Surgical Safety Checklist - Quality Improvement Organizations

Report
321 Genesee Street Oneida
(315) 363-6000
www.oneidahealthcare.org
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
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
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
Director of Patient Safety and
Quality
William Griffiths, RN, MSHS,CPHQ
Dr. Sabhash Das
Anethesiologist
Quality Improvement Designee,
Susan Smith, RN
Manager of Infection Prevention
Jeanne Miller, RN, BSN,CIC
Circulating RN
Kristen Menard, RN
Infection Prevention RN
Nancy Sheridan, RN, BSN
Surgical Scrub Technician
Christine Bryson, ST
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
“Hurdles” Identified
 Current system failures and challenges
 Communication breakdown
 Distractions
 Did we learn from past mistakes?
Surgical Safety Checklist
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Sign In
Time Out
Sign Out
(Nurse & Anesthesia)
(Entire OR Team)
(Nurse, Anesthesia & Surgeon)
Patient has confirmed
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Identity
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Site
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Procedure
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Consent
Site marked/ Not applicable
Anesthesia safety check completed
Pulse oximeter on and functioning
Thermometer available and functioning
Does patient have a:
Known allergy
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Yes
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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
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Surgeon, anesthesia professional and nurse
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Nurse verbally confirms with the team:
verbally confirm
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Name of procedure recorded
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Patient
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Completion of instrument, sponge
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Site
and needle counts
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Procedure
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Specimen labeling: read specimen
Anticipated Critical Events
label aloud, including patient name
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Surgeon Review: What are the critical or
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Whether there are any equipment
unexpected steps, anticipated blood
problems to be addressed
loss, estimated case time length?
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Surgeon, anesthesia professional and nurse
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Anesthesia Team Review: Any patientreview the key concerns for recovery and
specific concerns?
management of this patient.
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Nursing Team Review: Has sterility been □
Normothermia post-op (post-op
confirmed? Are there equipment issues
temperature is documented before leaving
or concerns? Correct equipment?
OR)
*Based
on the NYSPFP modified WHO Surgical Safety Checklist
Sufficient supplies?
Has antibiotic prophylaxis been given in last 60
minutes?
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Yes
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Not applicable
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Redosing available for cases >3 hours
Hair removal using clippers or depilators?
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Yes
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Not applicable
Glycemic monitoring in place?
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Yes
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No
Is essential imaging displayed?
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Yes
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No
OHC’s PROGRESS
OHC Surgical Adverse Events
5
A: IC and OR monthly
meetings began
B: Checklist and Webinar
with OR
C: Checklist introduced to
surgeons
D: Checklist fully
4
3
2
C
A
D
1
0
Sep-12
B
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
Apr-13
May-13
Jun-13
Jul-13
Aug-13
Sep-13
Oct-13

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