 13019. Check

with your state board of nursing for acceptance of this activity

for relicensure.

Conflict of Interest DisclosuresMs Johnson, Ms Logsdon, Ms Fournier, and Ms Fisher

have no declared affiliations that could be perceived as

posing potential conflicts of interest in the publication of

this article.

The behavioral objectives for this program were created

by Rebecca Holm, MSN, RN, CNOR, clinical editor, with

consultation from Susan Bakewell, MS, RN-BC, director,

Perioperative Education. Ms Holm and Ms Bakewell have

no declared affiliations that could be perceived as posing

potential conflicts of interest in the publication of this

article.

Sponsorship or Commercial SupportNo sponsorship or commercial support was received for this

article.

DisclaimerAORN recognizes these activities as CE for RNs. This rec-

ognition does not imply that AORN or the American Nurses

Credentialing Center approves or endorses products mentioned

in the activity.

http://dx.doi.org/10.1016/j.aorn.2013.08.016

� AORN, Inc, 2013

SWITCH for Safe

ty: PerioperativeHand-off ToolsFAY JOHNSON, BSN, RN, CNOR; PATTY LOGSDON, MSN, RN, CNOR;

KIM FOURNIER, ADN, RN, CNOR; SANDRA FISHER, BS, RN, CNOR 2.3www.aorn.org/CE

ABSTRACT

Communication breakdown is the leading cause of reported sentinel events in the

perioperative setting. Barriers to optimal communication include noise, stress,

multitasking, and rapid turnover between procedures. AORN has identified commu-

nication during personnel changes (ie, hand offs) as a point of vulnerability for the

surgical patient. A standardized hand-off method provides an opportunity for

personnel to ask and answer questions and should be available in the perioperative

setting. At one facility, the standardization of hand-off reporting resulted in the

development of new hand-off tools specific to the perioperative environment. A

standardized reporting method enabled health care providers to address commu-

nication barriers and to maintain their focus on the patient during critical moments

(eg, shift changes), thereby improving patient safety. AORN J 98 (November 2013)

495-504. � AORN, Inc, 2013. http://dx.doi.org/10.1016/j.aorn.2013.08.016

Key words: communication tools, communication breakdown, hand-off tools, hand-

off reports, patient safety, hand-off communication.

Communication of essential information

during the transfer of patient care from

one perioperative care provider to another

is critical to patient safety and continuity of care.

The leading cause of reported sentinel events in the

OR is communication breakdown.1,2 “A sentinel

event is an unexpected occurrence involving death

or serious physical or psychological injury, or the

risk thereof. Serious injury specifically includes

loss of limb or function. . . . Such events are called

‘sentinel’ because they signal the need for imme-

diate investigation and response.”3 Barriers to

concise communication include noise, information

overload, inattention, stress, multitasking, and

time pressures caused by rapid turnover between

procedures.4 More than 3,000 sentinel events

http://dx.doi.org/10.1016/j.aorn.2013.08.016

� AORN, Inc, 2013

analyzed from 1995 to 2004 revealed that 65% of

reported problems were caused by poor communi-

cation.5 In 2005, that percentage increased to 70%,

of which half of reported events occurred during

the hand-off communication period.5 Communi-

cation during personnel changes is a point of

vulnerability during which incorrect information

can be conveyed or crucial information omitted,

leading to medical error. Hand offs are the most

common health care transaction prone to error.6

In 2006, The Joint Commission published

National Patient Safety Goal 2E. The purpose of

this safety goal was to guide providers in imple-

menting a standardized approach to hand-off

communications, including ensuring that they have

an opportunity to ask and respond to questions.5

November 2013 Vol 98 No 5 � AORN Journal j 495

November 2013 Vol 98 No 5 JOHNSON ET AL

In an effort to deal with communication failures,

The Joint Commission revised and expanded that

safety goal in 2008 to require the following:

1. Interactive communications allowing for the

opportunity for questioning between the giver

and the receiver of patient information.

2. Up-to-date information regarding the patient’s

care, treatment, services, condition, and any

recent or anticipated changes.

3. A process for verification of the received in-

formation, including the use of repeat-back and

read-back, as appropriate.

4. An opportunity for the receiver of the handoff

information to review relevant patient histor-

ical data, which may include previous care,

treatment, and services.

5. Interruptions during handoffs are limited to

minimize the possibility that information would

fail to be conveyed or would be forgotten.7

Health care facility management personnel should

develop and implement a process to comply with

this safety goal.5

HAND-OFF COMMUNICATION

The terms hand-off, handover, sign-over, and shift

report are synonymous. A “hand off” may be de-

scribed as the transfer of patient information, along

with the authority and responsibility to care for that

patient, from one health care provider to another

during the transfer of care.8,9 For example, a hand

off in the OR may be from one RN circulator to

another RN circulator or from one scrub person to

another scrub person. The “hand-off communica-

tion report must be complete, concise, concrete,

clear, and accurate.”4(p5) All team members in-

volved should have the opportunity to ask ques-

tions, respond to questions, and discuss patient care

provided by the previous clinician and care that

will be required by the next clinician. Standardized

hand-off systems and techniques are widely avail-

able and include the following formats:

n SBAR: situation, background, assessment,

recommendation;

496 j AORN Journal

n I PASS the BATON: introduction, patient,

assessment, situation, safety concerns, (the)

background, actions, timing, ownership, next;

n SHARQ: situation, history, assessment, recom-

mendations, questions;

n Five Ps: patient, plan, purpose of plan, problem,

precaution; and

n Five Ps, second version: patient, precautions,

plan of care, problems, purpose.10,11

Although these hand-off methods help to ensure

clear and complete hand-off communication, none

are specific to the needs in the perioperative

environment.

SETTING

As a result of a 2010 safety survey, members

of the Surgical Services Partnership Council at

Providence St Vincent Medical Center, Portland,

Oregon, learned of perioperative nurses’ concerns

regarding inconsistencies in hand-off reporting.

Although the SBAR method was used for hand-off

communications throughout the hospital, it did

not address specific and critical information that

needed to be relayed during the intraoperative hand

off. The result was inconsistent use of SBAR by

health care providers or personnel performing their

own version of SBAR. Critical information related

to surgical patientsdsuch as totals of medications

administered, instruments off the sterile field, and

details about specimens or countsdoften may not

be communicated for various reasons (eg, distrac-

tions, need for rapid room turnover). Such incon-

sistency was creating a patient safety issue.

In response to these concerns and after review-

ing resources about hand-off communication for

guidance,11,12 council members decided that

a standardized hand-off tool designed specifically

for the OR was needed. Council members then

identified barriers to effective communication at

the facility, which included the following:

n the lack of an established process or written

script for hand offs;

PERIOPERATIVE HAND-OFF TOOLS www.aornjournal.org

n reports given verbally (ie, no written report

template), which forced individuals to rely on

memory alone;

n personnel breaks taken without team members

performing a thorough hand-off report;

n noise distractions (eg, music playing, back-

ground conversations, equipment noise);

n personnel who multitasked (eg, completing

documentation, performing the surgical prep,

positioning the patient) during the hand off;

n personnel feeling pressured to perform rapid

turnovers between procedures;

n the inconvenient timing of the hand off in re-

lation to the status of the procedure (eg, a hand

off occurring during the beginning or end of the

procedure or at a critical point in the procedure,

such as during positioning or counting); and

n the facility’s recent conversion to electronic

charting and the subsequent increase in charting

demands, which affected the intraoperative

workflow.

Relying on memory, being distracted by noise

and other activities, and adjusting to new work-

flows all interfered with accurate reporting. In

addition, the preceding items indicated that per-

sonnel at our facility were encountering several

barriers to optimal communication, namely not

having a standardized hand-off approach or accu-

racy in reporting, followed closely by a lack of

completeness and clarity during the information

exchange. Given the perioperative team members’

variety of experiences, training, and backgrounds,

council members decided that a standardization

tool was necessary to improve processes and ensure

patient safety.

After careful assessment of safety concerns and

the identified barriers to hand-off communication,

the council decided to develop and implement its

own scripted solution. This resulted in SWITCH

(Figure 1), a new hand-off tool for improved

communication. The acronym SWITCH stands for

n surgical procedure,

n wet (ie, fluids),

n instruments,

n tissue (ie, specimen),

n counts, and

n have you any questions?

Each of the SWITCH acronym categories permitted

additional subcategories, such as medications in the

wet category, to allow perioperative team members

to adequately address communication specific to

their various roles and hand-off needs. Similar to

other communication techniques, SWITCH is easy

to remember because, as an acronym, it spells

a word that conveys the critical activities that occur

when personnel care for the patient. Unlike other

communication techniques, however, the SWITCH

tool is geared toward the specialized needs of the

perioperative environment. The council’s goal in

developing the SWITCH tool was to standardize

the hand-off reporting process and to ensure that

a face-to-face hand off occurred between outgoing

and incoming personnel.

ROLLOUT

In preparation for implementing the SWITCH tool,

the council considered how difficult change can

be for individuals. An individual’s resistance to

change can be attributed to factors such as habits,

complacency, disorganization, perceived loss of

power, and not understanding the need for change.13

To alleviate the potential for any resistance to

change, council members made sure that all

personnel were aware of the need for and the

reasoning behind the change. This occurred during

several inservice meetings led by council members.

Input received from perioperative personnel during

these inservice meetings guided council members in

the development of the SWITCH tool and was es-

pecially helpful in delineating subcategories. An

early paper version of the tool was tested by peri-

operative personnel for several weeks, and feedback

that council members received on the written layout

and content was taken into consideration before

rollout of the final version.

The official rollout of SWITCH began with

council members educating personnel about the

AORN Journal j 497

SWITCH for OR Hand Off

S Surgical procedure

□ Diagnosis □ Stage of procedure (ie, beginning, middle, end) □ Specific patient concerns (eg, allergies, implants, health status) □ Imaging needed (eg, x-ray) □ Incision type/dressings needed □ Plan for postoperative patient disposition □ Procedure to follow

W Wet (ie, fluids)

□ Medications on the sterile field (ie, type, amount) □ Irrigation (ie, type, amount) □ Blood loss and blood products available □ Urine out □ Drains

I Instruments

□ Need to reprocess instruments for to-follow cases □ Instruments on hold □ Implants needed

T Tissue (ie, specimen)

□ Specimen (ie, name, source of specimen) □ Grafts (ie, type, source of graft, location of graft [eg, specimen refrigerator, dry storage

cabinet]) □ Type of laboratory procedure (eg, frozen, touch prep)

C Counts

□ Sponges, needles, sharps, and instruments □ Items off the sterile field or in body cavities

H Have you any questions?

□ Status of charting?

Figure 1. Initial use of the new SWITCH tool was for the hand off between two RN circulators or scrub person toscrub person. Modified and used with permission from Providence St Vincent Medical Center, Portland, OR.

November 2013 Vol 98 No 5 JOHNSON ET AL

new tool. During mandatory inservice programs for

personnel from each shift, council members re-

viewed the reasons for changing hand-off reporting

and presented the SWITCH tool itself. Next, peri-

operative personnel participated in role-playing

exercises and an activity of matching hand-off

information to the correct SWITCH category. All

personnel, including those who were not able to

attend, were assigned an electronic learning module

498 j AORN Journal

that council members created to orient personnel to

and further educate them about SWITCH.

To promote awareness and aid in retention

during the rollout, council members distributed

paper SWITCH forms to each of the ORs in the

facility. These forms used bullet points to illustrate

each category of the hand-off tool. Laminated

forms also were available at the RN circulators’

computer work station, to be used with a dry-erase

PERIOPERATIVE HAND-OFF TOOLS www.aornjournal.org

marker for written hand-off reporting. This lam-

inated form allowed the RN circulator to write key

notes that would prepare him or her to give a hand-

off report efficiently and remember critical patient

information. Another large laminated SWITCH

tool was placed on the wall near the scrub person’s

back table. It permitted the scrub personnel to easily

read the form and to give his or her hand off in a

standardized fashion. Council members also dis-

tributed smaller versions of the laminated cards to

team members to wear behind their name tags.

The SWITCH tool provided personnel a frame-

work with which to improve their hand-off skills

and prevent communication errors. For example,

during a hand off for a patient who is undergoing

a right mastectomy with a sentinel node biopsy and

breast reconstruction with placement of a tissue

expander, the hand-off report between two RN

circulators when one is leaving for a break

(Figure 2) would include the following:

n S: surgerydright mastectomy, sentinel node

biopsy, reconstruction with tissue expander

Figure 2. Two RN circulators perform a SWITCH hand off

placement; patient is allergic to penicillin;

patient will be transferred to the postanesthesia

care unit (PACU) after surgery

n W: wetd0.25% bupivacaine plain (30 mL),

50,000 units of bacitracin diluted in 1,000 mL

of 0.9% sodium chloride irrigation solution, two

15-Fr closed collapsible drains opened on sterile

field

n I: instrumentsdusing the two trays of mastec-

tomy instruments; tissue expanders available

in room

n T: tissuedone specimen: right breast to be sent

to pathology for permanent section and two

sentinel nodes sent to pathology for touch prep

n C: countsdverify count board: 20 laparotomy

sponges, 12 suture needles, six knife blades, two

electrosurgical unit tips

n H: have you any questions? What is the status of

filling out the implant card?

An example of a scrub person’s hand off to another

scrub person (Figure 3) for the same patient might

include the following:

before a shift change.

AORN Journal j 499

Figure 3. One scrub person performs a SWITCH hand off with another scrub person before a shift change.

November 2013 Vol 98 No 5 JOHNSON ET AL

n S: surgerydright mastectomy, sentinel node

biopsy, reconstruction with implant; have two

separate Mayo stands and back tables; patient is

allergic to penicillin

n W: wetd0.25% bupivacaine plain (30 mL),

50,000 units of bacitracin diluted in 1,000 mL

of 0.9% sodium chloride irrigation solution, two

15-Fr closed collapsible drains opened on sterile

field

n I: instrumentsdusing the two trays of mastec-

tomy instruments; tissue expanders in room but

not opened

n T: tissuedthree specimens: right breast to be

sent to pathology for permanent section and

two sentinel nodes sent to pathology for touch

prep handed off the surgical field to the

RN circulator

n C: countsdverify change of shift count: eight

laparotomy sponges in sponge counting bag

off the field, 12 laparotomy sponges on the field,

500 j AORN Journal

12 sutures, six knife blades, two electrocautery

unit tips

n H: have you any questions?

EXPANSION

After implementation of SWITCH, the council

redesigned the tool’s concept so that it could be

used for indirect perioperative patient care areas

throughout the OR. The charge nurses at the OR

front desk did not have a standardized reporting

method, and the outgoing charge nurse sometimes

failed to relay critical information to the oncoming

charge nurse. The partnership council member who

initiated the SWITCH concept was also the week-

end charge nurse. She proposed a modification of

the SWITCH tool that would make the front desk

scheduling charge reports more efficient and ef-

fective (Figure 4). By adjusting the SWITCH cat-

egories (ie, changing the words associated with

each letter of the acronym), a revised version of the

SWITCH for Front-Desk Hand Off

S Staff issues

□ Any personnel working overtime; any “on call” (ie, resource) working □ Any sick calls

W What still needs to be done

□ Rooms running □ Rooms to be set up □ Quality checks (eg, code carts, sterilizers)

I Items

□ Out for repair □ On loan outside of the department □ Expected for return

T Time

□ Available for procedures □ Gaps in schedule

C Cases

□ Add-ons—who has been notified? □ Cancellations—who has been notified?

H Have you any questions?

□ Other

Figure 4. Use of the SWITCH hand-off tool extended beyond the OR to front-desk personnel. Modified andprinted with permission from Providence St Vincent Medical Center, Portland, OR.

PERIOPERATIVE HAND-OFF TOOLS www.aornjournal.org

tool was developed to address the areas of concern

related to managing the OR scheduling (eg, per-

sonnel on duty, scheduled procedures).

The following example illustrates how the

modifications to the SWITCH tool can be used by

the charge nurses at the front desk:

n S: staffing issuesdneed one nurse for OR #4

and one scrub person for OR #7 because of sick

calls

n W: what still needs to be donedseven rooms

are running, robotics room needs to be set up,

code carts need to be checked

n I: itemsdinstruments and implants are coming

in for a special procedure in OR #6

n T: timedtimes available for add-ons or emergen-

cies; gap in schedule from 1230 to 1400 in OR #1

n C: casesdOR #14 delayed because of an

emergency, and the surgeon is late in OR #20;

all appropriate personnel have been notified

n H: have you any questions?

The charge nurses learned that each lettered item

may not always apply, but running through all of

the categories and possible subcategories of the tool

ensures that no one misses critical information. The

charge nurses decided to keep processed SWITCH

forms in a binder for future evaluation and analysis.

One council member was an anesthesia techni-

cian. He decided to use the OR SWITCH tool to

develop a modified version for the anesthesia de-

partment (Figure 5). Previously, this department

did not have a standardized method or scripted tool.

The work areas that anesthesia technologists are

AORN Journal j 501

Figure 5. Anesthesia personnel also were able to use SWITCH, which led to improved tracking of carts. Modifiedand printed with permission from Providence St Vincent Medical Center, Portland, OR.

November 2013 Vol 98 No 5 JOHNSON ET AL

responsible for extend beyond the main OR, mak-

ing hand-off communication more challenging.

With the SWITCH tool, the anesthesia technologists

were able to improve communication at break

502 j AORN Journal

times and shift changes. This success led to de-

partmental use of SWITCH to establish a more

effective tracking system of specialty carts and their

locations. Procedures that this group performed

PERIOPERATIVE HAND-OFF TOOLS www.aornjournal.org

outside the main OR became more easily tracked,

and less time was spent locating lost equipment

in different departments. Equipment from radi-

ology, the catheterization laboratory, endoscopy, and

the neonatal intensive care unit stopped getting mis-

placed, which improved efficiency and reduced

replacement costs. The hand-off tool also made it

easier for anesthesia technologists to identify which

carts need to be cleaned and restocked, which resulted

in a more efficient and effective department. Having

equipment readily available also hasmade it safer for

the patients.

At Providence St Vincent Medical Center, the

anesthesia professional is typically accompanied to

the PACU by the surgeon, resident, or physician

assistant. The anesthesia professional gives the

main hand-off report to the PACU nurse. The RN

circulator may call the PACU nurse with a specific

patient concern before the patient is transferred to

the PACU or may accompany the anesthesia pro-

fessional to the PACU if he or she has specific

hand-off information that may not be given by the

anesthesia professional. This variability facilitates

faster room turnover. A standardized hand-off tool

is being developed at this time for the hand-off

communication between the anesthesia profes-

sional and PACU RN.

FEEDBACK AND SUCCESS

A council member shared the SWITCH hand-off

tool for the RN circulator and scrub person with

personnel from several other hospitals in the Port-

land area. Additionally, council members presented

the tool at a local AORN chapter meeting, on

AORN MemberTalk (ie, AORN listserv), and as

a poster presentation at the 2012 AORN Congress

in New Orleans, Louisiana. The council received

positive feedback regarding the hand-off tool. After

using SWITCH for one year, Surgical Services

Partnership Council members presented a survey to

measure compliance with the tool’s use. Of the 33

team members (ie, 20 nurses, 12 surgical technol-

ogists, one anesthesia technologist) who completed

the survey, 97% thought that the SWITCH hand-off

tool was very important for patient safety and 87%

thought it was easy to use. Council members have

listened to the comments of the survey. As a result,

council members added a subcategory to the form

for dressings and drains. Other comments received

were that

n personnel want to be able to give their report

without feeling rushed or interrupted,

n the script provides a verbal and written report

but also allows time for asking and answering

questions,

n nurses like the versatility of having both lami-

nated and paper forms of the tool available, and

n standardization of hand-off reports keeps the

care provider’s focus on the patient and in-

creases patient safety.

Managerial feedback expressed support and en-

couragement for using SWITCH for every patient

every time, and managers have requested audits

of the paper version of the tool to document

compliance.

Council members successfully implemented the

Universal ProtocolTM for time outs14 and, subse-

quently, the World Health Organization Surgical

Safety Checklist.15 Equally important to managers

and council members alike, as well as to patient

safety, has been the successful implementation of

the SWITCH hand-off tool. Hand-off reports are

a time for health care providers to focus on the

transfer of care without interruption, a time to

pause, and a time to “SWITCH for Safety.” The use

of the SWITCH tool at our facility has kept the

focus of the hand-off exchange on the care of the

patient and, in fact, has spotlighted patient safety

while at the same time ensuring concise and

complete reporting. Perioperative services is

a specialized service area in which using a stan-

dardized, scripted tool has benefited all RN circu-

lators, scrub personnel, anesthesia technologists,

and indirect patient care providers but, most im-

portantly, the patients.

AORN Journal j 503

November 2013 Vol 98 No 5 JOHNSON ET AL

Editor’s note: The Universal Protocol for Pre-

venting Wrong Site, Wrong Procedure, Wrong

Person Surgery is a trademark of The Joint

Commission, Oakbrook Terrace, IL.

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and communication in surgery: a systematic review. Ann

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2. Taneva S, Grote G, Easty A, Plattner B. Decoding the

perioperative process breakdowns: a theoretical model

and implications for system design. Int J Med Inform.

2010;79(1):14-30.

3. Sentinel event. The Joint Commission. http://www.joint

commission.org/sentinel_event.aspx. Accessed August 9,

2013.

4. Hospital and Health Service Performance Division.

Promoting Effective Communication Among Healthcare

Professionals to Improve Patient Safety and Quality of

Care. Melbourne, Australia: Victoria Government De-

partment of Health; 2010:1-12.

5. The Joint Commission. Improving handoff communica-

tions: meeting National Patient Safety Goal 2E. Joint

Perspect Patient Safety. 2006;6:9-15.

6. Van Dam S. A process prone to error and needing im-

provement. Forum. 2007;25(1):14-15.

7. 2008 Hospital Patient Safety Goals: Implementation

expectations for handoffs. The Joint Commission. http://

www.jointcommission.org/NR/rdonlyres/82B717D8-

B16A-4442-AD00-CE3188C2F00A/0/08_HAP_NPSGs_

Master.pdf. Accessed October 2, 2013.

8. Friesen MA, White SV, Byers JF. Handoffs: implications

for nurses. In: Patient Safety and Quality: An Evidence-

Based Handbook for Nurses. Rockville, MD: Agency for

Healthcare Research and Quality; 2008:1-17.

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http://www.healthcareinspirations.com/hci_hand-off_

communications.html. Accessed August 9, 2013.

10. Sandlin D. Improving patient safety by implementing

a standardized and consistent approach to hand-off

communications. J Perianesth Nurs. 2007;22(4):289-292.

11. Patient Hand Off Communication Tool Kit. AORN, Inc.

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_Hand_Off_Tool_Kit/Patient_Hand_Off_Tool_Kit.aspx.

Accessed August 30, 2013.

12. Transitions of care (TOC) portal. The Joint Commission.

http://www.jointcommission.org/toc.aspx. Accessed

August 9, 2013.

13. Simms E. The components of change: creativity and

innovation, critical thinking and planned change. In:

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Roussel L, Swansburg R, eds. Management and Lead-

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Sudbury, MA: Jones and Bartlett Publishers; 2006:55-80.

14. The Universal Protocol. The Joint Commission. http://

www.jointcommission.org/standards_information/up

.aspx. Accessed August 9, 2013.

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_resources/SSSL_Checklist_finalJun08.pdf. Accessed

August 9, 2013.

Fay Johnson, BSN, RN, CNOR, is a clinical

level 4 perioperative nurse in the OR at

Providence St Vincent Medical Center, Portland,

OR. Ms Johnson has no declared affiliation

that could be perceived as posing a potential

conflict of interest in the publication of this

article.

Patty Logsdon, MSN, RN, CNOR, is a peri-

operative nurse in the OR at WakeMed Health

and Hospitals, Raleigh, North Carolina. Ms

Logsdon has no declared affiliation that could be

perceived as posing a potential conflict of in-

terest in the publication of this article.

Kim Fournier, ADN, RN, CNOR, is a clinical

level 4 perioperative nurse in the OR at

Providence St Vincent Medical Center, Portland,

OR. Ms Fournier has no declared affiliation that

could be perceived as posing a potential conflict

of interest in the publication of this article.

Sandra Fisher, BS, RN, CNOR, is a clinical

ladder level 4 perioperative nurse in the OR at

Providence St Vincent Medical Center, Portland,

OR. Ms Fisher has no declared affiliation that

could be perceived as posing a potential conflict

of interest in the publication of this article.

EXAMINATION

CONTINUING EDUCATION PROGRAM

2.3

www.aorn.org/CESWITCH for Safety: Perioperative

Hand-off Tools

PURPOSE/GOAL

�

To provide knowledge specific to improving hand-off communications during

perioperative transfers of care from one health care provider to another.

OBJECTIVES

1. Discuss the leading cause of reported sentinel events.

2. Identify barriers to communication.

3. Describe hand-off communications.

4. Identify standardized formats used for hand offs.

5. Discuss SWITCH tools used for perioperative hand offs.

The Examination and Learner Evaluation are printed here for your conven-

ience. To receive continuing education credit, you must complete the Exami-

nation and Learner Evaluation online at http://www.aorn.org/CE.

QUESTIONS

1. The leading cause of reported sentinel events in

the OR is

a. assessment.

b. communication breakdown.

c. the physical environment.

d. medication management.

2. Barriers to concise communication include

1. inattention.

2. information overload.

3. multitasking.

4. noise.

5. stress.

6. time pressures.

a. 1, 3, and 5 b. 2, 4, and 6

AORN, Inc, 2013

c. 2, 3, 5, and 6 d. 1, 2, 3, 4, 5, and 6

3. The most common health care transactions prone

to error are

a. billing.

b. electronic data interchange.

c. hand-off communication.

4. A hand off includes the transfer of

1. patient information.

2. the authority to care for the patient.

3. the responsibility to care for the patient.

4. staff department meeting information.

a. 1 and 3 b. 2 and 4

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c. 1, 2, and 3 d. 1, 2, 3, and 4

5. Standardized formats for hand offs include

1. SBAR.

2. I PASS the BATON.

3. SHARQ.

l 98 No 5 � AORN Journal j 505

November 2013 Vol 98 No 5 CE EXAMINATION

4. Five Ps.

5. Five Ps, second version.

a. 4 and 5 b. 1, 2, and 3

506 j AORN Journal

c. 1, 2, 3, and 4 d. 1, 2, 3, 4, and 5

6. In the OR, the SWITCH acronym stands for

surgical procedure, what needs to be done,

instruments, time, counts, and have you any

questions.

a. true b. false

7. According to the OR SWITCH tool, the plan for

postoperative patient disposition belongs in the

___________ section.

a. surgical procedure

b. wet

c. tissue

d. have you any questions?

8. According to the OR front-desk SWITCH tool,

identifying gaps in the OR schedule belongs in

the ___________ section.

a. staff issues b. items

c. time d. have you any questions?

9. According to the anesthesia SWITCH tool, iden-

tifying items that are broken or out for repair

belongs in the ___________ section.

a. specialty carts and departments

b. white carts

c. instruments

d. helpful communication

10. Of the 33 team members who completed a survey

after using the SWITCH hand-off tool for a year,

97% thought that the SWITCH hand-off tool was

very important for patient safety.

a. true b. false

LEARNER EVALUATION

CONTINUING EDUCATION PROGRAM

2.3

www.aorn.org/CESWITCH for Safety: Perioperative

Hand-off Tools

This evaluation is used to determine the extent

to which this continuing education program

met your learning needs. Rate the items as

described below.

OBJECTIVES

To what extent were the following objectives of this

continuing education program achieved?

1. Discuss the leading cause of reported sentinel events.

Low 1. 2. 3. 4. 5. High

2. Identify barriers to communication.

Low 1. 2. 3. 4. 5. High

3. Describe hand-off communications.

Low 1. 2. 3. 4. 5. High

4. Identify standardized formats used for hand offs.

Low 1. 2. 3. 4. 5. High

5. Discuss SWITCH tools used for perioperative hand

offs. Low 1. 2. 3. 4. 5. High

CONTENT

6. To what extent did this article increase your

knowledge of the subject matter?

Low 1. 2. 3. 4. 5. High

7. To what extent were your individual objectives met?

Low 1. 2. 3. 4. 5. High

8. Will you be able to use the information from this

article in your work setting? 1. Yes 2. No

� AORN, Inc, 2013

9. Will you change your practice as a result of reading

this article? (If yes, answer question #9A. If no,

answer question #9B.)

9A. How will you change your practice? (Select all that

apply)

1. I will provide education to my team regarding

why change is needed.

2. I will work with management to change/

implement a policy and procedure.

3. I will plan an informational meeting with

physicians to seek their input and acceptance

of the need for change.

4. I will implement change and evaluate the

effect of the change at regular intervals until

the change is incorporated as best practice.

5. Other: ________________________________

9B. If you will not change your practice as a result of

reading this article, why? (Select all that apply)

1. The content of the article is not relevant to my

practice.

2. I do not have enough time to teach others

about the purpose of the needed change.

3. I do not have management support to make

a change.

4. Other: ________________________________

10. Our accrediting body requires that we verify

the time you needed to complete the 2.3 con-

tinuing education contact hour (138-minute)

program: _________________________________

November 2013 Vol 98 No 5 � AORN Journal j 507