During the past year, Barnabas Health implemented an OR safety initiative at all of its medical centers.
Using grant funding from the Cardinal Health Foundation, the six system medical centers embarked on a strategy called “Stop, Look, Listen and Now Go!” The goal, according to a news release, was to capture the full attention of the OR team during every step of the time out, the period of time before a procedure when the surgical team confirms the correct surgery is about to be performed on the correct patient to ensure against wrong-site surgery and other possible errors.
Barnabas perioperative nurse educators Donna Giannetto, RN, MA, CNOR; Theresa Metta, RN, MSN, CNOR; Mary Koch, RN, MSN, CNOR; and Donna Fidel, RN, BSN, CNOR, helped design and coordinate the initiative.
“The Cardinal Health Grant helped us to focus our total attention on the time-out process,” Sari Kaplon, RN, MBA, NE-BC, vice president of patient care services at Saint Barnabas Medical Center, Livingston, N.J., said in a news release. “Stop, Look, Listen and Now Go! helped all levels of staff in the OR master the time-out message.”
Under the leadership of a multidisciplinary perioperative committee, Barnabas Health implemented an education program to teach steps of the time-out process and provide staff with the right words to use to call a stop to surgery if there were any protocol discrepancies. It also implemented a new surgical safety checklist that summarizes the steps of the time-out process.
Enlarged, laminated posters of elements from the checklist and dry-erase boards on which to note patient-specific information also were added. The boards and posters were mounted, when possible, in ORs to serve as visual cues to team members. A standardized tool is used for performance audits to monitor the steps of the process. Audit findings are reported at least monthly to the director of ORs.
After outcomes were measured, Barnabas reached its goal of 95% compliance, according to the release, for specific indicators of correct performance, including use of two patient identifiers; use of laminated, surgical-safety checklist boards; confirmation of the surgical procedure; operative site/side clearly marked; anesthesia and surgical concerns addressed; radiology/lab reports present and confirmed; and attentiveness of the team during the process.
From January through April 2012, Barnabas Healths overall compliance reached 100% on selected indicators, the release said.
One lesson learned by the nursing team, according to the release, is there is no substitute for planning. Experienced members of a planning committee help to bring out ideas and expose details that could easily be missed. One example, according to the release, is that although poster boards on the walls of ORs could be helpful, some ORs did not have enough open wall space.
Among other lessons, the release said, were that management support is crucial and empowers staff to advocate and speak up for patient safety, and a well-defined chain of command enforces compliance. The initiative also benefited from surgeon and anesthesiologist support, which set the example for the time-out process results to be achieved in a speedier transformation. •