Safety: Focus on the Fundamentals

I have been a surgical nurse for more than 30 years and a patient numerous times. I’m fully aware, from both sides of the table, of the importance of safe surgical care. There are numerous factors that go into protecting patients from harm, and many are built on these five foundational elements.

• Exhibit humanity. Seeing your patient as more than just another case sets the tone for safe surgical care. I read about a doctor who asks patients to write down personal information about themselves before surgery. This information is shared with the surgical team in the OR before the surgery begins. While I have not seen this in action, the concept is right on target. Understanding that the person on the table is important to someone — their family, loved ones, friends — can make an enormous difference in the overall focus of the surgical team.

To exhibit the humanity of health care, tell your patients what to expect throughout their surgical encounter. This will help to alleviate some of their anxiety in an already uncomfortable situation. Consider that the patient could be you or someone you care about and treat them as if they are. We have all heard the saying, “It’s minor surgery until it’s your surgery.” I can personally attest to the truth that there really is no minor surgery.

Surgery creates vulnerability in patients and anything you can do to develop trust with them while they’re in your care will help them feel less vulnerable during a stressful time.

• Transfer with intent. Moving patients presents an elevated risk for a negative safety event. In the routine of “get ‘em in, get ‘em out,” you might unintentionally rush through the process. Whenever you’re transitioning patients onto the surgical table, lock the OR bed and the stretcher and make sure you have enough staff members on hand to get the job done. Put the safety strap on the patient before taking the stretcher out of the room. I cannot tell you how many times I have seen patients lying on the OR bed unsecured with no one standing next to them while the circulator rolls the stretcher into the hallway. Also make sure surgeons participate in the positioning of the patient. Verify that patients are properly positioned with the surgeons and document their involvement in the process.

• Advocate for safety. Speak up when something does not look or feel right. If you bring a concern to your team’s attention and receive pushback, do not be afraid to stand up for the patient and follow the chain of command, if necessary. You are the patient’s advocate and no one — even those giving you pushback — would want the surgical team to ignore concerns during their own surgery.

You can rely on acceptable standards of care to support your efforts to advocate for patient safety. As an expert witness, one of the things I am asked about during malpractice trials is the acceptable standard of care and what a prudent nurse would do. If your facility follows AORN standards as a reference for best practice, make sure you know what the standards require and follow them to the letter.

• Remain alert. With phones ringing, the radio blaring, sales reps helping the surgeon and staff coming in and out of the OR, you could easily become distracted from focusing on protecting patients from harm. There are two key times to block out all distractions and be laser focused on your patient: intubation and extubation. During these critical stages of surgery, anesthesia needs you at the patient’s side in case of an airway emergency. I’ve seen nurses, while anesthesia is intubating, leave the patient to count supplies with the scrub nurse or leave the room to retrieve a forgotten item. I was trained to not leave the patient’s side until released by the anesthesia provider in order to help get the patient through this high-risk period safely.

Also stop what you’re doing during counts of surgical items placed in the patient during surgery. As the patient’s advocate, you set the tone for safety during this important task. Don’t let the ringing phone or someone coming into the room distract you from ensuring an accurate count. Retained surgical items not only cause unwarranted devastation to your patient and their loved ones, but they could also land you in a deposition defending your actions.

And, of course, every member of the surgical team should be actively engaged in the safety time out. As a surveyor, I have had many opportunities to observe time outs and am still amazed that some team members continue to work on preparing the room or patient for surgery instead of actively participating in the final safety check. If you’re going through the motions to check the boxes on a safety checklist, you’re not fully focused on the patient’s well-being.

• Create a nonpunitive culture. To establish a safe environment for patients, it’s important for surgical professionals to learn from one another. Just as positive encounters create trust with patients, positive encounters create trust in each other. One effective approach is to acknowledge actions staff take to ensure patient safety. As you see these actions, recognize them in a public forum.

Every member of your team should feel comfortable discussing mistakes they made, whether it’s a near miss or an actual event, without fear of reprisal or termination. For this to be accomplished, take an honest look at the culture of your organization and implement policies for staff to feel empowered to discuss safety-related issues. Only then can real change take place.

Being a patient has helped me be a better nurse. You can make a positive difference in someone’s life every day by focusing on the unique needs of individual patients and providing the safest possible environment throughout their care. OSM