Internet use in the OR—is it safe?

AORN Journal, Nov, 2004 by Suzanne C. Beyea

Previous "Patient Safety First" columns have described Internet resources related to patient safety that can help nurses in their efforts to provide safe patient care. This column addresses another issue related to using the Internet--specifically, is it safe to use while providing nursing care in the OR?

In some health care settings, clinicians have a number of advanced communication technologies, including computers with Internet access, cellular telephones, personal digital assistants, and pagers, that are readily available for use. These innovations can facilitate access to health information that can improve patient care, but they also can distract individuals from their primary roles and responsibilities and create unanticipated problems, in addition, many health care facilities have not implemented guidelines for their use.

A DEADLY DISTRACTION

Imagine this scenario. An elective, minimally invasive aortic abdominal aneurysm repair is scheduled in an OR. Before surgery begins, the circulating nurse provides anesthesia team members with a dose of antibiotics, which they set on their cart while they are busy inserting lines and setting up monitors. This experienced circulating nurse has worked in the vascular service for many years, and she has confidence in the members of the surgical team. While the team is completing the set-up process, the circulating nurse decides to quickly check her e-mail. As a result, she fails to notice that during line placement, the anesthesia team members set their tray on the edge of the anesthesia cart, and when the anesthesia care provider is cleaning up, she inadvertently bumps the antibiotic into the trash.

The circulating nurse resumes her focus on the patient and the OR environment when the procedure is underway. After a time, she believes that the patient is stable and tolerating the procedure well. Deciding that this would be a good time to review recent research, she turns her back to the surgical field and takes just a few minutes to go online to read an article in a recent medical journal.

While the nurse is busy at the computer, a medical student assisting the team contaminates his hands by adjusting the light. The contamination is not observed by the surgeon and surgical technologist, who are busy at the field, or by the nurse, who still is on the computer. When the nurse finishes using the computer and refocuses on the patient, all seems well. The medical student hands the surgeon the graft for placement, and no one in the OR is aware that the medical student has contaminated the graft. Several days later, the patient develops a deep wound infection at the site of the graft. The anastomosis ruptures, and the patient dies during emergent surgery.

This hypothetical, devastating adverse outcome resulted from a combination of subtle, unobserved slips and lapses. Combined, they led to the tragic outcome of a deadly surgical site infection. The circulating nurse missed critical opportunities to perform cross-checking activities and help prevent errors that contributed to the development of an infection. Surveillance and vigilance are essential functions of the circulating nurse. Without them, the risk of patient harm, disability, and even death increases significantly.

A GROWING CONCERN

With increasing Internet access in the OR, more clinicians are expressing concern about colleagues who they believe are accessing the Internet inappropriately--either for inappropriate reasons or at inappropriate times. Imagine the nurse who is surfing the Internet while circulating a procedure. It sounds preposterous, but this practice appears to be fairly common when in casual conversation clinicians include "web surfing" as one of the multiple tasks they can safely perform when caring for patients. In most surgical settings, the computer screen is configured so that the clinician has to turn his or her back to the surgical field, compromising the clinician's ability to monitor the procedure and the clinical environment.

Some individuals are proficient at both providing clinical care and using computers and may believe that they can do both things well simultaneously. In reality, this is not possible, and clinical care may suffer. Patients deserve clinicians who are focused on their specific care and needs. If a clinician is distracted answering an e-mail message or surfing the Internet, he or she may miss clinical cues that suggest early signs and symptoms of complications or deterioration in a patient's condition.

Having access to the Internet and other communication devices does not automatically sanction their use at any time the user deems it appropriate. Numerous anecdotes exist about inappropriate computer use in the workplace. Many facilities have policies regarding the use of the Internet during work hours, but often, clinicians either are not aware such policies exist or do not believe their personal use of the computer is a problem or policy violation. Other facilities do not have strict policies about the personal use of computers and may have confidence in their employees to use professional judgment about their use of computers at work.