Implementation of a Surgical Safety Check List Cyber-Sight Nurse Education Course (Modified for lecture use by Heather Machin, RN) This course will explain what a surgical safety check list is and why it is important.

At the end of this presentation you should know: < The components of the check list < Who is responsible for implementation parts of the checklist < Potential points of conflict and how to avoid and/ or resolve them < How to use the checklist < Value to be derived from use of the checklist The student should keep in mind throughout the course the aim of the checklist, who is responsible for its implementation, what are the possible conflicts and how to avoid or resolve them and the value for the patient and the team in using the checklist to its maximum advantage.

Why this checklist in the operating room? In order for a surgical procedure to be completed successfully a team must work together to ensure that all of the required components are accounted for and working. The surgeon depends on a well-functioning team to in the operating room working together effectively and each doing his or her own job to complete a successful operation. The nurse is in the unique position to deal with all components of the process from the patient to anesthesia, instruments, and the anesthesiologist. 3

Safe Site Surgery will help the surgical team to avoid: Surgical deaths and errors The adverse legal issues Surgical infection Poor communication among surgical team members Safe surgery not only leads to accomplishing the surgical goals, but saves lives! There are common and deadly but preventable problems that can occur in the operating room that lead to adverse results. Strongly held political commitment and clinical will can cloud judgment and hamper dealing with the condition at hand. Surgical infection can be the result of poor technique. And lack of open and effective communication among team members can cause a breakdown in any area of the procedure.

A set of Safety Checks has been assembled to reduce the number and severity of adverse events involving: Surgeons Anesthesiologists Nurses Public health experts Those involved in the operating room include the surgeon, anesthesiologist, nurses (and their support). Each component has its own duties and expertise. A unifying factor is the public health expert who can look at the “big picture” and provide input about how the various pieces fit.This check list is not a regulatory device but is designed to be a useful tool for those teams working in the operating room. No one member of the team has absolute authority over what takes place in the operating room.

3 Components of the Check Sign In Time Out Sign Out

Components of the Checklist 1 Patient identity confirmed Site marked Anesthesia safety check Allergy Airway and pulse oximeter if general anesthesia Prosthesis and surgical needs Sign in As the patient enters the room and before induction of anesthesia As the patient enters the operating room identity must be confirmed, the site of the operation marked or agreed upon. In eye surgery this is primarily laterality and it is very important. Anesthesia is frequently local or regional for eye surgery. This has been decided at the time of scheduling, but it should be confirmed with the patient. If the block has been done before entering the room a method for confirming this must be in place. Any allergies the patient might have should be noted. At this time any needed corrective measure can be taken without any adverse effect.

Components of the Checklist 2 Time out Before the start of surgical intervention Identify/introduce team Team verbally confirms patient site, procedures/ allergy Surgeon/review critical steps Anesthesia/concerns? Nurse/sterility and special instruments, sutures, medicines Before the actual start of the surgery with the incision each member of the team verbally reports ot the other members providing what is considered pertinent or essential information. In the conduct of eye surgery the nurse has very important duties that will impact the result. In addition to ensuring sterility the nurse will have the proper sutures and needles, and any other special instruments needed and this could include the h lens parameters appropriate for the patient.

Components of the Checklist 3 Sign out To be completed before the patient leaves the operating room: Documentation Surgical instrument and sponges account Specimen (if any) labeled Equipment problems? Review any concerns for recovery Team reviews key concerns Before the patient leaves the room the nurse verbally confirms with the team the name of the procedure, account for the instruments and sponges if any, label the specimen, address any equipment issues (problems). After this, the entire team has the opportunity to review any concerns that might have come up. By using this type of communication any concerns would be spoken of more as a routine and responsibility instead of just more” complaining”. In this way communication could be constructive and lead to fewer such problems in the future

Some important considerations for the nurse Is the patient fasting (Nil Per Oral – NPO)? When did the patient eat last? Is the necessary imaging displayed? Are the surgical items that you have “pulled” what the surgeon needs? Do you need to check with the surgeon first? Is the patient situated on the table without unnecessary pressure that could cause nerve damage? How long will the procedure take? Are all members of the team ready to start? The nurse should be able to respond to all of the above in a responsible way: The patient has been NPO since……, the necessary images are on the view box and more are available, the following suture and needles combination is available. Is this satisfactory? The patient is on the operating table with suitable padding (if general) and in a comfortable position that will make it easy for the patient to remain still (if local or regional).

Quiz Sign in, time out, and sign out are the major components of the checklist? T F You don’t have to check allergies before surgery? T F Who is responsible for the safe surgery check?

Questions Heather Machin, RN ORBIS International Heather.machin@orbis.org