Safety: Make Today a Safe Day

Let's make it a safe day, LBJ! That's what the charge nurse here at Lyndon B. Johnson Hospital in Houston announces to the entire perioperative team at the end of every morning huddle. I can't help but smile each time I hear it, because those 7 words are more than just a catchy phrase. They represent a hospital-wide culture change and serve as a daily reminder to focus on safety protocols that improve staff collaboration and eliminate preventable errors. Nowadays, our team is on the same page when the huddle breaks, but we didn't always see eye to eye.

Nurses and techs used to believe surgeons acted like know-it-all dictators. Surgeons, meanwhile, thought nurses were bossy and the surgical team as a whole needed to listen more intently during procedures. Maybe both groups had a point.

Efforts to change our safety culture began by bridging the communication gap between surgeons and other staff members. Leadership from all levels — nursing, physicians and administration — was committed to the initiative. We divided surgeons and surgical team members into several small groups, being mindful to have someone from each discipline in every group. They sat and shared their perspectives on patient care, voiced complaints about how things were currently working and shared solutions for improving surgical safety. The face-to-face discussions broke down barriers by giving everyone the opportunity to clear the air and get on the same page for safer patient care. Surgeons now receive more input from staff in a more productive and collaborative OR environment.

The small group discussions also helped level the leadership hierarchy in the OR, which led to one of the most important aspects of our new culture of safety. Surgeons still take the lead in running rooms, but their voices aren't the only ones that are heard. Nurses, techs and anesthesia providers are empowered to speak up when they believe a patient could be harmed. I'm concerned, they say, and everyone in the room knows to immediately stop what they're doing to address the issue. It's not an empty phrase; leadership provides immediate, on-the-spot backup if a surgeon refuses to pause for safety. Nurses tell me they're now far less hesitant to speak up to protect patients.

Surgeons take the lead in running rooms, but their voices aren't the only ones that are heard.

Our renewed effort to improve patient safety also includes these important steps:

• Time-out audits. I'm sure your surgical team pauses before procedures to identify the patient and surgical site and review important safety factors, but are they engaged in performing complete and inclusive time outs? Get out from behind your desk to find out. I perform 30 audits a month in GI procedure rooms and other clinical leaders do the same in the ORs to ensure we're taking time outs and we're performing them correctly, and that everyone in the room is actively involved in the process.
• Documented safety checks. We created a pre-op readiness checklist that the pre-op nurse, anesthesia provider and circulating nurse complete and sign. The form requires the group to ensure that the surgical consent is accurate, H&Ps are on hand, surgical sites are marked and marked correctly, and infection prevention protocols have been enacted. We also created a perioperative safety guide that the OR circulator completes. It asks patients about allergies they have, confirms the correct surgical site, rechecks that required paperwork is present and complete, ensures the patient is NPO and makes sure needed equipment and implants are in the OR.

Since rethinking and reemphasizing our hospital's culture of safety, more near-misses have been reported, but fewer of them have resulted in patient harm. That means our staff is more aware of breaches in safety policies, but fully engaged in using the checks we have in place to ensure inevitable lapses don't result in adverse events.

Improving patient safety doesn't require a complete overhaul of your policies and procedures, but it does demand reemphasizing basic practices that you should implement for a reason: they work. You can begin to change your safety culture by sending your team on its way each morning with a call to protect patients from harm. And if you're lucky, like us here at LBJ, your facility's name rhymes with day. OSM