Surgical equipment

How Nurses can Ensure Surgical Safety

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Nurses play a pivotal role in patient surgeries. They may participate by prepping an individual for surgery, assisting in the procedure or aiding in the recovery process. Some nurses experience a combination of all three roles. As nurses are an essential part of the surgical process, it’s crucial that they make sure the procedure remains as safe as possible in order to improve overall patient and staff outcomes.

This path to making sure patients are safe in the operating room begins when they enter the operative suite and encompasses all applicable types of preventable medical errors, which may include medication or dosage mistakes. Nurses, surgeons and the support staff must take concrete steps to prevent these errors, which begins with effective communication between all involved and careful attention to patient needs.

“Surgical safety improves when non-technical strategies, tools and behaviors are combined with proficient surgical skills,” William Robb, MD, co-chair of NSPSS and past-chair of the AAOS Patient Safety Committee, remarked to Medical News today. “Each member of the surgical team needs to know how to effectively communicate and appropriately adapt during an adverse situation. An empowered, well-trained surgical team improves surgeon performance and patient outcomes.”

A brief history of the journey to surgical safety

Preventable surgical errors have always received significant attention, especially in recent years. Though they occur with far less frequency than other types of medical errors, the Joint Commission collected data on these events since 1995 and found that wrong-site surgery consistently ranked as the most highly cited reason for concern.

The American Academy of Orthopedic Surgeons then reported in 1998 that orthopedic surgeons had a 25 percent chance of experiencing an error in surgery throughout the course of their careers. This report, and other events and studies, prompted numerous campaigns advocating for patient safety and surgical best practices throughout the medical industry at large.

In 2008, the World Health Organization released the Surgical Safety Checklist to improve communication and teamwork in the OR, while ensuring patients receive the highest degree of care possible. It was created after extensive consultation and research regarding how to decrease errors and adverse situations in the OR. The 19-item checklist has resulted in a significant reduction in mortality rates and is used by a large number of surgical providers around the globe.

The checklist begins before the patient has been administered anesthesia, when health care providers must first ask, “Has the patient confirmed his/her identity, site, procedure and consent?” At the end of the procedure, before the patient leaves the OR, providers must also ask, “What are the key concerns for recovery and management of this patient?” Only after all of these questions are thoroughly answered can nurses and surgeons be confident that they have taken steps toward the surgical safety of their patient.

How can nurses advocate for surgical safety?

The first step in ensuring surgical safety for all involved includes following set guidelines regarding OR safety. The WHO checklist is a strong safety foundation on which to build from. After implementing the surgical safety checklist, nurses should encourage the creation of surgical safety education programs. Such programs include surgeons, residents, medical students, nurses, pre-op team members and more professionals.

In these groups, participants can give feedback on areas that are relevant to their work and collaborate to ensure that top-notch safety practices are followed at every level during the surgical process. Within these teams, members can conduct safety training modules and training sessions that will keep participants informed about modern safety practices and keep their skills sharp for years to come.

Another way to promote surgical safety is a data collection system that measures and improves OR safety outcomes. This may be set definitions and a continuous reporting structure, along with usability and accessibility for all stakeholders, which includes everyone from health care providers to medical society databases. More data and easier access to it keeps medical professionals in check and striving toward even better patient safety outcomes.

Eliminating surgical risks

The high potential for serious harm as the result of surgical errors necessitates vigorous efforts to eliminate or reduce their frequency. By following a systematic, hierarchical approach, nurses and surgeons can maintain a high degree of surgical safety. The Joint Commission previously identified a few factors that may contribute to a higher than average risk for wrong-site surgery. These include having multiple surgeons involved in a procedure, multiple procedures in a single visit, unusual physical characteristics of the patient and unusual time pressures to start or finish the surgery.

Nurses can follow set standards, implementing the surgical safety checklist to not only keep a patient safe, but to be a strong member of the surgical team. This is because, while the surgeon should be the one overseeing the safety process, it would place an undue burden on them to assume they are the only one to identify all surgical risks. Any risk of error may be reduced by including all team members into the site verification process. The OR must be a safe space for any member of the team to feel comfortable pointing out a potential error without fear of reprimand or dismissal.

As such, the Joint Commission established three principle components that must be addressed before any procedure begins. The first step is the pre-procedure verification process, where the health care staff makes sure that all relevant documents, information and equipment is available and in working order. The team must also address any discrepancies or health care outcomes before they begin.

Next, nurses and surgeons must mark the operative site, which means that any procedure involving marking of an incision or insertion should be carefully assessed and determined that the site would not negatively affect quality or patient safety. There are specific site marking method standards, so members should be consistent in the method in which they choose to employ.

As part of the third step, team members should finally perform a “time out” before the procedure, where they handle a final assessment of the correct patient, site and procedure they will be handling. They should take this time to recognize and evaluate any potential problems or causes for concern. The main takeaway for any nurse in the OR is simply to ensure that all communication channels are unblocked and everyone is on the same page in regards to patient surgical safety.

Students who earn a BS in Nursing from Rutgers University will not only learn about surgical safety standards, but also understand the critical nature of these measures in the overall health of themselves and their patients. A higher level of education in the nursing field will enable these medical professionals to provide the best service possible to those individuals who need it most.

Recommended Reading:
Time Management Tips for Nursing Students
What International Opportunities are there for Nurses?

Sources:

http://www.medicalnewstoday.com/releases/312200.php

https://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Patient-Safety-and-Quality-Improvement/Patient-Safety-in-the-Surgical-Environment

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547842/

https://www.mercyhospital.org.nz/files/dmfile/SurgicalSafetyChecklistPolicy.pdf

https://www.healio.com/orthopedics/journals/ortho/2016-3-39-2/%7Bf02fc9d5-e71e-4d38-86c0-1760ed75d62e%7D/effectiveness-of-surgical-safety-checklists-in-improving-patient-safety

https://www.nursingtimes.net/how-implementing-the-surgical-safety-checklist-improved-staff-teamwork-in-theatre/5013056.article

http://www.who.int/patientsafety/safesurgery/tools_resources/SSSL_Manual_finalJun08.pdf

http://nursing.rutgers.edu/academics/RNtoBS/index.html

http://apps.who.int/iris/bitstream/10665/44186/2/9789241598590_eng_Checklist.pdf

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