Patient Safety: Passionate About Advocating for Patients

By: Daniel Cook

Published: 9/1/2020

Share:

The surgical teams at UPMC Horizon and Jameson prioritize protecting those in their care.


This isn’t the first time members of the surgical team within the University Pittsburgh Medical Center (UPMC) health system have been recognized for their efforts to protect patients from harm. A couple years ago, two nurses at UPMC Horizon hospital earned the Speak Up for Patient Safety Award — one nurse stepped in during a pre-op time out to avert a wrong-site surgery and the other discovered the wrong weight for a pediatric patient had been entered into the electronic health record, a good catch that prevented a potentially devastating dosing error. The actions of the nurses were rightfully recognized, but their willingness to speak up to protect patients was more commonplace than worthy of congratulations.

“I’ve always felt patient safety is extremely important in the surgical environment because patients can’t advocate for themselves,” says Rhonda Sebastian, MSN, RN, CNOR, clinical director of surgical services at UPMC Horizon and UPMC Jameson, sister hospitals and winners of the 2020 OR Excellence Award for Patient Safety. “Staff are empowered to speak up for patients. If they see something wrong, they say something. We’ll always stand behind them.”

The hospitals promote safe patient care in several other effective ways:

  • Communication and collaboration. The hospitals’ Professional Practice Council — comprised of nurses, surgical techs, central sterile techs and OR service techs — meets monthly and provides a forum in which staff members can address operational and clinical issues that impact safe patient care.

It took a lot of effort and education, but the tired trope of “what happens in the OR stays in the OR” has been replaced with a culture of open communication. “We conduct regular in-services and policy reviews to ensure frontline nurses understand patient safety is our number one priority,” says Ms. Sebastian. “It’s engrained in every member of the care team on a daily basis.”

  • Constant learning. All new surgical nurses are required to take the AORN Periop 101 course and must seek certified perioperative nurse (CNOR) status — the health system provides a prep course — after working in the OR for two years. In 2018, certification of the hospitals’ nurses increased from 18% to 88%. Overall, 92% of the care team — including central sterile techs and central sterile supply staff — achieved certification. “I’m big on continuing education,” says Ms. Sebastian. “It not only benefits staff, it also benefits patient care.”

She talks the talk and walks the walk. Ms. Sebastian is both a CNOR and a certified instrument specialist, which she obtained because she manages the central sterile department and wanted to understand the intricacies involved in working in that important aspect of safe surgical care.

Central sterile techs are told upon hire that they must become certified instrument specialists. “I look for people who want to make a career out of working in sterile processing,” says Ms. Sebastian. “I let them know they’re some of the most important members of our team, because we can’t provide safe care if they don’t properly sterilize instruments.”

  • Due diligence. The hospitals’ standardized policies and procedures are reviewed and updated annually to ensure staff always follow evidence-based practices, and AORN guidelines are posted on the health system’s intranet for staff to access. Members of the anesthesia and surgical teams conduct daily huddles at the beginning of each shift and again in the afternoon near the end of the day. They review the schedule, add-on cases, staffing and equipment needs, and discuss potential patient safety concerns that demand special attention throughout the day.

Honorable Mention
Keeping the Safe Patient Care Promise
BADGES OF HONOR All staff wear ICARE tags to remind themselves of the principles that guide their actions.   |  Tabitha Turner, RN, MSN, CNOR, CGRN

Every member of the surgical care team at Cone Health MedCenter Mebane (N.C.) Surgery Center embraces the ICARE (Communication, Accountability, Respect and Empowerment) standard:

  • Communication. The surgical team reviews the surgical safety checklist before every procedure to ensure site markings are correct, paperwork is completed and on hand, fire safety has been addressed and members have had a chance to voice patient safety concerns.
  • Accountability. Members of the surgical team don’t hesitate to give constructive feedback to their colleagues to make sure they honor their commitment to safe patient care. “We’re all empowered to have crucial conversations with surgeons and all team members, which truly builds a culture of accountability,” says Center Director Dana Hatchett, RN, BSN, MBA, RNFA, CNOR. “We feel comfortable having those conversations because we know it’s what best for patients.”
  • Respect. The center’s staff and physicians are committed to respecting patients’ decisions and rights. They also speak to colleagues in positive ways to support and build each other up.

    • Empowerment. Surgical team members are taught to own their actions. They work together to solve issues and focus on ways to ensure safe patient care is always prioritized. They’re also encouraged to take the lead on process improvement initiatives.

“Most of our nurses have completed a project that has bettered our facility in some way,” says Tabitha Turner, RN, MSN, CNOR, CGRN, the surgery center’s assistant director.

One project helped to streamline the care of patients who answer “yes” to a self-harm question during pre-op assessments. A nurse created an easy-to-use flowsheet staff use to direct patients to needed follow-up care after discharge. “Mental health touches us all in some way,” says Ms. Turner. “Even though we work in a surgery center, we have a duty to care for our patients holistically.

“When we tell our patients we’ll always be by their side, we take that promise seriously,” she continues. “Patients are placing their lives in our hands, and we’re their voice when they’re unable to speak. At the end of the day, we always fall back on ICARE standards. We care for each other, ourselves and our patients.”

— Dan Cook

Surgical cases start late twice a month so the entire care team can participate in mock codes. “Emergency situations — such as malignant hyperthermia events — are rare in the OR, so we make sure staff practice the response protocols,” says Ms. Sebastian. “We want them to stay abreast on the latest techniques and fully understand their roles.”

  • Smoke-free ORs. Both hospitals have received AORN’s Gold Level Go Clear Award, which is given to facilities that achieve full compliance in the elimination of surgical smoke. “That was a big undertaking — it took close to a year to accomplish,” says Ms. Sebastian. “We received pushback from surgeons, but we educated and persisted. Evacuators are now used in 100% of cases. That was a huge win for us.”

In a recent Press Ganey survey, every member of the surgical services team said they view patients as individuals with specific care needs and treat patients with equal effort, even when circumstances make providing safe care difficult.

“We’re always staying current with safe perioperative practices and the latest trends and developments in safe practices,” says Ms. Sebastian. “The dedication and passion of our staff are worthy of recognition.” OSM

Honorable Mention
Engaged Staff Is Prepared to Protect Patients
LEARNING OPPORTUNITY The Monticello Community Surgery Center's staff take part in a pre-pandemic airway management in-service.   |  Victoria Brozovich, RN, CAPA

Monticello Community Surgery Center has always prioritized patient safety — even before it officially opened. Days before hosting its first case in March 2014, the facility’s staff hosted a day of mock surgeries with family members serving as patients. It was a fun and effective way to evaluate patient care processes and identify and correct issues before the OR doors opened for real, says Victoria Brozovich, RN, CAPA, clinical manager of the facility in Charlottesville, Va.

Creative approaches to maintaining patient safety at the facility continue. Ms. Brozovich organizes competency fairs held in the first quarter of each year to review compliance requirements, conduct safety drills and practice emergency preparedness. The fair is held on a Saturday from 8 a.m. to 4:30 p.m., so it doesn’t interfere with patient care and staff can dedicate their time and attention to learning how to be safer providers. Staff members bring homemade dishes for their colleagues to enjoy as they listen to presentations by guest speakers and vendor reps, watch safety-related YouTube videos and participate in live drills.

The center’s patient registration manager is an amateur actor and once masterfully played the role of an incapacitated surgeon during a lesson in fire safety. He had the staff laughing — but also engaged. The day is kept light with an emphasis on serious learning. “Our medical director always says the events we cover might never happen, but we practice as if they will,” says Ms. Brozovich. “We’re always prepared for whatever might happen.”

— Dan Cook