Avoiding wrong-site surgery for 5 years isn't long enough
Avoiding wrong-site surgery for 5 years isn't long enough
Hospital implements tools for improvement
You would think that going five years without an incident of wrong-site surgery would bring contentment to any surgery program. At Beth Israel Deaconess Medical Center in Boston, however, leaders are constantly trying to improve, so they have incorporated a script, poster, and checklist into their surgery processes.
Donald W. Moorman, MD, associate surgeon in chief, and Charlotte Guglielmi, RN, BSN, MA, CNOR, perioperative nurse specialist, spoke about Beth Israel's changes at the recent "Perioperative Safety Symposium: Improving, Enhancing, and Sustaining Positive Patient Outcomes" sponsored by Joint Commission Resources (JCR) and the Council on Surgical and Perioperative Safety (CSPS).
After several episodes of wrong-site surgery in the early part of this decade, Beth Israel leaders implemented a multiyear training program that incorporated an interdisciplinary, team-based format, Moorman says. "We wanted to build work flow into our policies," he said. "Based on that, we've had no wrong-site surgery in over five years or any major adverse event in the OR."
A timeout script was created by the Operational Task Force on Safety, Moorman says. The task force, which meets biweekly, includes Guglielmi, clinical nurses, surgical techs, high-volume attending surgeons and clinical anesthesiologists. Guglielmi says, "There are no solutions unless you engage the people who deal with it every day."
The script, which has been in place about six months, declares the elements of the timeout and who needs to articulate them at the point of care, she says. [The script is available.] The script is mirrored in the electronic documentation system, Guglielmi says. (See timeout screen.) If the timeout isn't documented, "a nurse cannot enter an incision time into the system without an override," she adds.
Note that with electronic medical records, some defense attorneys are examining the electronic time entry to be certain that critical data, such as the timeout, are not entered after a problem occurs, sources say.
Another positive change that came out of the task force is that the hospital has posted posters that say, "Attention all team members. Please turn off the radio until the final timeout is completed. Thank you."
The same policy applies for MP3 players, Guglielmi says. Marsha Maurer, RN, MS, senior vice president, patient care services, and chief nursing officer at Beth Israel, refers to the timeout as a time of reverence, she says. Everyone should be listening to each other and paying attention, Guglielmi says. "You can't do it if there's a lot of noise around you," she says.
Additionally, a checklist has been developed for time outs based on materials from the World Health Organization, the Centers for Medicare & Medicaid Services, and The Joint Commission. Although the checklist only takes about one minute to complete, some staff members seem to be getting more lax in paying attention, Moorman says.
"We'll be doing observations of scripted timeout, to see if people are actually more engaged and actively participating in a meaningful way to create a patient safety-centered envelope around the procedure," he says.
You would think that going five years without an incident of wrong-site surgery would bring contentment to any surgery program. At Beth Israel Deaconess Medical Center in Boston, however, leaders are constantly trying to improve, so they have incorporated a script, poster, and checklist into their surgery processes.Subscribe Now for Access
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