Editorial
Not far into a case, the circulating nurse calls for a missing instrument to be delivered. A nurse from the next OR comes in to fetch a piece of needed equipment. A student from a local nursing program is in the room observing. The surgeon has invited a visiting colleague…
A cure for the distracted time-out before surgery
Does this ever happen in your OR? The circulating nurse calls for the time-out. But the team doesn’t seem to be focusing. Music is playing, an assistant is draping the C-arm, and team members are talking about the football game. The circulating nurse tries again and gives up. A cognitive…
Malignant hyperthermia: A crisis response plan
Malignant hyperthermia (MH) is a genetic skeletal muscle disorder that is incited by anesthesia drugs including succinlycholine and inhaled anesthetic agents (Gurunluoglu et al, 2009; Hopkins, 2011; Kim et al, 2011). The disorder is particularly dangerous because it rapidly develops into a hypermetabolic state resulting in hyperpyrexia, tachycardia, and intense…
The best solution to drug shortages: Anticipation
The downside of scientific advances is that we come to depend on them and assume they will always be available. In the case of lifesaving pharmaceutical products, that has not been true for a long time. Ambulatory surgery centers (ASC), because of their relatively low purchasing power and lack of…
Smartphones, tablets in the OR: With benefits come distractions
Use of personal mobile devices is pervasive in surgery departments. As in the rest of life, they bring benefits but also risks, OR Manager found in an online survey. An overwhelming majority of respondents—86%—say they believe personal use of mobile devices in the OR sometimes distracts providers from patient care.…
A clearer, more robust surgical consent process
A large Chicago-area health system has built a clearer, more robust process for resolving any discrepancies in the surgical consent prior to the day of surgery. Consent discrepancies are a risk factor for wrong-site surgery. “We realized that by the time the patient arrives in the surgery area, it is…
Joint Commission tools to prevent wrong surgery
Surgical teams received more ammunition in their quest to avoid wrong-site surgery when the Joint Commission’s Center for Transforming Healthcare issued its latest set of guidelines, called the Targeted Solutions Tool (TST). Released February 14, 2012, the TST is available free to Joint Commission-accredited hospitals and ambulatory surgery centers (ASCs).…
Capnography: New standard of care for sedation?
Capnography—is it the standard of care for patients having moderate sedation? Should capnographic monitoring be added for procedures performed under moderate sedation in areas like the preop holding area, GI endoscopy unit, and cath lab? The issue is generating discussion following an update in the American Society of Anesthesiologists (ASA)…
Joint Commission targets fatigue from clinicians' extended hours
In a new alert, the Joint Commission adds its voice to calls to curb fatigue from extended work days and work hours. The alert highlights evidence linking fatigue to adverse events and outlines actions organizations can take to mitigate fatigue, especially among nurses and physicians. The commission says the alert…
Shared savings don't jeopardize patient outcomes
A 4-year study shows patient outcomes didn’t change significantly when hospitals and physicians joined in a pay-for-performance (P4P) program for 8 types of surgery. The researchers say this is one of the first studies of P4P to look at patient outcomes. The project used a gainsharing model in which 3…
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