Using aviation safety measures to enhance patient outcomes

AORN Journal,  Jan, 2003  by Russell M. Rivers,  Diane Swain,  William R. Nixon

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* inquiry (ie, asking questions when unsure),

* preprocedure team building,

* preprocedure briefings,

* communication during unexpected events,

* assertion,

* recognition of possible adverse events, and

* postprocedure debriefing (ie, critiques, reviews).

Further data collection through over-the-shoulder assessments, structured interviews, and critical incident reports will be necessary to document the anticipated performance improvements.

Improvement in communication skills. All participants completed post-training surveys designed to examine whether they perceived the training as valuable. Responses were collected and analyzed using a five-point Liken-type scale. More than 75% of staff members strongly or very strongly agreed that dynamic outcomes management training provided useful knowledge for improving actual job skills. More than 81% strongly or very strongly agreed that dynamic outcomes, management training would increase their effectiveness in the OR. As the foundation of this training rests on effective communication, these high percentages suggest that staff members believe communication will improve.

Surgical counting error reduction. Dynamic outcomes management training decreased the number of surgical count errors by 50%. Aviation training team members analyzed the number of errors related to counts during a six-month period before training and compared this to data compiled during the six months during and after training. The number of surgical procedures performed during each segment was not significantly different. Analysis showed a 50% reduction in the number of incorrect counts during the second six-month segment. Interviews with staff members and administrators revealed no unusual staff turnover or other significant changes (eg, data collection methods, chain of custody for data, reporting methods).

IMPLICATIONS

The benefits of standardizing processes and improving team skills affect many aspects of perioperative nursing. For example, training new staff members becomes much smoother, and possibly faster, when all team members perform similarly and communicate effectively. Learning curves can be decreased greatly. Procedure delays are minimized when team members effectively communicate and use standardized checklists to ensure that all supplies, diagnostic studies, and laboratory reports are available when needed. Valuable OR time and resources can be saved.

Errors occur less frequently with the reduction of randomness. For example, counting instruments and needles becomes much more routine when instrument setups are standardized and communication techniques are consistent. Changes in care, such as during shift changes, present much less risk when procedures and processes are standardized and pertinent information is transferred adequately. The ability of team members to recognize and effectively communicate red flags can prevent possible mishaps and many of the subsequent losses that often occur. It is difficult to estimate the potential savings associated with a 50% reduction in counting errors, but considering the high cost of litigation associated with cases involving retained objects, this reduction is of obvious value.