Patient Safety: Solving Problems That Were Large in Scope

• Safe starts. Patient safety for Centinela Valley Endoscopy Center in Inglewood, Calif., begins at reception: The patient signs in on a label, which a staffer immediately removes for HIPPA purposes. If there’s a similar or soundalike patient last name that day, a color-coded “Name Alert” on the schedule informs staff; the patient’s chart is flagged as well. When transported to pre-op, staff confirm name, date of birth, and that the procedure the patient signed for is correct. After the doctor and nurse complete pre-op tasks, the nurse checks the patient’s ID band and makes sure the proper consent has been signed. Signs placed on the patient’s blanket to advise the procedure room nurse, tech and doctor about special needs — HOH (hard of hearing), dentures, weakness on right side, etc.; that information is also on the patient’s chart.

In the procedure room, the technician and nurse again check the ID band. Once the doctor is ready to begin, a timeout is performed to ensure the nurse, doctor and tech are in agreement that this is the correct patient and the correct procedure. The patient is asked about allergies at various points before the procedure.

• Fun while learning. Orchard Surgical Center in Salem, N.H., uses annual “skills fairs” as a creative and fun way to keep staff engaged and knowledgeable on the latest in patient safety. Its “Show and Tell” fair found each department taking 3 or 4 topics and procedures and creating short, interactive, hands-on demonstrations. “A Day in the Life of” found each department, including front desk admissions, creating and performing a skit with the help of the nurse manager; the skit followed a patient (played by a staff member) throughout the perioperative day — from front desk to pre-op to the OR and PACU — where a surprise code that was played out. “What If” delved into unexpected situations — an armed intruder, a code in the OR, a power outage, and a surgeon fainting in the OR were just a few. “They were all great, and according to our staff surveys, they loved them and felt the teaching was effective,” says the center’s COO Cathy Dentremont, RN, MBA.

• A really realistic drill. MEDARVA Stony Point Surgery Center (SPSC) in Richmond, Va., decided to really spice up one of its patient safety drills earlier this year. Caleb Cox, SPSC’s director of business development and physician network. That live person was Shane Stanford, MSN, SPSC’s director of clinical services. Mr. Stanford, who had splashed water on his face and hair to make it look like he was sweating, casually walked up to a nurse in the surgery center’s PACU and said, “I’m having chest pain and need you to help me. I think I’m having a heart attack.”

The nurse followed protocol and checklists, laid him on a stretcher and began following the typical procedure for a code blue.

After the code call went over the intercom, Mr. Stanford informed the nurse and her team that this was a drill, but they were to continue on as if it were real. The staff followed detailed tasks when responding to the code. The entire test took about 45 minutes. “Training in our surgery centers needs to be as realistic as possible,” says MEDARVA Healthcare CEO Bruce Kupper. “When a real person is the focus of training, it changes the environment. If you can train using simulations as close to reality as possible, it leaves a stronger impression on your staff and is more meaningful.”

— Joe Paone