Donna S. Watson

Surgical Fires: 100% Preventable, Still a Problem

73-year-old man with a subdural hematoma was scheduled to receive bilateral parietal burr holes. As a result of the patient’s high risk for comorbidities, the procedure was performed with monitored anesthesia care. The anesthesia care provider placed an oxygen mask loosely on the patient’s face, with administration of oxygen at 6 L per minute. The circulating nurse shaved and prepped the patient’s head with a solution of iodoform in 74% isopropyl alcohol. After allowing the solution to dry for two minutes, the surgeon and scrub person draped the patient. The surgeon completed the burr hole procedure on the right side uneventfully. After removing the drapes and repositioning the patient’s head, the circulating nurse prepped and draped the left side in the usual manner. The surgeon then used an electrosurgical monopolar pencil after making the incision. Staff members heard a muffled “pop,” and immediately saw smoke coming from under the drapes. The surgeon quickly removed the drapes from the patient’s head, which was engulfed in flames. The anesthesia care provider turned off the oxygen flow. The fire was immediately controlled. The sequence of events lasted less than 15 seconds; however, the patient’s postoperative period was complicated with a lengthened intensive care unit (ICU) stay of two months before he was discharged to a rehabilitation center. 1

The power of influence

We have been impacted by numerous tragedies in recent months. We wonder how such horrific tragedies could take place in our country. What factors contributed to such irrational crimes? I believe there were many contributing factors such as the constant exposure to violence in literature, movies, and television, and the jettisoning of morality and Judeo-Christian ethics, but one of the strongest contributors is the influence of the family.

National patient safety goals and implementation.

The AORN Journal is seeking contributors for the Patient Safety First column. Interested authors can contact Donna Watson, column coordinator, by sending topic ideas to journalcolumns@aorn.org. he role of the perioperative team is to continuously monitor and improve the quality of care provided to every surgical patient. One of the many goals is to promote patient safety, which includes addressing problems and finding solutions to known patient safety issues. Adhering to the National Patient Safety Goals (NPSGs) program is required for the more than 15,000 Joint Commission-accredited health care organizations. The program was initially developed in 2002 by the Joint Commission to assist accredited organizations in addressing patient safety concerns. The Joint Commission has updated the NPSGs annually. The process and development is overseen by a panel of safety experts that includes nurses, physicians, pharmacists, risk managers, and others who are recognized in their respective fields as experts on patient safety issues. The Patient Safety Advisory Group (previously referred to as the Sentinel Event Advisory Group) provides recommendations for specific NPSGs for adoption or retirement annually. In 2009, the Joint Commission implemented a new numbering format, allowing for electronic sorting, easier tracking, and the addition of new requirements to the existing ones, thereby eliminating confusion. Each NPSG requirement now has a unique six-digit number that does not change. The 2009 requirements are expected to be fully implemented by January 1, 2010, and some have defined milestones at three, six, and nine months. This article covers only NPSGs for which there was a change in 2009. For complete information on the NPSGs, visit http://www.jointcommission.org/ PatientSafety/NationalPatientSafetyGoals.

The Benefits of Enhanced Recovery Pathways in Perioperative Care

olleagues, it is my pleasure to serve as the AORN Journal Guest Editor for this special issue focused Con patient management and enhanced recovery pathways (ERPs). Perioperative nurses must deliver quality care that is efficacious and safe for every patient. It is incumbent that we keep abreast of current evidence-based practices that integrate innovative technologies, care pathways, and patient care delivery models intended to enhance patient experiences and outcomes. This issue introduces evidence-based perioperative multimodal ERPs designed to challenge traditional standards of care with an emphasis on a coordinated multidisciplinary care approach for the surgical patient. The article by Brady et al describes the process for developing and implementing an ERP for the patient undergoing colorectal surgery. The article by Schatz reviews strategies for implementing an ERP in a minimally invasive thoracic surgery program. Last, the article by Sammons and Ritchey discusses the use of the transversus abdominis plane block for elderly patients undergoing surgical procedures to relieve pain and reduce the use of narcotics or sedatives during the immediate and extended postoperative recovery period.

Concept Analysis: Wrong-Site Surgery

A concept analysis was conducted on the concept of wrong-site surgery (WSS) using the principle-based method by Penrod and Hupcey. It included analysis of WSS within the context of epistemological, pragmatic, linguistic, and logical principles. The analysis found that WSS is an important concept that is universally accepted, but the definition could be improved with inclusion of comprehensive labeling for types of WSS that may occur, such as wrong patient, wrong site, wrong level/part, wrong procedure, and wrong side. Wrong-site surgery falls into the domains of both nursing and medicine, and there is limited research on the topic specific to nursing interventions, perceptions, and contributions to prevent WSS.

10 years in, why time out still matters.

n January, The Joint Commission’s Universal Protocol for the Prevention of Wrong Site, Wrong Procedure, and Wrong Person SurgeryTM turned 10 years old. During the past decade, the Universal Protocol has become widely adopted and is nearly synonymous with patient safety. Its three fundamental components are preprocedure verification, site marking, and time out. Perioperative practitioners who use the Universal Protocol to prevent medical errors have learned that process alone does not provide a safety net for preventing wrong-person, wrong-site, or wrong-procedure events in the surgical setting. According to The Joint Commission, failures in leadership, communication, and human factors were the top three causes of more than 900 wrong-site surgeries reported from 2004 to 2013.

A Few Minutes With Donna S. Watson

BIOGRAPHY Over the years, I have held a variety of positions that have always focused on care of the surgical patient. These experiences included clinical, management, and education, and these opportunities have allowed me to view nursing broadly in the ever-changing health care landscape. Additionally, these experiences have laid a solid foundation for my present position as a customer solutions director at Covidien. One consistent theme over the years has been the ability to have credible resources based on evidence that allow for improved patient experiences and outcomes. I have been fortunate to contribute to patient care and outcomes through publication of articles, chapters, and books.

Keeping Current on Patient Safety

ient S December 1, 2009, marked the 10th anniversary of the landmark report from the Institute of Medicine entitled To Err is Human: Building a Safer Health System, which brought the issue of patient safety to the forefront of health care in the United States. Today, health care continues to evolve with regard to patient safety; health care professionals are implementing the latest information technologies, monitoring identified quality indicators from field experts, developing and implementing standards of practice, and participating in education and training to minimize preventable medical errors. Each of these undertakings can be daunting; however, as health care professionals, we must maneuver through a maze of information to ensure that patient care is based on evidence. Periodically, this column identifies Internet resources about patient safety that could be helpful for busy clinicians. Electronic resources continue to be valuable because they often contain the latest information about current patient safety issues. The following are just a few of the many available patient safety electronic resources.

The code of silence.

causes major hepatitis scare in Colorado”—revealed a shocking story that has affected more than 6,000 patients in the Denver area. The scrub person is a 26-year-old surgical technologist (ST) with a drug abuse problem, specifically an addiction to narcotics. She also has hepatitis C. The ST reported periodic self-administration of 100 mcg to 250 mcg of fentanyl from syringes that she obtained from OR anesthesia carts. She replaced the fentanyl-filled syringes with used saline-filled syringes that she kept in her pocket. To date, 24 patients who underwent surgeries in facilities in which the ST worked have tested positive for hepatitis C and are undergoing testing to determine whether there is any link to the ST. This column addresses issues attributed to lack of education regarding nurse drug addiction and implications for patient safety. The prevalence of substance abuse and addiction among health care professionals is assumed to be the same as that for the general population. This issue, however, is rarely discussed openly. Many facilities do not have annual inservice or educational programs to increase awareness on the topic; and suspicions of a coworker’s substance abuse are generally ignored. Situations like that of the ST’s negligent behavior as a result of her substance abuse problem necessitate the need for nurses to become involved and break the code of silence when they suspect a peer has a substance abuse and addiction problem. WORKPLACE RISK FACTORS Perioperative staff members work in a stressful and demanding environment, which can place them at an increased risk for developing a substance abuse problem. Contributing workplace factors may include • stress, • prolonged work shifts, • mandatory overtime, • rotating shifts, • injuries associated with musculoskeletal pain and discomfort, • knowledge of the medications, • easy access to controlled substances, and • fatigue. To effectively protect patients, perioperative nurses should be aware of the signs of potential substance abuse that a colleague may exhibit, as well as appropriate actions to take and expectations to report suspicious behavior. Performancerelated signs that may indicate a potentially serious substance abuse problem include • increased absenteeism, tardiness, and schedule confusion; • frequent errors in practice; • sleeping on the job; • poor clinical judgment; • inattention to standards of care; • disorganization and neglect of details;

The only game in town

New updated! The latest book from a very famous author finally comes out. Book of the only game in town, as an amazing reference becomes what you need to get. Whats for is this book? Are you still thinking for what the book is? Well, this is what you probably will get. You should have made proper choices for your better life. Book, as a source that may involve the facts, opinion, literature, religion, and many others are the great friends to join with.