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How safe is your OR? 8 things to consider

 
 When she witnessed a near mix-up between a hernia repair and an orthopedic surgery for a pediatric patient, the lightbulb went off for Krista Bragg, DNP, CRNA, chief nurse anesthetist and manager of perioperative education at
The Reading Hospital and Medical Center in West Reading, Pa.

Patient safety in the operating room is still not as good as it should be.

Hospitals stopped receiving reimbursement for wrong patient, wrong site and wrong procedure surgeries in 2009, according to Dr. Bragg, and while wrong surgeries have decreased since then, they are still happening. At current rates, each 600-bed hospital can expect to see at least one wrong site surgery per year.

Since time out processes were put in place in 2004, surgical errors have also not improved as much as clinicians hoped. Errors still occur 4,000 times a year in the U.S., according to Dr. Bragg. Foreign objects are left behind 39 times per week and wrong site surgery occurs at a rate of 20 times per week.

To help improve patient safety in the OR, Dr. Bragg highlighted the following seven points to consider in a May 9 session at the Becker’s Hospital Review 6th Annual Meeting in Chicago.

1. Involve physician champions in the time out process. This process is critical to establishing the basics, making sure the OR team is operating on the right patient, for example. However, pressure to get the surgery started causes many teams to rush or providers to skip the time out process. Surgeons, followed by anesthetists, are most likely to miss the time out process, according to Dr. Bragg. “When you have surgeons or providers who are not compliant or who do not like to participate in the safety culture you have a real problem,” Dr. Bragg said. This isn’t always because providers don’t want to participate, but the procedure is often performed at the most inopportune time, she said. The team may perform the time out process while the anesthetist is at work or the surgeon is prepping. The key is to involve physician champions, she said, to encourage and ensure all providers participate.

2. Customize the surgical checklist. “The time out process takes care of the low-hanging fruit,” Dr. Bragg said. “The checklist takes care of the next layer.” The checklist is essential for patient safety in the OR. For example, at one facility, Dr. Bragg recounted a hip replacement surgery in which the patient was cut open down to the bone when the surgeon realized the equipment wasn’t sterile — the C-arm hadn’t been draped. The surgeon froze and didn’t know how to proceed. The team decided to close the patient up and abort the surgery at that time.

“Nine out of 10 times the surgical checklist doesn’t find anything new, but the one time it does can make a big difference,” Dr. Bragg said. The checklist should also be customized to fit the particular needs of each institution. Now, the C-arm has been added to the checklist at the facility where the hip replacement went awry.

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