Perioperative safety: Patient Focus

Question 1

Preoperative Verification

Confirmation and verification includes the following:

Answer 1

• Patient’s name on the ID band
• Date of birth
• Medical record number
• Consents

Question 2

Time Out

Answer 2

• It should be documented which includes:
o The patient’s identity using 2 patient identifiers
o The site and side (right/left distinction) of the surgical procedure
o Verification of the procedure to be performed

Question 3

Time Out Discrepancies

Answer 3

• The procedure should NOT begin until the discrepancy is addressed and agreed upon by all team members.
• If the discrepancy is not resolved, follow the facility policy and notify appropriate hospital officials.
• Document all discrepancies and resolutions in the medical record.

Question 4

Strategies to prevent retained surgical items (RSI) include:

Answer 4

• Using the same standardized approach for every count procedure
• Unnecessary activity and distractions should be eliminated during the counting process
• Types of items to be counted include: radiopaque soft goods, sharps, miscellaneous items and instruments.

Question 5

Strategies for Preventing RSIs – A Team Approach

Answer 5

• A standardized approach should be used by the circulating nurse and scrub person each time a count is conducted. Counting items in the same sequence each time in a logical progression as determined by hospital policy is a standardized approach that reduces the risk of human error.
• Any of the surgical team members can initiate a count or an additional count.
• Surgeons should be actively engaged in supporting the count procedure by communicating when counted items are placed in the wound, acknowledging the start of the count procedure, and performing a methodical wound exploration when counts are initiated.
• Anesthesia care providers should participate by planning anesthetic milestones to enable the perioperative team to conduct appropriate counts.

Question 6

Patient transfer from the OR bed to the Gurney

Answer 6

• Lock the wheels of the gurney and the bed
• Make sure the patient is covered with a sheet or light blanket
• Gather and secure IV lines, catheters, and other apparatus so they will not be disturbed during the transfer.
• Apply a safety strap just above the patient’s knees.

Question 7

In the OR, the patient has a heightened risk for skin injury due to:

Answer 7

• Preexisting metabolic conditions (diabetes)
• Unusual positions or positioning devices
• Use of electrical equipment
• Prolonged length of surgery
• Reduced tissue perfusion
• The use of chemical agents

Question 8

Methods to Reduce Intraoperative Skin Injury

Answer 8

1. Positioning - Protect sensitive areas by using appropriate positioning devices
2. Electrical and Thermal Equipment – Ensure that warming devices that use forced air heat are used appropriately and according to manufacturer’s instructions. DO NOT place the hose of the warmer under the patient’s blanket.
3. Implantable Electronic Devices – Manage the sources of electromagnetic interference.
4. Mechanical Safety Issues – never place heavy instruments or equipment on the patient. Never lean on the patient.
5. Chemical Safety Issues – Ensure that prep solution does not pool on the patient skin or the drapes. Use blotting towels to absorb excess prep solution. Be sure to remove the towels after the prep is completed. Allow adequate time for the prep solution to dry.