Safety First in Texas ORs
Monday January 12, 2009
Print This- Select Text Size:
Comments
advertisement
Recent patient safety initiatives include a revised Universal Protocol as part of the Joint Commission's 2009 Patient Safety Goals, and the 2008 launch of the World Health Organization's Safe Surgery Saves Lives program, designed to help reduce errors and promote safe surgery worldwide.
The Universal Protocol comprises a pre-procedure verification process, marking the procedural site, and a time out before the procedure. Texas hospitals are combining the protocol with effective communication to promote patient safety in the OR.
"It's like when you fly," says Sandra Fly, RN, director of quality at St. David's Medical Center in Austin. "It's about keeping everyone safe on the plane. Our goal is to keep our patients safe during surgery."
Check and Recheck
Pre-procedure checking occurs when the procedure is scheduled, during pre-admission testing, when the patient arrives at the hospital, before the patient enters the OR and any time a patient is transferred to another's care. Verification typically includes patient identification and patient consent; needed documents such as a history and physical; diagnostic and radiology test results; and any blood products, implants, devices or special equipment needed.
"It's important to standardize processes," says LaNell Scott, RN, CNOR, director of perioperative services for San Antonio's Christus Santa Rosa Medical Center. The OR sees 3,500 to 4,500 patients each year. For interaction consistency, the staff uses the acronym ADIET: acknowledge patient, duration of task, introduce self, explain what will occur, and thank you. The surgeon who will be performing the procedure uses an indelible pen to mark the surgical site in the preadmission area.
"We get patients involved in their safety," says Olinda Lindsey, RN, BSN, CNOR, surgical nurse educator in the OR at St. David's. "That includes marking the site." Lindsey says patients are told that they may need to answer the same questions multiple times to help ensure information is correct.
Time Out
A time out with all surgical team members before the incision provides the opportunity for a final check. In most hospitals, the circulating OR nurse leads the time-out process, which is done either before anesthesia begins or immediately before starting the procedure. It's vital that all members of the team give the time out their complete attention.
"We do two time outs," says Scott. "The first is before anesthesia induction and the second one is right before the incision."
At St. David's, nurses use a white board that has a template to prompt nurses what to ask as part of the time out. "It's a script," says Lindsey. "We ask about antibiotics, implants, positioning and other items." Nurses write on a clear cover sheet so the information can be erased and the board used again for the next patient.
Communication
Computers make it easy to include checklists as reminders for staff and to document completion of checks and time outs, but other methods are also needed for effective communication. Nurses use their creativity to develop some of those methods. For example, at Christus Santa Rosa, patients who are at risk for falls are given a pair of red socks instead of green socks. Different color markers (black for original information, red for changes and green for add-on cases) for the procedure board, make it easier for personnel to readily find the needed information.
One potential danger point in the OR is when care is transferred from one healthcare worker to another. The surgical technologist and the OR nurse give a report to their relief counterparts. As part of the handoff, hospitals require a surgical count, including sharps, sponges and, in some facilities, instruments.
"The handoff is done at the patient's bed side," says Scott. "It includes the patient's history and the surgery checklist information."
Other items that hospitals include in the handoff are allergies, placement of the grounding pad and medications on the sterile field. The handoff from the OR nurse to the PACU nurse is equally important. In some facilities it's a phone call, while in others, the nurse accompanies the patient to the PACU.
"It's like a three-person team report: the OR nurse, PACU nurse, and anesthesiologist," says Scott. Information includes the procedure, drains, IV lines, medications given and family or friends in the waiting area.
Fly notes that, "A good handoff is real time. It's the information happening between the two people. The verbal is the most important part of the handoff."
Keep Your Eye on the Ball
Texas hospitals use several strategies to keep everyone focused on safety.
"We do a lot of inservices," says Lindsey, and the hospital uses AORN standards as a guide.
"We use monthly communication boards and posters for staff and physicians," says Scott. "For quick tidbits, we use e-mail."
Fly agrees that constant education and reminders are key. "We send out articles and information about errors that have happened at other hospitals to alert the staff," she says. OR staff are included on the patient-safety committee and quality council, and patient-safety items are included in the hospital and physician newsletters.
Safety needs to be top of mind every day, and staff should proactively identify potential safety hazards. Scott says staff started documenting the drying time for prep solution since wet solution poses a fire hazard. "They also do a visual check."
Fly adds that nurses are well-positioned to be safety leaders. "Changes in patient safety are so dependent on nurses. Nurses are the ones who can take the lead, and we need to jump on it."
Scott agrees. "Nurses hold themselves to a higher standard, and they take ownership."
Cynthia Saver, RN, MS, is a freelance writer.
To comment on this article e-mail editorSC@nurseweek.com.
Time Out
As part of the Universal Procedure, any invasive procedure requires a focused "time out" before the start of the procedure. Everyone on the team must give the time out their undivided attention and not be distracted. When more than one procedure is being performed on the same patient, a time out must be done for each procedure. Items covered in the time out include confirmation of:
* Correct patient.
* Correct procedure.
* Correct site.
* Correct patient position.
* An accurate consent form.
* Availability of necessary radiology films, implants and imaging.
* Need to administer antibiotics for fluids for irrigation purposes.
* Safety precautions based on the patient's history or medication use.
Completion of the time out and other parts of the Universal Procedure must be documented in the patient's medical record.
Reader Comments
Login
Be the first to comment!