Home Study Program: can we build a safer OR?

AORN Journal,  April, 2004  by Gina Pugliese,  Judene M. Bartley

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The article "Can we build a safer OR?" is the basis for this AORN Journal independent study. The behavioral objectives and examination for this program were prepared by Rebecca Holm, RN, MSN, CNOR, clinical editor, with consultation from Susan Bakewell, RN, MS, education program professional, Center for Perioperative Education.

Participants receive feedback on incorrect answers. Each applicant who successfully completes this study will receive a certificate of completion. The deadline for submitting this study is April 30, 2007.

Complete the examination answer sheet and learner evaluation found on pages 785-786 and mail with appropriate fee to

AORN Customer Service
c/o Home Study Program
2170 S Parker Rd, Suite 300
Denver, CO 80231-5711

or fax the information with a credit card number to (303) 750-3212.

You also may access this Home Study via AORN Online at http://www.aorn.org/journal/homestudy/default.htm.

Behavioral Objectives

After reading and studying the article on ensuring safety in the OR, the nurse will be able to

1. identify standards that are being established to guide safe patient care,

2. explain why surgical site marking requirements were changed,

3. discuss injuries that commonly occur in the OR, and

4. describe methods to improve safety in the OR.

People who work in health care--from a manufacturers design engineer to the circulating nurse in an OR--are among the brightest, most dedicated workers in the United States. As skillful and devoted as they are at creating better products or making sick people well, however, at the end of the day, they simply are human beings. As we all know too well, humans and the machines they create make mistakes.

The Institute of Medicine, in a series of reports on the safety and quality of health care, noted that health care errors kill approximately 98,000 patients and cost almost $29 billion each year. (1) The Institute also suggests that the US health care system needs a complete redesign to improve quality and keep patients safe.

Society in the United States has zero tolerance for health care errors. When human lives or the quality of those lives are at stake, it would seem obvious that nothing but error-free outcomes are acceptable, and a health care provider who makes a mistake should be held accountable. Health care facilities, however, are moving away from a culture of perfection and learning more about the science of human factors and how human wiring predisposes people to make certain types of errors. The goal is to learn how systems can be redesigned to make it easier to work more safely and more difficult to make a mistake.

The road to overcoming the culture of blame is long, and information about errors and close calls needs to be analyzed to make the system safer. Just as the airline industry has done, the health care industry must encourage anonymous reporting in a blame-free environment and evaluate each incident and close call so systems can be redesigned to prevent future errors. The challenge is to become acutely aware of risks in the OR environment and implement measures to reduce risk and make it more difficult to make a mistake. Marking the surgical site is just one example of a system redesign that can help eliminate errors, such as wrong site surgery. (2)

As OR safety issues from an unexpected fire to a sharps injury are explored, the title of the first Institute of Medicine report (ie, To Err is Human: Building a Safer Health System) seems applicable. Current health care environments should be considered, including the limitations on human capability, and opportunities should be explored to create the kind of environment needed to provide safe care for patients.

ORGANIZATION GUIDELINES

National Patient Safety Goals (NPSG), a significant set of standards affecting safety in surgery, recently were added to traditional standards from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). (3) These goals focus attention on specific actions designed to reduce risks to surgical patients, including

* verification and read-back of verbal orders;

* surgical site marking involving the patient;

* a time out for final verification that it is the correct patient and correct procedure; and

* the use of a preoperative verification process, such as a checklist to ensure that appropriate documents are available.

In May 2003, JCAHO published its findings that hospitals had found it challenging to adhere to JCAHO's 2003 patient safety goals, including one pertaining to surgical site marking. Consequently, the 2004 goals, which become effective July 1, 2004, build on the 2003 goals and include a Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery that was developed as a consensus product of a national summit on wrong site surgery.

Representatives and leaders from surgical, medical, and nursing specialty organizations, including AORN, the American Association of Orthopedic Surgeons (AAOS), and the American College of Surgeons participated in the summit and agreed on the need for this Universal Protocol. (2) Meanwhile, a host of other respected national organizations have been active in initiatives related to worker and patient safety in surgery and are implementing similar goals for reducing risk.