ORX Awards 2021 - Patient-Safety - Practicing to Protect Patients

Patient Safety OR Excellence

By: Dan Cook | Editor-in-Chief

Published: 8/30/2021

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Staff at The Valley Hospital respond to most emergency situations like they’ve been through them before — because they have.


Bonnie Weinberg, MSN, RN, CNOR, is a soothsayer of simulation training. “She truly has a gift,” laughs Donna Lagasi, RN, MS, BSN, director of OR services at The Valley Hospital in Ridgewood, N.J. “She’ll think of an emergency response drill to run, and the scenario we practice often happens in real life a couple weeks later.”

Ms. Weinberg’s prophesying helped the hospital earn this year’s OR Excellence Award for Patient Safety. “Simulation training increases outcomes of knowledge, skills and behavior,” says Ms. Weinberg, the hospital’s clinical practice specialist. “Training for high-acuity, low-volume events helps to build a clinical foundation and improve team dynamics — including communication and situational awareness — that leads to optimal outcomes.”

Each simulation she runs involves seven surgical team members — a number that ensures each participant is actively involved in the drill — who enter the session unaware of the emergency they’re about to face. Ms. Weinberg’s uncanny ability to run meaningful drills comes into play here, too. “Bonnie always adds a wrinkle the team isn’t expecting,” says Ms. Lagasi.

Ms. Weinberg laughs — somewhat mischievously, to be honest — in agreement. For example, she recently ran a simulation during which the surgical team had to respond to a patient coding. Ms. Weinberg’s wrinkle: The patient was in the prone position. Responding team members had to think on their feet and quickly retrieve a stretcher, so they could flip the patient over to administer life-saving treatments.

The team debriefed at the end of the training to discuss their performance and identify potential barriers to an efficient and effective response. Ms. Weinberg always follows up on the lessons learned during sim trainings, and implements new emergency response protocols as needed. For example, surgical teams now keep stretchers immediately outside the OR door during cases involving the prone position, so they’re ready to respond in seconds if the patient codes.

 

Site Marking Starts With the Scheduler
HONORABLE MENTION
TRUST BUT VERIFY Scheduler Dalia Rodriguez reviews the scheduling form with a patient to ensure the procedure and intended surgical site are noted correctly.  |  Celia Smith

Preventing wrong-site surgery requires a multilayered verification process that begins long before patients enter the OR. “We’ve developed a culture where everyone who cares for patients, whether over the phone or in person, plays a part in keeping them safe,” says Celia Smith, administrator at the Houston Premier Surgery Center in The Villages. “Performing correct-site surgery is one of the things we focus on.”

The facility’s scheduler first verifies the procedure — type and location — with the patient and compares their response to what’s noted on the scheduling form and surgeon’s orders. If the scheduler notices any inconsistences, she notifies the center’s director of nursing and calls the surgeon’s office for clarification.

After that initial check, the case’s information is passed to the center’s preadmission department, where the registered nurse who performs the pre-op assessment also verifies the correct procedure and site with the patient.

On the day of surgery, the front desk receptionist verifies the procedure type with the patient during check-in. In pre-op, a nurse reviews the procedure and correct surgical site with the patient and discusses the site-marking process — the surgeon’s orders, consent form and history and physical are verified, and the procedure and surgical plan are discussed with the patient — which culminates with the surgeon signing their initials on the body part where the procedure will take place.

Questions that arise about the correct site at any stage of the facility-wide verification process create a hard stop until the issues are clarified and corrected. “We’ve caught discrepancies that were truly near misses,” says Ms. Smith.

The center views patient safety as a shared priority that requires collaboration across all ranks and disciplines, according to Ms. Smith. She says, “I’ve been deeply impressed by the proactive stance staff take on site verification and the active participation of our anesthesiologists and physicians during the safety time out.”

— Dan Cook

ON THEIR TOES Realistic drills that involve a few surprising twists train surgical team members to react quickly and calmly when the unexpected happens.  |  Bonnie Weinberg

“Simulation training gives staff a safe environment in which to learn and make mistakes,” says Ms. Weinberg. “That increases positive results.”

It’s also why every member of the surgical team swears by the Vegas Clause: What happens in simulation training, stays in simulation training. “We have to be mindful of each person’s performances because everyone responds differently during an emergency,” says Ms. Lagasi. “We also want to keep the simulation scenarios secret, so the element of surprise is preserved for each group that enters the training sessions.”

After a recent difficult airway drill, staff were faced with the same situation (no surprise there) and an anesthesiologist said he couldn’t believe how well and how smoothly the team jumped into action. “Instead of running around frantically, everyone understood their defined roles,” says Ms. Lagasi. “They were able to respond quickly, but also calmly.”

The Valley Hospital’s leadership has created a safety culture based on transparency and non-punitive responses to mistakes. Safety Stars are recognized during staff meetings for turning potential errors into near misses. Safety coaches are identified in each department to ensure their teams employ the tools and practices intended to protect patients from harm. Safety Stories are celebrated instead of punished. “We learn the most from storytelling,” says Ms. Lagasi. “Hearing about situations colleagues faced that jeopardized patient safety is helpful when you encounter similar scenarios.”

The sharing of Safety Stories involves not only what went wrong, but the tools and practices that could have prevented the error from occurring. In some cases, the stories identify gaps in care that lead to informed practice changes. For example, after an anesthesiologist placed a wrong-side regional block, he felt empowered to share his experience with the hospital’s leadership and frontline staff. Now, the procedure rooms where blocks are placed are considered “no distraction” zones and at least two members of the surgical team must be present during pre-block time outs to confirm the correct site is being blocked.

The Valley Hospital is on its way to becoming a high reliability organization, which involves implementing repeatable protocols and practices that prevent mistakes from causing serious patient harm. “High reliability is about being preoccupied with failure. It demands looking at a situation and determining what could go wrong — and deciding if you’re prepared to respond if it does,” says Ms. Lagasi. “It involves learning from good catches and always being prepared so cases go well, and your patients remain safe.” OSM

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