Extended Time Out in Operation Rooms - Essay Example

 Extended Time Out in Operation Rooms Introduction Wrong site surgeries remain a huge challenge to hospitals and health care personnel, it includes operating surgeries on the wrong side/site of the body, wrong procedure or on the wrong patient (The Joint Commission, 2013). According to the Joint Commission Center for Transforming Healthcare, wrong site surgeries occur as much as 40 times per week cross the whole country (Infection Control Today, 2013). In order to reduce the incidence of wrong site surgery, the Joint Commission implanted universal protocol, which included a surgical time out, safety checklist and surgical briefings. However, despite those ongoing protocols, the effectiveness of those safety strategies is still unknown. Wrong site surgery can cause extreme bad outcomes, which may range from performing surgery on the wrong site of the body and delayed the necessary treatments to amputating the wrong leg then the patient is suffering both physically and psychologically. In order to improve better outcomes and prevent those preventable surgical mistakes, an extended surgical time out (STO), also called second time out was implanted into the health care system. This dissertation discusses the effectiveness of the extended STO out based on evidence from research and case studies, and it also explores the interventions used to reduce risks of wrong site surgery. This dissertation also analyzes patient who is allergic to epinephrine and how extended surgical time out improved their quality of care. Evidence Based Nurse Practicing Journal articles The article, “The extended surgical time-out: does it improve quality and prevent wrong-site surgery?” focuses on pediatric surgery and review the results of implementation of an extended surgical time out. The members of Harbor-UCLA Medical Centre implemented extended surgical time out beginning January 2006. The protocol included confirming patient’s ID, anesthetic and technical details, medications administered and the available ones and the need for special equipment and blood products (Lee, 2010). The impacts of implementing surgical time out was then studied before induction of anesthesia and surveys of both before and after implementing the pre-induction STO were recorded. The results of this study showed that there were no significant differences in elapsed time to incision for both urgent and elective operations and after implementing pre-induction surgical time out (Lee, 2010). The second article, “"Team time-out" and surgical safety-experiences in 12,390 neurosurgical patients” used team out principles in preoperative checklist to examine the patient safety as a result of its intervention (Oszvald et al, 2012). Authors of this article conducted their study between 2007 and 2011. The preoperative checklist included preoperative assessments of the patients, imaging controls, identification, post operative treatment and team time out which were all signed by the respective physician for departments except time out which was signed by the theater nurse on behalf of the surgeon. The results of this study shows that there was one sided bur hole in an emergency case and one wrong sided lumber in an elective case out of 8795 surgical procedures in the department (Oszvald, et al, 2012). Authors also found that as a result of implementation of team time out principles and preoperative checklists no error occurred in all 3595 surgical procedures between 2011 to 2012 (Oszvald et al, 2012). The third article, “Surgical time out checklist with debriefing and multidisciplinary feedback improves venous thromboembolism prophylaxis in thoracic surgery: a prospective audit” focused on auditing of errors that were captured by an extended surgical time out checklist in relation to the introduction of a safety culture. The authors of this article designed a time out checklist in accordance to the standard operating procedures’ guidelines. This was aimed at making a final check that the required safety criteria were met prior to incision. This was introduced in May 2008 and was made a compulsory prelude to all operating theatres by medical director. Data was then collected between May 2008 and May 2010 and errors captured classified in the following five categories; blood, imaging, VTE prophylaxis, clerical or miscellaneous (Berrisford et al, 2012). The implementation of an extended surgical time out checklist was prospectively audited and errors captured were analyzed and related to other improvements to safety culture. The results of this study showed that time out was performed in 96.8% of the 990 patients who were undergoing thoracic surgery (Berrisford et al, 2012). However, the first 15 months saw a lag period when the team was subjected to human factors training, escalated VTE prophylaxis to regular departmental meetings, debriefing was introduced and VTE prophylaxis errors were greatly reduced. In conclusion, this study found out that extended surgical time out intervention with the use of checklist at the time of surgery is crucial in error identification and correction in VTE prophylaxis in high proportion of patients (Berrisford et al, 2012). However, there was a time lag between capturing and eliminating errors thus there is need for human factors training, multi disciplinary feedbacks meetings and debriefing. Extended Time Out in Operation Rooms Nursing guidelines for using this intervention are outlined in the joint commission’s Universal Protocol. The protocol outlines the pre-procedure verification, marking of the procedure site, as well as time out before starting the procedure. However, verification protocols of the site vary from one hospital to the other hence there is need to balance, safety, efficiency and simplicity. Surgical time out before incision has been recognized as a strategy to incorporate quality parameters during surgical operation. Lee (2010) noted that the implementation of extended surgical time out during operation led to confirmation of administration of all antibiotics was during the STO and also noted four significant equipment findings which altered the planned procedure. Lee (2010) also reported improved communication among the operating staff hence there was significant improvement in confidence and well prepared for the operation. However, one wrong site operation was detected even though pre-induction STO was implemented due to inadequate marking and was attributed to system error. In the view of the results of this study, two important findings are evident, improved communication among operation staff, confirmation of antibiotic administration and enhanced workflow during operation. However, extended STO did not eliminate wrong site surgery. Analysis of Patient Scenario During my clinical practice, I took care of a patient who is allergic to epinephrine. However, this condition was not documented in the Electronic Medical record (EMR) because the circulating nurse failed to document that as he was disturbed by something during the interview. As a result, the circulating nurse administered 0.5% lidocaine with epinephrine as local. However, the patient’s allergic condition was confirmed during the second time out when allergies were being confirmed and luckily enough nothing had happed. Extended time out in operation rooms is the chosen intervention for this patient scenario because the main problem in this scenario is communication breakdown and wrong drug administration. Research has shown that using extended surgical time out before anesthesia administration enhances communication among surgical staff doesn’t disrupt workflow and help in confirming timely antibiotic administration (Lee, 2010). Berrisford et al (2012) tested an extended surgical time out intervention strategy to test the impact on the preventive measures. Up to 167 patients were involved in this study and were recruited across all surgical specialty services. However, unlike the normal extended surgical time out, extended the concept to “a preparatory pause” (Haugen et al, 2013). This study shows that the use of extended time out (preparatory pause) resulted into increased compliance and improved patient safety. In this regard, extended surgical time out should be implemented to become an effective checklist in my patient’s case since it enhances communication and confirmation of every step in operation rooms. It also ensures responsibility is not only with the surgeon but with all the operation room or surgical staff. This is critical in my patient in order for the surgeons to meet much of the required contemporary process measure thus reduce complications and the resultant costs of complications. Summary Through my daily experience, I believe that when the extended time out in operating rooms is developed and implemented, it will improve preoperative work as well as enhance the focus of the entire team. This is because through this intervention, focus is normally drawn to the expected difficulties of the operation, procedure, as well as the special needs that may be required in the treatment of a particular patient. This is particularly very important during emergency situations when surgical staffs are expected to act fast with high level of accuracy. During such situations, the extended team time out is crucial in synchronizing the team members involved thus help improve patient safety. I will also implement this intervention in my future practice because it improves communication, confirms timely administration of antibiotics enhance preoperative risk avoidance which may be overlooked by many. References Berrisford, R. G., Wilson, I. H., Davidge, M., & Sanders, D. (2012). Surgical time out checklist with debriefing and multidisciplinary feedback improves venous thromboembolism prophylaxis in thoracic surgery: a prospective audit. European Journal Of Cardio-Thoracic Surgery: Official Journal Of The European Association For Cardio-Thoracic Surgery, 41(6), 1326-1329 Haugen, A. S., Murugesh, S., Haaverstad, R., Eide, G. E., & Softeland, E. (2013). A survey of surgical team members' perceptions of near misses and attitudes towards Time Out protocols. BMC Surgery, 13(46) 1-7. Infection Control today. (2013). Wrong-Site Surgery Cited as Top OR Safety Challenge Among U.S. Hospitals, Survey Finds. Retrieved from http://www.infectioncontroltoday.com/news/2013/08/wrong-site-surgery-cited-as-top-or-safety-challenge-among-us-hospitals-survey-finds.aspx Joint Commission (2013). Sentinel Event Policy and Procedures. Retrieved from http://www.jointcommission.org/Sentinel_Event_Policy_and_Procedures/ Lee, S. L. (2010). The extended surgical time-out: does it improve quality and prevent wrong-site surgery?. The Permanente Journal, 14(1), 19-23. Oszvald, Á., Vatter, H., Byhahn, C., Seifert, V., & Güresir, E. (2012). "Team time-out" and surgical safety-experiences in 12,390 neurosurgical patients. Neurosurgical Focus, 33(5), E6 Read More