1. 321 Genesee Street Oneida (315) 363-6000 www.oneidahealthcare.org

2. Oneida Healthcare Center Hospital Description Level I medical center Located in rural Oneida Approximately 3,600 surgeries annually Joint Commission Accredited daVinci Robotic Surgery 2012 EHR implemented in August 2012

3. Population Served Approximately 24 communities in Madison and western Oneida counties Population approximately 80,000 Nearly 50% patients insured by Medicaid General, Orthopedic, Ob/Gyn, Urology, Thoracic, ENT surgeries performed

5. OHC’s Surgical Safety Team Director of Nursing Sherry Willis, RN OR Nurse Manager Kristy Russ, RN Physician Leads: Dr. David Gordon MD, Chief of Surgery Dr. Sabhash Das Anethesiologist Director of Patient Safety and Quality William Griffiths, RN, MSHS,CPHQ Quality Improvement Designee, Susan Smith, RN Manager of Infection Prevention Jeanne Miller, RN, BSN,CIC Infection Prevention RN Nancy Sheridan, RN, BSN Circulating RN Kristen Menard, RN Surgical Scrub Technician Christine Bryson, ST

6. What do we do about it? Reviewed our current checklist/time out Formalized the team and viewed webinars Conducted observations in the OR Monthly regular meetings with Quality/Infection Prevention/OR staff Regular attendance at Surgery Dept. meetings Revised checklist with input and assistance from OR staff

7. “Hurdles” Identified Current system failures and challenges Communication breakdown Distractions Did we learn from past mistakes?

8. Sign In (Nurse & Anesthesia) Time Out (Entire OR Team) Sign Out (Nurse, Anesthesia & Surgeon) □ Patient has confirmed □ Identity □ Site □ Procedure □ Consent □ Site marked/ Not applicable □ Anesthesia safety check completed □ Pulse oximeter on and functioning □ Thermometer available and functioning □ Does patient have a: □ Known allergy □ Yes □ No □ Difficult airway/aspiration risk □ No □ Yes, equipment/assistance available □ Risk of >500ml blood loss (7mg/kg children) □ No □ Yes □ Normoglycemia status □ Yes □ No, initiate protocol to achieve normoglycemia □ Surgeon, anesthesia professional and nurse verbally confirm □ Patient □ Site □ Procedure □ Anticipated Critical Events □ Surgeon Review: What are the critical or unexpected steps, anticipated blood loss, estimated case time length? □ Anesthesia Team Review: Any patient- specific concerns? □ Nursing Team Review: Has sterility been confirmed? Are there equipment issues or concerns? Correct equipment? Sufficient supplies? □ Has antibiotic prophylaxis been given in last 60 minutes? □ Yes □ Not applicable □ Redosing available for cases >3 hours □ Hair removal using clippers or depilators? □ Yes □ Not applicable □ Glycemic monitoring in place? □ Yes □ No □ Is essential imaging displayed? □ Yes □ No □ Nurse verbally confirms with the team: □ Name of procedure recorded □ Completion of instrument, sponge and needle counts □ Specimen labeling: read specimen label aloud, including patient name □ Whether there are any equipment problems to be addressed □ Surgeon, anesthesia professional and nurse review the key concerns for recovery and management of this patient. □ Normothermia post-op (post-op temperature is documented before leaving OR) *Based on the NYSPFP modified WHO Surgical Safety Checklist Surgical Safety Checklist

9. OHC’s PROGRESS