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May 5, 2022
Publish Date: May 4, 2022   |  Tags:   Patient Safety


Make Wrong-Site Surgeries Never Events

Wearing the Right Stuff in the OR

Redefining Partnerships Between IDNs and Manufacturers - Sponsored Content

ECRI Names Top Threats to Patient Safety

Preventing Slips and Trips in the OR


Make Wrong-Site Surgeries Never Events

These five strategies can help prevent these horrific and expensive mistakes.

Wrong Site David Ring
ABSOLUTE CERTAINTY Before incisions are made, all members of the perioperative team should feel empowered to express concerns about the location of the surgical site.

Wrong-site, wrong-side and wrong-patient surgeries are never acceptable, even on an OR's busiest day. Follow these five basic steps to avoid these devastating surgical errors.

Mark sites clearly. Verbal communication isn't enough. "It's very easy when you're doing the time out to say, ‘We're going to work on the second digit from the right,'" says James W. Bowers, BSN, RN, CNOR, TNCC, clinical nurse educator and service line coordinator for nine departments at West Virginia University Hospitals in Morgantown. "But if you turn the hand over, the second digit isn't the correct one you marked. It's the other second digit."

Confirm before cutting. Providers should reiterate where they will be working after the time out, just before the knife hits the skin. "Even though the surgeon has confirmed the site with the patient and the team confirmed the site during the time out, confusion can still occur once the patient is prepped and draped," says Dawn Yost, MSN, RN, CNOR, CSSM, business manager of perioperative services at West Virginia University Hospitals. Visual contact should be made with the site mark both during the time out and immediately before the initial incision. Make sure the mark isn't wiped off when the surgical site is prepped.

When in doubt, stop. If scrub personnel, the circulator or any nurse doesn't believe it's safe to proceed with a case, they should not hand the surgeon the knife. Any confusion about the surgical site is more than enough reason to call for a hard stop. New employees should be trained to be unafraid to speak up in these situations, and management should support them, even if an analysis shows the case would have been safe had it proceeded.

Enhance time outs. Hang a large poster in every OR that includes all information to be verified during time outs. The poster should serve as a reminder for nurses, anesthesia providers, surgeons and other staff to discuss all aspects of safe care. Use traditional patient identifiers such as birthdays and medical chart numbers in addition to confirming the patient's name. "We've had two patients with the same name having surgery at the same time," says Ms. Yost.

Check pre-op images. X-rays, CT scans and MRIs can assist in helping to ensure surgery is performed in the right place. "Things can get confusing once a patient is put onto their side or otherwise moved, so it's important to not only have all imaging available, but ensure that it is displayed so everyone can see it," says Mr. Bowers.

The goal, says Ms. Yost, is to create a culture of safety, perform consistent time outs and unrelentingly advocate for patients. "Then strenuously audit to make sure your daily practices really reflect what your policies are," she adds.

Wearing the Right Stuff in the OR

AORN's latest surgical attire guideline include several new recommendations.

Attire AORN, Inc.
DRESSED FOR SUCCESS AORN's most recent evidence-based recommendations address a number of previously ambiguous issues surrounding surgical attire.

AORN's evidence-based surgical attire guideline, which promotes cleanliness in the surgical space to protect patients and personnel from transmission of pathogens, was updated in July 2019. "Many providers aren't aware of the latest recommendations," says Lisa Spruce, DNP, RN, CNOR, CNS-CP, ACNP, ACNS, FAAN, director of evidence-based perioperative practice at AORN. "They frequently refer to the 2015 guideline. Much of it has changed." Here are the key updates.

Laundering. The newest recommendations suggest laundering scrubs at healthcare-accredited laundry facilities or onsite if your facility has the proper equipment and can meet state regulatory requirements or the CDC's recommendations for laundering. "Home washing machines are not monitored for quality, consistency or safety, and many energy-efficient home washers don't get hot enough or agitate enough," says Dr. Spruce, who adds that retail detergents usually aren't powerful enough to properly clean soiled scrubs.

Arm coverings. AORN previously recommended that surgical professionals keep their arms covered in semi-restricted and restricted areas. After no studies were found to evaluate the effects of wearing long sleeves at any other time than during skin prepping, now it simply recommends that arms may be covered during preoperative patient skin antisepsis. "It's not a must-have," says Dr. Spruce. "It's a personal decision."

Footwear. AORN recommends wearing clean protective shoes whose soles cannot be pierced and that meet healthcare organization and OSHA safety requirements. Dr. Spruce recommends providers keep a dedicated pair of hard-soled shoes at the facility. She adds that shoe covers are only necessary in areas contaminated with fluids, gross contamination or blood, after which the covers should be removed and discarded, followed by performance of proper hand hygiene.

Head coverings. AORN now recommends that providers cover their scalp and hair when entering semi-restricted and restricted areas, although it offers no recommendation on the specific type of head covering. In that vein, AORN now says hijabs, veils, turbans and bonnets that meet certain specifications may be worn. "Policy restrictions or policies that do not address the use of religious head coverings in perioperative settings can be a barrier for members of some religious groups who currently work or aspire to work in procedural areas," says Dr. Spruce.

Religious head coverings should be clean, unadorned, constructed of tightly woven and low-linting material, and should fit securely, with loose ends tucked in the scrub top. Coverings such as kippahs and yarmulkes that cover only a portion of the hair and scalp may be worn under another head covering. Beards should be covered in restricted areas and when preparing items in the clean assembly section of the sterile processing area.

Jewelry. Due to a lack of evidence, AORN currently offers recommendations only for earrings, as one study demonstrated that pierced ear holes can be contaminated, and the provider's hand could be as well if they touch the holes. "Earrings should be contained in a head covering or not worn," says Dr. Spruce.

Dr. Spruce says AORN's guideline provides an evidence-based starting point upon which facilities can build further policies and protocols. "The guideline is such a great resource because it provides recommendations and the evidence to back them up," she says.

Redefining Partnerships Between IDNs and Manufacturers
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ECRI Names Top Threats to Patient Safety

Staffing shortages and the mental health of healthcare workers are urgent issues.

A steady decline in the number of healthcare professionals and the emotional exhaustion of overworked frontline workers during COVID-19 are dual threats to the well-being of patients, according to a list of the year's top safety concerns issued by ECRI, a nonprofit patient safety organization in Plymouth Meeting, Pa.

The pandemic has forced a reckoning with the mental health needs of healthcare workers, says the report, which referenced a survey published in February 2021 that said 35% of nurses experienced poor quality of sleep, 24% demonstrated heightened anxiety during unexpected events and 13% reported mental trauma.

ERCI says these issues can be addressed if healthcare organizations establish a tone of personal connection, make sure leaders recognize the effects of burnout and work with frontline staff to create wellness solutions.

"Shortages in the workforce and mental health challenges were broadly known and well-documented for years," says Marcus Schabacker, MD, PhD, president and CEO of ECRI. "Both physicians and nurses were at risk of burnout, emotional exhaustion and depression prior to 2020, but the pandemic made both issues significantly worse."

Data included in the report does not present a positive picture of the nationwide healthcare staffing shortage. The median age of nurses in 2020 was 52 years, with nearly 20% at or near traditional retirement age. Nursing schools will not be able to fill the pipeline with enough nurses to replace retiring nurses or fill existing staffing gaps. Physicians are also in short supply, with the shortage reaching as many as 77,100 across medical specialties.

The development of an inclusive workforce, promoting the growth of clinical leaders within individual organizations and working with nursing schools to expand capacity and resources are among ERCI's recommendations to combat widespread staffing shortages.

"Healthcare and government leaders must aggressively manage these challenges amidst a lingering pandemic and a weakened health system by prioritizing recruitment, retention and clinician resilience," says Dr. Schabacker. "As leaders, their most important job is ensuring that patient health and safety are top priorities."

Preventing Slips and Trips in the OR

Employ specialized equipment to help keep your staff safe and upright.

Kathy Beydler, RN, MBA, CNOR, CASC, has seen her fair share of safety issues and concerns in the OR. "A friend of mine got her foot tangled in an improperly placed kick bucket, which caused her to fall and hurt her knee," she says. "She was out of work for a few weeks and had to do physical therapy."

A nurse and outpatient surgery center administrator who is now a principal consultant at Whitman Partners in Memphis, Tenn., Ms. Beydler believes the risks of slips, trips and falls should never be minimized. "It just takes one person who could have their life completely impacted by an injury," she says.

Fortunately, equipment such as power strips, cord covers and fluid management systems are available to reduce the dangers of cluttered and wet OR floors. Ms. Beydler also recommends bright, easy-to-see orange cord alerts that draw providers' attention to cords and tubes on the floor. These alerts are inexpensive, easy to remove and disposable, she says.

Lakeland (Fla.) Surgical & Diagnostic Center has installed two electrical receptacles in each of its four ORs to prevent tripping. "They consolidate the cords in one convenient and centralized location," says Executive Director Nikki Williams, RN, CNOR.

For fluid-intensive cases, such as arthroscopy, surgeons also rely heavily on drapes equipped with fluid collection pouches. Floor- or ceiling- equipment-mounted booms, which limit the number of video towers and equipment carts needed around the surgical table, have become popular in newer facilities.