Perioperative Safety
When do Rule/Knowledge based performance occur?
they occur when a nurse misinterprets a situation or incorrectly applies a rule. Examples: A nurse misinterprets test results, or a nurse fails to respond to a device alarm.
When do Skill-based errors occur?
they occur when our attention is diverted and we fail to monitor the actions we are performing. Example: A nurse inadvertently hits the wrong control button - the correct button is near the incorrect button.
Culture of Safety includes:
A sense of trust among team members. Development and support of a proactive approach rather than a reactive, blaming approach. Dissemination and verification of receipt of information to all levels of staff and management. A sincere commitment to affirming safety as the first priority.
What is HIPPA?
The Health Insurance Portability and Accountability Act (HIPAA) provides federal protections for individually identifiable health information held by covered entities and their business associates and gives patients an array of rights with respect to that information.
The Institute of Medicine (IOM) Report stated that:
"changes within health care organizations will have the most direct impact on making care delivery processes safer for patients" and recommended the following: Health care organizations, health professionals, and the Federal Drug Administration (FDA) should strengthen the focus of existing processes on patient safety issues. Health professional licensing bodies should implement meaningful patient programs and periodic reexaminations and re-licensure of doctors, nurses, and other key providers. Health professionals should work with certifying and professional societies to make a visible commitment to patient safety by developing permanent committees dedicated to safety improvement. The US Food and Drug Administration (FDA) should give more attention to the safe use of medications.
CMS is a government agency charged with regulations for payment. Significant to patient safety is the decision by CMS to impose financial disincentives for selected negative patient care outcomes, resulting from unsafe practices, by refusing to pay for the extra cost of treating those outcomes. Name a few examples of facility-acquired unsafe patient outcomes that are no longer reimbursable.
*Pressure Ulcer stages III abd IV *Falls and trauma *Surgical site infections *Retained foreign object (RFO) *Wrong site surgery *Deep Vein Thrombosis (DVT)
AORN has endorsed The Joint Commission's "Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery™" and has developed a "Correct Site Surgery Tool Kit" that details steps for implementing the Universal Protocol. This tool kit was designed to standardize the implementation of the universal protocol. The four steps are:
1. Patient participation 2. Identifying the patient 3. Marking the site 4. Time Out
WHO launched the World Alliance on Patient Safety to examine patient safety in acute and primary care settings. Its action initiatives include:
Clean Care is Safe Care - focuses on hand hygiene Safe Surgery Saves Lives - the WHO Surgical Safety Checklist came from this initiative Surgical Hand Preparation - includes discussion on the length of preoperative hand antisepsis, encouragement of the use of brushless hand scrubs, and review of hand scrub preparations.
What are the responsibilities of an OR staff?
Know, understand, and comply with facility policies, procedures, and practices related to safety, including their facilities emergency power outage plan. (Staff members do not write the emergency power outage plan, but are expected to know, understand and comply with it. Practice sound, basic and OR-specific safety Monitor, identify, and report safety hazards
What are Lack of attention and situational factors?
Lack of attention and situational factors play a significant role in medical errors. Be able to identify those situational factors that contribute to medical errors. Distraction (e.g., background noise, conversations, radios) Fatigue and/or sleep loss Drugs (including alcohol, and caffeine) Juggling multiple activities Stress Boredom Frustration Anxiety Anger Physical stamina due to occupational musculoskeletal injuries (e.g., back, shoulder)
Tre or false: CMS wants to emphasize that the financial cost of insufficient patient safety controls be directly borne by facilities deemed responsible.
TRUE
What is the responsibility of the OR management team?
They are responsible for setting up guidelines, policies, and practices that are related to safety and in accordance with regulatory agency guidelines and standards *Setting and updating appropiate electrical, fire, volatime liquids, radiation, and patient management safety policies and procedures *Monitoring the overall safety of the OR environment *Monitoring and enforcing compliance with safety policies *Educating staff members about identifying and reporting safety issues, hazards, and violations to the appropriate authorities *Ensure electrical devices and equipment receive timely, required maintenance *Establishing an emergency plan for the event of electrical power outage *Establishing and maintaining a schedule and maintain documentation safety checks conducted on back-up and safety apparatus
