Effective RN to RN handoffs are a critical part of nursing care. Evidence shows that poor communication and variation in procedure result in in inadequate handoffs between nurses. Accurate and complete communication during handoffs reduces error, improves patient safety and improves nurse satisfaction. We sought to conduct a systematic review of articles that focused on RN to RN handoffs. We desired to see research that discussed barriers to effective handoffs and identify characteristics of effective handoffs. Our goal is to use evidence to revise and improve the current RN to RN handoff practice and to create a standardized communication handoff tool that can be used for handoffs during the perioperative process. As a result, we have completed a literature review of current research articles to establish a baseline best practice and clearly define critical components of an effective RN to RN handoff. We distributed a survey to various units in the hospital (Operating Room, Preop, Post Anesthesia Care Unit, Postop, and Inpatient Nursing Units) to establish baseline opinions and findings regarding the current process and quality of RN to RN handoffs. The same groups were asked about what how they would like to see our handoff practice improved. We then created an action plan, based on evidence from the literature review and our own survey results, to improve current practice, starting in our unit (the OR with RN to RN break and shift handoffs) and then establish new practice throughout the hospital. We involved nursing leadership in discussion and execution of the plan to reinforce and encourage staff during practice change. The information and was presented in staff meetings for all involved units an a go live date for new practice was established. Results showed that nurses appreciated a standard handoff procedure guiding the transfer of care of a patient during the perioperative time period. This reduces the risk of missed information and harm to a patient. A specific handoff tool further promotes patient safety by supporting the communication of essential information.