1. NICU and OR Handoff
Starting 2/25/19

2. Why the Change? High reliability organizations rely on standardization
In the past there have been patient safety issues that could have been prevented with a standardized handoff
For effective post-op management of respiratory support, pain control and wound care it is important to know of any issues/complications that occurred during the OR procedure

3. What Does the Handoff Include and What is the Process?
Goal: Optimize patient care and safety, as well as improve ICU/Perioperative Services relationships.
An understanding would exist that:
There may be times when emergent cases, difficult cases, and / or staffing issues can make any of the discussed ICU goals difficult to achieve.
If any of the guidelines designed here are unable to be met, clear explanation and open communication will occur between team members.

4. What Does the Handoff Include and What is the Process?
Patients arriving to an ICU from the OR:
The OR Nurse will call the ICU Unit Clerk within 30 minutes prior to leaving the OR. Circulator nurse will alert unit clerk of anticipated time of arrival and ventilator status, thus ensuring:
ICU staff available and room ready (RN, RT, Provider)
RT available with appropriate equipment

5. What Does the Handoff Include and What is the Process?
Upon arrival to the ICU the goal is for an expedient and thorough handover report:
Any immediate nursing issues can be briefly identified by OR circulating nurse (circulator does not need to stay for full report)
Patient is connected to ventilator, remains attached to the transport monitor, and unless there is an emergent situation, the patient handoff is performed with full attention of ICU team including RT, nursing staff, and accepting ICU provider.
Safe, thorough and complete report should be achieved within 10 minutes.
Following report, monitors are switched from transport to bedside monitor. Initial monitor to be switched to the ICU monitor, this should include the arterial line if there is one.
Any infusions running should be checked in the presence of both the anesthesia team and ICU nurse.
Any questions by either team can be voiced at this time and resolved.
Anesthesia Provider will relinquish the patient to the ICU teams and return transport monitor to OR (if it came from the OR).

6. Other pertinent information will be shared at the end of the handoff.
Note here the # of attempts, this is important if NICU plans to extubate (may have edema etc.)
IV lines and what medications and infusions were administered will be documented. It is important to know what time medications were given so any new NICU orders or existing orders for medications are not timed incorrectly.
Other pertinent information will be shared at the end of the handoff.