The Final Count Is Correct

In accordance with the World Health Organisation (WHO 2008) checklist and Local trust policies, a team briefing was held before the day’s list started. The checklist is part of a second Global Patient Safety Challenge initiative entitled ‘Safe Surgery Saves Lives’, aimed at reducing the number of surgical deaths worldwide and was launched in June 2008. This not

The OR is naturally a high risk environment, surgery naturally exposes staff to patient blood and body fluids, involves the handling of sharp instruments, and the close interactions of the surgical team within a limited amount of space (Jagger et al., 2011). Operations involve the types of sharps; trocars, some surgical instruments, saws, drills, reamers, and some suture needles and scalpel blades that may not easily be replaced with Safety Engineered Devices (SED’s) (Guest, Kable, & McLeod, 2010). The majority of sharps injuries within the OR result from handling sharps, such as needles, blades and sharp instruments hand-to-hand (Jagger et al., 2011).

In a survey carried out by the Nursing times, it was said that two thirds of Nurses believed that shortage of equipment compromises patient safety (Ford, 2010).

A nurse-driven protocol is the recommended tool to be used by the nurse to remove catheters without orders following set CDC guidelines and prevent CAUTI

The current policy requires the attending surgeon mark the correct site for surgery with the patient confirming the site in the preoperative holding area prior to receiving any anesthesia. Currently a safety checklist is used during the time out process in the O.R. but the patient is sleeping. The expectation is the site marked by the surgeon and the patient will remain visible after the patient is drapped for the procedure. The National Patient Safety Agency (NPSA) in 2005 noted this to be an appropriate procedure.

With all of the possible problems that could occur during surgery, a wrong-site, wrong-patient mistake is one that should never arise. Nightingale Community Hospital (NCH) fully understands the importance of doing away with these errors and has set up protocol to work towards this goal. While the protocol is in place, it is not fully compliant with Joint Commission (JC) standards.

The term “safety comes first” or more simply put, “safety first,” is a message that patients not only want to hear, but also want to know is the focus of the professionals that are caring for them; in particular, when they are under anesthesia and have limited or no ability to speak up or lookout for themselves. The National Patient Safety Agency (NPSA) has implemented two initiatives; Rocognising and Responding Appropriately to Early Signs of Deterioration in Hospitalised Patients (NPSA, 2007) and How to Guide: Five Steps to Safer Surgery (NPSA, 2010). Understanding that human beings make up the healthcare professional workforce, it is evident that tools and checklist can and will only be as good as the how people utilize and follow

Use at least two patient identifiers when providing care. Double checking of ID bands and ID/Driver’s license of patient if possible. Using labels to mark all materials /items needed for the procedures. A two person check off procedure must be implemented. Items requiring labeling include: patient records, signed consents, and all assessments, diagnostic tests and x-rays. Also included should be any item that is needed for the procedure (blood products, devices, and equipment). Using a matching system, so that all items in the procedure area are matched to the patient. The matching system must be completed by a minimum of two staff members. These staff members should include a qualified staff member, nursing staff involved in the procedure, recovery room staff, and discharge staff.

At least half a million deaths per year could be prevented with effective implementation of systemic improvements in operating rooms. Specifically, multiple studies have found implementing the use of the WHO Surgical Safety Checklist would significantly reduce surgical morbidity and mortality due to surgical errors.

The nurse is responsible for positioning the patient and should assess the patient throughout to see how well he is tolerating it. If the patient is on a heart monitor, the nurse should monitor vital signs and heart rate as the catheter is being put in for any fluctuations. Afterword’s, the nurse should assess for complications or adverse reactions like pneumothorax. Make the patient comfortable and listen to bilateral breath sounds. Obtain a stat XRAY to verify correct placement.

"The final count is correct" is a common statement that operating room (OR) nurses use daily. This statement is a signal of safety for closing the patient 's operative site. The occurrence of a retained surgical item (RSI) was the most frequently reported sentinel event from 2010 through 2012 and again in 2014 (The Joint Commission [TJC], 2012, 2014). Counting of surgical items is necessary to provide protection and safety of the patient. One of the highest priorities for the OR nurse is assuring the final count of items used in the surgical procedure is accurate.

For hip replacements, knee replacements and fractures the nursing care would be the same for all as the nurse should assess for continuous drainage of fluid from incision, sloughing or necrosis of skin in operative area and any signs and symptoms of wound infection (i.e. chills, fever, altered mental status). The perioperative nurse will also implement additional measures to reduce risk for infection in the operative area such as using strict sterile technique when performing wound care and emptying wound drainage device, maintain patency of the wound drainage device to prevent accumulation of drainage in surgical area, avoid urinary catheterization but if it becomes necessary, take precautions to prevent urinary tract infection and administer prophylactic antimicrobials if ordered. If signs and symptoms of wound infection occur the nurse should administer antimicrobials as ordered and prepare patient for surgical debridement and/or revision arthroplasty if planned (Haugen, N., Galura, S., &

Collins, S. J., Newhouse, R., Porter, J., & Talsma, A. (2014). Effectiveness of the Surgical Safety Checklist in Correcting Errors:A Literature Review Applying Reason's Swiss Cheese Model. AORN Journal, 100(1), 65-79 15p. doi:10.1016/j.aorn.2013.07.024. Retrieved from http://eds.a.ebscohost.com.lopes.idm.oclc.org/ehost/pdfviewer/pdfviewer?sid=85958cdb-ba0c-4598-9153-212be5b6c407%40sessionmgr4001&vid=1&hid=4210

Never events are serious, largely preventable patient safety incidents that should not occur (NPSA 2010). Being in the surgical aspect of nursing, keeping patients safe throughout their surgical

“The Process Improvement in Stanford Hospital’s Operating Room” case has many issues when it comes to regards to its existing instrument provisioning process taking place within the Operating Room (OR) of Stanford’s Hospital. This process entails getting instruments ready for a surgery in the OR and the cleansing of these instruments afterwards; however, there are many problems that arise in this process.