Time to tone it down: Strategies for managing noise, distractions
"Our society has become a lot louder, and we tolerate a lot more noise," says Verna Gibbs, MD, director of NoThing Left Behind and professor of clinical surgery, University of California, San Francisco. That includes the OR, where phones, overhead pages, alarms, suction, ventilation equipment, medical devices such as drills,…
When staff speak up on safety, do managers listen--and act?
Checklists, time-outs, and other patient safety tools are supposed to make care safer. But what happens when a safety tool alerts a team to a problem that otherwise would have been missed and could harm a patient? Will team members speak up? The vast majority—85%—of nurses in a new study…
Wrong implants a theme in errors
Ophthalmology and orthopedics led the list of OR specialties with incorrect surgery in an analysis of 51⁄2 years of data from 130 Department of Veterans Affairs (VA) facilities. A wrong implant was the most common error type for both specialties, accounting for 22 of 45 ophthalmology events and 12 of…
Briefings head off communication failures
A structured OR team briefing before a case can dramatically reduce communication failures, a new study from Canada finds. In the study surgeons, nurses, and anesthesia providers held a short briefing guided by a checklist. Researchers documented communication problems before and after the briefings were implemented. Results showed communication failures…
ORs vary in how they do time-out, and many don't follow own policy
How ORs conduct time-outs varies widely—and facilities tend not to follow their own policies. These findings are part of a statewide project in Pennsylvania to learn how wrong-site surgery happens and how to prevent it. As part of the project, researchers observed one or more steps of 48 procedures at…
A time-out tool helps to improve compliance at the patient's bedside
The highest priority of any health care provider is to ensure patient safety. The single most important tool for preventing errors is the ability to communicate. According to the Joint Commission, the number one cause of sentinel events is a breakdown in communication among the surgical team, patient, and family.…
Debriefings are an early-warning system
A nurse goes to the refrigerator to get blood for an evening case, only to find it has already been taken back to the blood bank. A set is missing the same instrument for the second time this week. There have been problems with timely delivery of blood units for…
Nurses, physicians get behind effort to introduce preoperative briefings
A unified effort by physician and nurse leaders to introduce preoperative briefings has helped boost perceptions of OR safety at a Colorado hospital. The briefings, held right before the incision, are an expanded timeout that allows the team to check critical information and establish an atmosphere of open communication. Preop…
Support for staff when things go wrong
The patient had come to the OR for joint replacement surgery. Though she had a complicated medical history, there was no reason to believe she would have serious problems. But during the surgery, things went wrong, and despite everyone's efforts, the patient died. It hit the team hard, including the…
Timeout: It's as easy as apple pie!
The timeout protocol is an essential step before any invasive procedure to prevent wrong site, wrong procedure, and wrong person surgery. The pause also allows for the antibiotic to be given and charted, implants to be checked for accuracy, and equipment to be assessed for functionality. The timeout protocol is…
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